The round table sent 5 experts to analyze the current situation of lymphoma diagnosis and treatment from 5 perspectives and look forward to the future development direction

Lymphoma is a malignant tumor of the immune system that originates in the lymph nodes and tissues

01

In recent years, the progress of drugs in the field of lymphoma has been "all the way up", broadening the scope of choice of drugs and means for clinical doctors to treat, but improving the survival rate of lymphoma has a long way to go, and it is necessary to face the problem of

It is recommended that authoritative organizations such as the Chinese Anti-Cancer Association, the CSCO Anti-Lymphoma Alliance, and the China Clinical Oncology Association should drive the standardized lecture tour of the diagnosis and treatment concept of lymphoma, and lead the establishment of the Lymphoma Specialty Alliance to provide multidisciplinary consultation of typical cases, thereby improving the concept and practice level

02

03

At this stage, there is no uniform standard for the indications for CAR-T treatment, and it is recommended to use the enrollment criteria of the ZUMA-1 study to screen suitable patients ^[9]: ≥ 18 years old, histological confirmation of LBCL, refractory disease of chemotherapy, Eastern American Tumor Group (ECOG) score of 0 or 1, previous absence of allogeneic hematopoietic stem cell transplantation (allo-HSCT) or CAR-T therapy, no central nervous system disease, etc
.

For centers with some experience in CAR-T treatment, the treatment criteria can be appropriately relaxed to include patients with central nervous system infiltration, advanced age, ECOG score of 2-3 points
, and previous CD19 CAR-T therapy.

Most of the preparation of CAR-T cells is derived from the patient's own T cells, and the patient's previous treatment may affect his T cell function
.

Early CAR-T treatment can improve the adaptability of T cells and enhance the function of the immune system, resulting in better functioning CAR-T cells
.

At this stage, CAR-T treatment of lymphoma is mainly used after the second or third line ^[10], clinical trials have begun to explore the efficacy and safety of CAR-T treatment in the first-line treatment of high-risk LBCL, and the preliminary results show that the complete remission rate is nearly 80% (Figure ^{1) [11]}, and the application prospect of CAR-T treatment in the earlier line treatment of LBCL is worth looking forward to
.

Fig.
1 Optimal response (ORR, CR, PR, etc.
) in high-risk LBCL patients receiving CAR-T ^therapy11

04

Professor Wang Jigang: HSCT's status cannot be shaken, and emerging drugs and therapies can empower it

In recent years, despite the emergence of a variety of new drugs and emerging therapies, the status of hematopoietic stem cell transplantation (HSCT) in the overall treatment of malignant lymphoma is still unshakable, and new drugs and emerging therapies have given more potential to hematopoietic HSCT, the most widely used of which is autologous hematopoietic stem cell transplantation (ASCT).

There are some refractory and early relapse of DLBCL patients in the clinic, such patients are often less sensitive to chemotherapy, even if salvage therapy, the survival prognosis is still not optimistic, and the efficacy of receiving ASCT alone is not ideal
.

For such patients, the combination of novel targeted drugs or cell therapies based on traditional second-line salvage chemotherapy regimens is expected to improve their response rates and give them the opportunity to receive ASCT to further improve efficacy
.

In addition, studies have shown that ASCT combined with new CAR-T therapy is expected to further improve the survival benefits of patients with DBLCL, and there is a wide space for
future exploration.

ASCT is indicated for chemotherapy-sensitive, relatively young and physically good physical status, with poor prognostic factors, and in patients with first-line induction chemotherapy after consolidation therapy; Also indicated for salvage consolidation therapy in patients with relapsed/refractory lymphoma after first-line treatment failure ^[12].

Allo-SCT is mainly used in: 1.
Malignant lymphoma with multiple recurrences, primary drug resistance and recurrence after ASCT; Chronic lymphocytic leukemia (CLL) with 2.
17p deletion or abnormal mutation of the TP53 gene, fludarabine or failure of combination immunotherapy therapy; 3.
Some highly aggressive malignant lymphomas, such as high-risk lymphoblastoma (LBL), hepatosplenic T-cell lymphoma, enteropathetic-associated T-cell lymphoma type II (monomorphous pro-epithelial intestinal T-cell lymphoma), invasive NK-cell leukemia and adult T-cell leukemia or lymphoma
.

