Unswerving, lighting up the hope of cure - CSCO Autologous Transplantation Working Group 2022 Lymphoma Tour (Hunan Station) ended successfully

After the opening speech, the academic session kicked off
.
The first session was chaired
by Professor Zhou Hui.

Professor Zhou Hui served as the host of the first session

Professor Liu Weiping, Peking University Cancer Hospital, shared the current situation and prospects
of ASCT in China.
China's total population is relatively large, but the number of ASCT cases is obviously insufficient, there is still great potential for application, and high-level evidence-based medical evidence is lacking
.
At present, the main application field of ASCT is MM and lymphoma, and a series of related studies have also been carried out in China, and it has been found that ASCT can bring good survival benefits to patients such as mantle cell lymphoma and T lymphoblastic lymphoma, pointing out the direction
for follow-up exploration.
In addition, the success of ASCT is closely related to stem cell mobilization, and the application of new drugs has significantly improved the success rate and number of stem cell collections, so that more patients can obtain transplant opportunities
.
In the future, the development of ASCT in China depends on the training of more professionals and teams, and we also look forward to the development
of more high-quality clinical studies suitable for Chinese patients.

Professor Liu Weiping made a report

In the discussion session, Professor Huang Wenrong of the Fifth Medical Center of the PLA General Hospital and Professor Li Fei of the First Affiliated Hospital of Nanchang University said that the current situation of ASCT development in China is related to drug accessibility, specialist talent gap, doctor and patient philosophy, regional economic level, etc.
, and strengthen ASCT education for doctors and patients.
It is imperative to improve the attention and recognition of ASCT by medical teams and standardize the prevention and treatment of ASCT-related complications
.

The second session was chaired by Professor Xu Jingyan of Gulou Hospital affiliated to Nanjing University School of Medicine.

Professor Xu Jingyan served as the chair of the second session

Professor Zou Dehui, Institute of Hematology, Chinese Academy of Medical Sciences, shared the new progress of ASCT in the treatment of
MM.
In the era of new drugs, ASCT is still necessary for MM patients who obtain a negative minimum residual disease (MRD) early after induction therapy, especially for patients with high-risk cytogenetic abnormalities and R-ISS stage III, which can further deepen the depth of remission and prolong survival
.
Persistent MRD negativity is a more important prognostic indicator than obtaining MRD negativity, and ASCT is an independent influencing factor for prolonging the duration of MRD-negative and is particularly important
for prolonging the duration of MRD-negative in high-risk patients.
In the future, it is expected to prolong the survival
of MM patients in China through standardized overall treatment.

Professor Zou Dehui gave a report

During the discussion, Professor Li Yufu of Henan Cancer Hospital and Professor Sun Xiuhua of the Second Affiliated Hospital of Dalian Medical University said that early transplantation is of great significance to MM treatment and may help patients achieve both progression-free
survival (PFS) and quality of life.

The third session was presided over by Professor Zeng Yun of the First Affiliated Hospital of Kunming Medical University.

Professor Zeng Yun served as the host of the third session

Professor Zhang Xi of Xinqiao Hospital of Army Medical University shared the progress and exploration
of ASCT in the treatment of lymphoma.
ASCT is one of the important and effective means to treat hematological tumors, and the first use rate of ASCT in lymphoma patients in China is low, but it is necessary to further promote
it due to good safety and high cost performance.
In the era of new drugs, ASCT technology is more accurate and standardized, and experts call for exploring better bridging and maintenance treatment options and combining with new therapies such as CAR-T to help ASCT exert higher efficacy and ensure the healthy development of
ASCT.

Professor Zhang Xi gave a report

In the discussion session, Professor Wu Huijing of Hunan Cancer Hospital and Professor Li Bingzong of the Second Affiliated Hospital of Soochow University said that different pretreatment, stem cell mobilization, bridging schemes, etc.
are required for patients with different subtypes of lymphoma, and the addition of new drugs has created more possibilities
for lymphoma patients.

The fourth session was chaired by Professor Li Zhiming, Cancer Hospital of Sun Yat-sen University.

