From September 6th to 8th, 2024, the 5th Tianjin International Lymphoma Academic Conference was successfully held. The conference featured 12 thematic sessions covering topics such as immunotherapy, translational research, and new drug development, creating a platform for promoting international academic exchange and collaboration. During the event, Hematology Frontier invited Dr. Ou Bai from The First Bethune Hospital of Jilin University to discuss the content of the Greater China region BTK Inhibitor Consensus on indolent lymphomas.

Hematology Frontier: When selecting the most suitable treatment approach for indolent lymphoma patients from various BTK inhibitors, what key factors guide your decision? Are there specific drugs that are preferred, especially when considering long-term treatment continuity and quality of life?

Dr. Ou Bai: When choosing different types of BTK inhibitors based on the individual characteristics of patients, two core principles can guide the decision-making process:

First, while indolent B-cell lymphomas share commonalities, their pathological subtypes differ, including chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), Waldenström’s macroglobulinemia (WM), follicular lymphoma, and marginal zone lymphoma (MZL), with varying responses to BTK inhibitors. Given the clinical data showing the efficacy of zanubrutinib, developed in China, it is prioritized for CLL or WM patients. For follicular lymphoma, zanubrutinib has also been approved as an indication and can be considered as a preferred option.

Second, selecting a BTK inhibitor should also take into account potential side effects related to off-target effects, including but not limited to hypertension, atrial fibrillation, and bleeding. New-generation BTK inhibitors, by reducing off-target effects, are expected to lower the occurrence of these adverse reactions and are thus more favored in clinical practice. For central nervous system lymphoma patients, it is especially important to choose a BTK inhibitor capable of effectively crossing the blood-brain barrier and demonstrating stronger efficacy against tumors in that location, such as orelabrutinib, which has shown advantages in this patient population according to related studies.

When considering long-term medication strategies, it is important to integrate the two factors mentioned above. For patients who have been on BTK inhibitors for over one to one and a half years and achieved minimal residual disease (MRD) negativity, gradual dose reduction or discontinuation can be considered. Additionally, discontinuation strategies may be combined with other innovative therapies, such as anti-CD20 antibodies or BCL-2 inhibitors, to achieve better treatment outcomes. The patient’s age is also a crucial factor in determining the treatment strategy. Younger patients may be more suitable for short-term treatment strategies, whereas older patients may require a long-term medication approach similar to managing hypertension to maintain stable disease control.

Hematology Frontier: What specific guidance does the recently published China Expert Consensus on BTK Inhibitor Therapy for B-Cell Lymphomas offer to clinicians treating indolent lymphomas? What effective promotion strategies do you think should be implemented to help more clinicians understand and apply this consensus?

Dr. Ou Bai: The China Expert Consensus on BTK Inhibitor Therapy for B-Cell Lymphomas followed a multi-stage scientific decision-making process. The consensus was reached based on extensive discussions and collective voting by all participating experts, ensuring its professionalism and practicality.

The consensus thoroughly covers various types of B-cell lymphomas. For patients with small B-cell lymphomas, the expert panel unanimously recommends using BTK inhibitors as a treatment option, regardless of genetic risk status, initial treatment, or relapse/refractory situations, highlighting the widespread value of BTK inhibitors in managing these diseases.

For the treatment of Waldenström’s macroglobulinemia, the consensus points out that either BTK inhibitor monotherapy or combination therapy with anti-CD20 antibodies is recommended. Regarding MZL and follicular lymphoma, especially in relapsed or refractory patient groups, BTK inhibitors are considered an important treatment option.

Among the available BTK inhibitors, new-generation BTK inhibitors, with their therapeutic performance and lower incidence of adverse reactions compared to the first-generation, have become the mainstream choice and are widely endorsed and recommended by experts.

In summary, the release of the China Expert Consensus on BTK Inhibitor Therapy for B-Cell Lymphomas not only provides scientific and standardized guidance for the clinical treatment of B-cell lymphomas but also promotes the widespread application and development of BTK inhibitors in the field of hematologic oncology.

Dr. Ou Bai

• Ph.D. Supervisor
• Deputy Director, Department of Hematology, First Bethune Hospital of Jilin University
• Head of the Lymphoma Specialty Alliance, First Bethune Hospital of Jilin University
• Clinical Expert, Lymphoma Specialty Construction Project, Capacity Building and Continuing Education Center, National Health Commission
• Member, Lymphocyte Disorders Group, Hematology Branch, Chinese Medical Association
• Vice Chairman, Second Committee, Hematology Branch, Chinese Geriatrics Society; Chair of the Youth Committee
• Deputy Leader, Lymphoma Group, Chinese Women Physicians Association
• Standing Committee Member, Chinese Anti-Lymphoma Alliance (UCLI) under CSCO
• Standing Committee Member, Lymphoma Professional Committee, Chinese Anti-Cancer Association
• Standing Committee Member, Oncology Clinical Chemotherapy Professional Committee, Chinese Anti-Cancer Association
• Deputy Secretary-General, Medical Oncology Branch, China International Exchange and Promotive Association for Medical and Health Care
• Chairman, Lymphoma Professional Committee, Jilin Province Health Management Committee
• Leader, Jilin Province CLL Working Group
• Top Talent in the Jilin Provincial Health System

Professor Bai has published 110 papers, including 42 SCI-indexed papers as first or corresponding author, and has led 30 projects at the provincial and national levels, including general and key projects under the Natural Science Foundation.