In short, HSCT has an accurate and high degree of efficacy in the treatment of lymphoma, which is worth promoting
.

Clinical specialists need to correctly understand the important role of HSCT in the treatment of lymphoma, so that more lymphoma patients can benefit
more.

05

Professor Wu Wei: Some elderly lymphomas may have entered the era of no chemotherapy, and clinically need to monitor the prognosis of immunotherapy in elderly patients

The treatment of elderly lymphoma patients is mainly based on the patient's situation, with the purpose
of relieving symptoms, improving quality of life and prolonging survival.

In recent years, with the gradual application of targeted drugs such as rituximab, otolizumab, and lenalidomide in the clinic, chemotherapy-free treatment options have become a hot topic
of research.

The use of chemotherapy-free combination therapy regimens in indolent lymphoma has been shown to provide a higher survival benefit ^[13] (Figure 2).


In older age, the overall survival rate after targeted therapy alone or in combination is not lower than that of chemotherapy
.

Therefore, clinically believed that targeted therapy is feasible for elderly patients with indolent lymphoma or serious complications, and has entered the era of
chemotherapy-free.

Fig.
2 Progression-free survival (PFS) between combination therapy regimens without chemotherapy and mono-targeted drug therapy [13]

Because targeted drugs and monoclonal antibodies are easy to affect the immune system of patients in the whole population, resulting in low immunity or complications
such as infection.

The autoimmune ability of elderly patients is relatively weak, and more attention should be paid
to the use of immunotherapy in the clinic.

At present, there is a consensus in China, that is, the immune function of patients receiving immunotherapy is systematically monitored, and related symptoms are recognized early and active intervention is
given.

In recent years, with the accumulation of experience and the updating of technology, the incidence of age-related immunotherapy adverse events has decreased, and the overall treatment strategy can be expected in the
future.

06

Professor Wang Xiaobo concluded:

At present, the treatment of lymphoma has achieved good results, becoming one of the tumors with high control rate and cure rate, but the struggle with lymphoma is still ongoing
.

At present, there are many promising basic research and clinical research to be carried out, and efforts should be made to promote the implementation of standardized diagnosis and treatment of lymphoma in the future, improve the accessibility of clinical drugs, and benefit more lymphoma patients
.

Expert Profiles

Professor Wang Xiaobo

The Second Affiliated Hospital of Dalian Medical University

Executive Director of Lymphoma Myeloma Clinic

Member of the Lymphocytic Diseases Group of the 11th Committee of the Hematology Branch of the Chinese Medical Association

Member of the Expert Committee of the Lymphoma Alliance of the Chinese Society of Clinical Oncology

Member of the Lymphoma Group of the Hematology and Tumor Committee of the Chinese Anti-Cancer Association

Member of the Academic Working Committee of Multiple Myeloma of the First Committee of the Hematology Branch of the Chinese Geriatrics Society

Member of the Standing Committee of the Lymphoma Branch of the Chinese Medical Education Association

Member of the Standing Committee of the Lymphatic Professional Committee of the Geriatric Health Care Association

Vice Chairman of Dalian Blood Branch, member of Liaoning Blood Branch of Chinese Medical Association

Lymphoma professional member of Liaoning Anti-Cancer Association

Member of the Standing Committee of the Lymphatic System Basic and Clinical Immunology Branch of the Liaoning Immunological Society

He was a clinical visiting scholar of lymphoma myeloma and stem cell transplantation at Mayo Medical Center in the United States

Expert Profiles

Professor Elime

The First Affiliated Hospital of Jinzhou Medical University

Director of the Department of Hematology, Leader of the Discipline

Doctor of Medicine, Doctoral Supervisor

Vice Chairman of Liaoning Blood Branch of Chinese Medical Association

Vice Chairman of The Basic and Clinical Branch of Liaoning Lymphatic Diseases of the Chinese Society of Immunology

Vice Chairman of Liaoning Blood Immunology Branch of Chinese Society of Immunology

Member of the Standing Committee of the Liaoning Lymphoma Professional Committee of the Chinese Anti-Cancer Association

Member of hemolytic lymphoma branch of Chinese Gerontological Society

Member of the Clinical Oncology Committee of the Chinese Association of Women Physicians

Member of the Standing Committee of the Hematology Youth Committee of the Chinese Medical Association

Executive editorial board member of China Journal of Tissue Engineering Research
.

