In the era of medical innovation, various targeted and immune drugs are emerging, leading to breakthroughs in lymphoma treatment. From January 26th to 28th, 2024, the “Chinese Society of Clinical Oncology (CSCO) Leukemia Expert Committee, Lymphoma Expert Committee, and Myeloma Preparatory Committee Working Meeting, as well as the 2024 CSCO Hematology and Lymphoma, and Myeloma Disease Academic Conference” was grandly held in the beautiful city of Haikou. At the conference, experts of all ages from both domestic and international arenas engaged in discussions and exchanges on the latest developments and hot topics in lymphoma diagnosis and treatment. “Oncology Frontier – Hematology Frontier” had the privilege to interview Professor Aichun Liu, Director of the Department of Hematology and Lymphoma at Harbin Medical University Cancer Hospital, regarding his perspectives and opinions on the overall treatment strategy for relapsed/refractory B-cell lymphoma, as well as sharing his team’s research plans and management experiences in lymphoma.

Oncology Frontier – