Editor’s Note: From July 11 to 13, 2025, the 9th Annual Hematologic Oncology Congress hosted by the Chinese Society of Clinical Oncology (CSCO) took place in Harbin. The conference brought together leading experts from China and abroad to discuss key topics in hematologic malignancies, including leukemia, lymphoma, and multiple myeloma. Topics ranged from basic research and innovative drug development to precision medicine strategies and clinical translation. At the conference, Professor Yu Zhang from Southern Hospital of Southern Medical University delivered a compelling presentation titled “Optimizing the Diagnostic and Treatment Pathway for AML at Southern Hospital.” In an exclusive interview with Oncology Frontier – Hematology Frontier, Professor Zhang shared further insights into the hospital’s innovative approaches and practical experiences in managing acute myeloid leukemia (AML).Oncology Frontier – Hematology Frontier: In your view, what role does early diagnosis play in optimizing the treatment pathway for AML? What innovative strategies has Southern Hospital adopted to ensure patients receive a precise diagnosis in the shortest time possible?
Professor Yu Zhang: Diagnosing leukemia can be complex and typically requires a comprehensive evaluation through bone marrow aspiration, flow cytometry, and molecular genetic testing. That said, leukemia does present with certain early symptoms and clinical signs that can provide preliminary clues for identification.
At Southern Hospital, we place special emphasis on a patient’s antecedent hematologic disorders (AHD) and any history of primary malignancies. Within myeloid leukemias, there is a subset known as “secondary leukemia,” often occurring in patients with a prior cancer history—especially those who have undergone chemotherapy or radiotherapy. These individuals are considered high-risk, making their identification critically important.
In addition, molecular genetic profiling plays a pivotal role in risk stratification. These molecular markers enable us to assess a patient’s prognosis with greater precision and guide the development of personalized, risk-adapted treatment strategies. Such individualized approaches not only help to optimize treatment efficacy but also support more effective disease management over the course of therapy.
Oncology Frontier – Hematology Frontier: After diagnosis, how do you develop personalized treatment strategies based on the specific AML subtype and pathological characteristics? What measures has Southern Hospital implemented to ensure accuracy and individualization in optimizing the treatment pathway?
Professor Yu Zhang: At our hospital, AML treatment is stratified in alignment with the latest recommendations from the European LeukemiaNet (ELN), following a “tailored therapy” or fitness-based approach. The decision-making process for treatment fitness is based on two key factors:
First, the patient’s physical condition and comorbidities, which determine their ability to tolerate a specific treatment regimen. Second, their genetic profile, which helps assess sensitivity to certain therapies.
For example, in patients over 60 years old with favorable genetic markers such as core-binding factor abnormalities, we often choose intensive chemotherapy as the induction regimen to ensure effective disease control. Conversely, in younger patients with high-risk genetic features, we may recommend enrollment in clinical trials that explore targeted therapies—such as the ongoing HVA randomized controlled trial at our center.
If a patient is found to have an FLT3-ITD mutation, we incorporate FLT3 inhibitors into their treatment plan. Similarly, for patients with IDH mutations, we consider adding targeted therapies specific to the mutation. This personalized approach maximizes treatment efficacy while minimizing unnecessary toxicity.
Oncology Frontier – Hematology Frontier: Treatment for AML extends beyond induction therapy. What are some of the unique approaches Southern Hospital has implemented for disease monitoring and management across the entire treatment course to help patients achieve long-term remission and survival?
Professor Yu Zhang: Comprehensive, longitudinal management is one of the hallmarks of our approach to treating myeloid leukemias. This includes four key components: diagnostic assessment, induction therapy decision-making, post-remission stratification, and ongoing treatment monitoring.
Take post-remission treatment as an example. Once complete remission is achieved following induction therapy, selecting the optimal subsequent treatment becomes a critical clinical decision. We use a combination of genetic risk classification and minimal residual disease (MRD) monitoring to guide this process.