Professor Li Zhiming served as the chair of the fourth session

Professor Zhao Donglu of Harbin Institute of Hematology and Oncology shared the application
of pegylated recombinant human granulocyte-stimulating factor (PEG-rhG-CSF) in lymphoma ASCT.
The proportion of invasive lymphoma in China is significantly higher than that in Europe and the United States, but the use rate of ASCT is relatively low
.
Long-acting PEG-rhG-CSF can be used for the mobilization and reconstruction of MM and lymphoma ASCT, and its efficacy is not inferior or even slightly better than that of recombinant human granulocyte colony-stimulating factor (rhG-CSF), and the price is lower
than rhG-CSF for reconstruction after lymphoma bone marrow peripheral hematopoietic stem cell transplantation.

Professor Zhao Donglu gave a report

In the discussion session, Professor Zhao Donglu and Professor Zhu Feng of the Affiliated Hospital of Xuzhou Medical University and Professor Huang Yunhong of Guizhou Cancer Hospital The exchange of experience said that at present, long-acting PEG-RHG-csf is mostly used for stem cell mobilization in relatively young, non-large weight patients, and it is not recommended to be combined with short-acting rhG-CSF to avoid unnecessary adverse reactions caused by excessive leukocyte proliferation.

The fifth session was chaired by Professor Peng Hongling of the Second Xiangya Hospital of Central South University.

Professor Peng Hongling served as the chair of the fifth session

Professor Sun Zhongyi of Hunan Cancer Hospital shared his center's experience
in applying ASCT to treat central nervous system lymphoma (CNSL).
Patients with an unconfirmed complete response (CRu) with high-dose methotrexate-based induction therapy are followed by consolidation therapy with high-dose chemotherapy plus ASCT, with the pre-ASCT pretreatment regimen being a predominance
of setipepite-based regimens.
The observation results showed that ASCT treatment can prolong the PFS of patients with primary central nervous system diffuse large B-cell lymphoma, and some patients with secondary CNSL with poor prognosis are expected to benefit
from ASCT treatment.

Professor Sun Zhongyi gave a report

In the discussion session, Professor Liang Yun of the Second Affiliated Hospital of Zhejiang University School of Medicine and Professor Ping Lingyan of Peking University Cancer Hospital said that secondary CNSL has central invasion, the prognosis of patients is extremely poor, and the effect of ASCT is still not ideal, especially patients with systemic and central recurrence need to be paid great attention to, and more new drugs and new treatment options are expected to be explored and applied in the future
。

The sixth session was presided over by Professor Li Zengjun of
Shandong Provincial Cancer Hospital.

Professor Li Zengjun chaired the sixth session

Professor Zhang Wei from Peking Union Medical College Hospital shared the progress of
primary CNSL diagnosis and treatment.
At present, histopathology and cerebrospinal fluid (CSF) cytology pathological diagnosis is the gold standard for diagnosis, and biomarkers such as interleukin 10 in CSF detection can be used for disease diagnosis, MRD monitoring and predicting recurrence
.
High-dose methotrexate is the cornerstone of primary CNSL therapy, and combination with cytarabine, setepep, and rituximab (MATRix) may further enhance efficacy
.
Induction therapy for primary CNSL in the new drug era began to try to do "subtraction" (such as reducing the dose of methotrexate) or in combination with new targeted drugs
.
Consolidation therapy after remission is still controversial, elderly patients need to be cautious with whole brain radiotherapy consolidation, relatively speaking, ASCT has less impact on patients' cognitive level, lenalidomide and BTK inhibitors have also shown good effects
.
ASCT sequential CAR-T has also shown encouraging efficacy
in salvage therapy for primary CNSL.

Professor Zhang Wei gave a report

In the discussion session, Professor Zhang Wei and Professor Liang Xinquan of Chenzhou First People's Hospital, Professor Wang Jun of Changde First People's Hospital, and Professor Liu Xiyu of Hunan Cancer Hospital The exchange of experience said that the current PD-L1 inhibitors, cellinisol, venetoclax and other new targeted drugs have achieved initial results, but the simple targeted combination program is difficult to cure, for the elderly and even patients with renal insufficiency, can not tolerate high-dose methotrexate, the addition of chemotherapy drug VM-26 may bring more benefits
.

The seventh session was chaired by Professor Liu Yao of the Cancer Hospital of Chongqing University.