He has presided over a number of projects of the Provincial Science and Technology Department, and published many Chinese and SCI papers

Expert Profiles

Liao Aijun Professor

Shengjing Hospital affiliated to China Medical University

Deputy Director of the Department of Internal Medicine, Chief Physician of the First Blood Ward, Professor, Doctoral Supervisor

Member of the Myeloma Professional Committee of the Hematology Branch of the Chinese Medical Doctor Association

Member of the Anti-Infective Group of the Hematology Branch of the Chinese Medical Association

Member of the Multiple Myeloma Group of the Hematology Branch of the Chinese Gerontological Society

Member of the Multiple Myeloma Group of the Hematology and Tumor Professional Committee of the Chinese Anti-Cancer Association

Member of the Blood Immunology Branch of the Chinese Society of Immunology

Hematology Branch of Chinese Medical Association is a member of the 8th Youth Committee

Member of the Standing Committee of the Hematology Branch of the Liaoning Medical Association

Member of the Lymphoma Professional Committee of the Liaoning Branch of the Chinese Anti-Cancer Association

Vice Chairman of Liaoning Hematology and Immunology Society

He is a visiting scholar at the Penn State Hershey Medical Center Cancer Institute and the City of Hope

He has undertaken a number of projects such as the National Natural Science Foundation of China, and published many SCI articles in journals such as Blood

Expert Profiles

Professor Wang Jigang

Northern Theater General Hospital

Director of the Department of Hematology, Master Supervisor

He graduated from the Third Military Medical University with a bachelor's degree in 1996 and received his master's and doctoral degrees in hematology from the same university in 2002 and 2005 respectively

Member of CSCO China Autologous Hematopoietic Stem Cell Transplantation Working Group

Member of the first China T-cell lymphoma working group of the Hematology and Tumor Professional Committee of the Chinese Anti-Cancer Association

Vice Chairman of the Hematology Committee of Liaoning Association of Traditional Chinese Medicine

Vice Chairman of the Lymphoma Group of Liaoning Society for Cell Biology

Member of the Standing Committee of the Lymphatic System Basic and Clinical Immunology Branch of the Liaoning Immunological Society

He is a member of the Liaoning Provincial Hematology Committee and a young member of the Hematology Committee of the Whole Army

He is also an expert in the Liaoning Provincial Medical Appraisal Expert Database and an editorial board member of the journal "China Tissue Engineering Research"

Expert Profiles

Professor Wu Wei

Benxi Central Hospital

Deputy Chief Physician, Department of Hematology

Young Member of Hematology Professional Committee of Liaoning Medical Association Member Member member of Lymphoma Professional Committee of Liaoning Oncology Society

Member of Lymphatic System Foundation and Clinical Immunology Branch of Liaoning Immunological Society

He specializes in the diagnosis and treatment of various blood diseases such as lymphoma leukemia, aplastic anemia, myeloproliferative diseases, and the application of new technologies

He has published several SCI and national papers

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Highlights of the public welfare touring exhibition activities:

Tribute to Chinese Physicians' Day Health China You and I Walk Together (30) | Professor Zou Duowu: Medicine is like using soldiers, and the doctor is destined to be a general

Tribute to Chinese Physicians' Day Health China You and I Walk Together (31) | Professor Zhang Beiping: The Combination of East and West Is Sincere and Good

Tribute to Chinese Physicians' Day Health China You and I (32) professor | Zhang Li: Clinical research is also focused on improving the quality of life of patients

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