For patients with intermediate-risk AML, if MRD negativity is achieved early and maintained, chemotherapy or autologous stem cell transplantation can be effective options with favorable outcomes. However, if MRD fails to convert to negative, we prioritize early inclusion in the pathway for allogeneic hematopoietic stem cell transplantation (allo-HSCT).
Moreover, we place great emphasis on dynamic MRD monitoring after treatment. For low- to intermediate-risk patients, long-term maintenance options remain limited. In these cases, real-time MRD tracking allows us to intervene preemptively—a strategy we refer to as “proactive maintenance.” This approach not only helps reduce treatment-related toxicity but also allows for the early detection of relapse, providing a foundation for timely therapeutic intervention.
Oncology Frontier – Hematology Frontier: With the growing adoption of immunotherapy and targeted therapies, how do you envision the future evolution of AML treatment pathways? What shifts do you foresee in the overall treatment strategies for AML patients under these emerging therapeutic modalities?
Professor Yu Zhang: At present, the range of targeted therapies available for AML patients in China remains relatively limited. The main options include venetoclax, ivosidenib, and gilteritinib. A key area of focus for domestic researchers is how best to integrate these targeted agents into the existing treatment paradigm. This exploration is primarily unfolding in two directions:
On one hand, for younger patients, combining intensive chemotherapy with targeted therapies holds significant promise. For instance, combining intensive chemotherapy with menin inhibitors shows great potential in treating AML associated with MLL rearrangements and NUP98 rearrangements—subtypes that have historically posed major clinical challenges.
On the other hand, elderly patients who are unfit for intensive chemotherapy often harbor multiple gene mutations. For this population, combining targeted therapies can reduce treatment-related toxicity while improving tolerability and achieving meaningful clinical responses. Take for example AML patients with IDH1 mutations who also carry FLT3 mutations—these cases often do not respond well to standard treatment. However, combining gilteritinib with ivosidenib has shown significantly improved remission rates. Moving forward, targeted therapy for AML should focus on the precise identification of disease-driving clones and tailoring treatment with drug combinations that match those clonal characteristics. The goal is to achieve highly effective yet low-toxicity regimens.
Another major advancement in AML therapy lies in optimizing transplantation and immunotherapy. Given the high degree of heterogeneity in AML, although many studies have explored the use of CAR-T cell therapy, challenges remain regarding target selection, toxicity, safety, and overall efficacy. As such, hematopoietic stem cell transplantation continues to be a cornerstone in AML treatment.
Considering the toxicity and treatment-related mortality risks associated with transplantation, future efforts must also emphasize refining pre-conditioning regimens, developing effective post-transplant maintenance strategies, and leveraging immunotherapy to prevent relapse. These avenues represent crucial directions in the evolving landscape of AML management.
Professor Yu Zhang
Southern Hospital, Southern Medical University
- Director, Subspecialty of Acute Myeloid Leukemia, Department of Hematology, Southern Hospital, Southern Medical University
- Member, Leukemia and Lymphoma Group, Hematology Branch, Chinese Medical Association
- Standing Committee Member, Hematology Branch, Chinese Geriatrics Society
- Member, Hematology Committee, Cross-Strait Medical and Health Exchange Association
- Member, Hematologic Oncology Committee, Chinese Anti-Cancer Association (CACA)
- Editorial Board Member and Certified Physician, CACA Clinical Practice Guidelines
- Member, Leukemia Committee, Chinese Society of Clinical Oncology (CSCO)
- Vice Chair, Regional Ethics Committee, Guangdong Pharmaceutical Association
- Vice Chair, Hematology Committee, Guangdong Geriatrics Healthcare Association
- Standing Committee Member, Hematologic Malignancies Committee, Guangdong Preventive Medicine Association
- Member, Internal Medicine Branch, Guangdong Medical Association
- Member, Leukemia Group, Hematology Branch, Guangdong Medical Association