Professor Liu Yao served as the chair of the seventh session

Professor Huang Liang of Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology shared the exploration
of CAR-T in the treatment of high-risk relapsed/refractory large B-cell lymphoma 。 Relapsed/refractory large B-cell lymphoma is highly heterogeneous, and new diagnosis and treatment and evaluation models are urgently needed, some studies have shown that ASCT sequential CAR-T treatment of relapsed/refractory large B-cell lymphoma has good efficacy and controllable safety, which is expected to overcome the adverse prognosis of high-risk factors such as TP53 abnormalities, and its mechanism may be myeloablative pretreatment chemotherapy to clear the inhibitory tumor microenvironment, inhibit the body's anti-CAR-T response, and promote the proliferation of CAR-T cells in vivo.
However, further confirmation
is needed in prospective clinical studies.

Professor Huang Liang made a report

In the discussion session, Professor Huang Liang met with Professor Chen Yan of Xiangya Hospital of Central South University, Professor Jiang Tiebin of Third Xiangya Hospital of Central South University, and Professor Li Yajun of Hunan Cancer Hospital Exchange of experience, indicating that CAR-T therapy is recommended for patients who are not sensitive to chemotherapy, such as primary drug resistance or recurrence within 12 months after first-line treatment; ASCT may be considered for patients with relapse after 12 months of first-line therapy; The use of CAR-T plus ASCT may be more
beneficial in patients with central involvement, TP53 mutation, or double-hit lymphoma.

The eighth session was presided over by Professor Zhou Ming of Hunan Provincial People's Hospital.

Professor Zhou Ming served as the chair of the eighth session

Professor Li Yuhua of Zhujiang Hospital of Southern Medical University shared the recurrence mechanism and countermeasures
of CAR-T treatment.
CD19 CAR-T has significant advantages over traditional chemotherapy for relapsed/refractory B lymphocytic malignancies, but there are still certain recurrence possibilities and safety issues
.
Reducing tumor burden before CAR-T infusion and using 4-generation CAR-T with a suicidal mechanism improves the safety of CAR-T therapy; The use of dual-target/multi-target CAR-T, CAR-T bridge Eps8-DC vaccine or new sustained-release microsphere vaccine infusion, CD19 CAR-T of exosome CD47 antibody will help reduce recurrence and improve the efficacy
of CAR-T therapy.

Professor Li Yuhua made a report

In the discussion session, Professor Li Yuhua met with Professor Deng Mingyang of the Second Xiangya Hospital of Central South University, Professor Zhou Fang of Hunan Cancer Hospital, and Professor Li Junjun of the First Affiliated Hospital of the University of South China The exchange of experience said that for patients with relapse within 3 months after semi-zygotic transplantation, receiving donor CAR-T infusion may increase the risk of graft-versus-host disease (GvHD), so donor CAR-T infusion should try to select patients
who have not had GvHD or have developed GvHD but are well controlled.

The ninth session was presided over by Professor Li Xin of the Third Xiangya Hospital of Central South University.

Professor Li Xin served as the chair of the fourth session

Professor Li Zhenyu of the Affiliated Hospital of Xuzhou Medical University shared the progress of CAR-T treatment of
MM.
Although the application of new drugs has improved the prognosis of MM patients, almost all patients will eventually relapse/progress, and real-world clinical practice has found that the use of CAR-T therapy in MM patients with multi-line recurrence/refractory treatment has considerable
efficacy.
Targets such as BCMA and GPRC5D are highly expressed on the surface of malignant plasma cells, and CAR-T targeting BCMA and GPRC5D has shown promising efficacy and safety
.
In the future, maintenance therapy after CAR-T therapy, the combination of CAR-T and drugs with synergistic effects, and new targets of CAR-T are worth further discussion
.

Professor Li Zhenyu gave a report

In the discussion session, Professor Li Zhenyu met with Professor He Yanjuan of Xiangya Hospital of Central South University, Professor Luo Zimian of Xiangtan Central Hospital and Professor Huang Lijun of Hunan Cancer Hospital The exchange of experience said that some young patients with good physical status can consider allogeneic hematopoietic stem cell transplantation after CAR-T treatment, and MM patients with poor prognosis such as extramedullary lesions should also consider starting maintenance therapy
as soon as possible after CAR-T treatment.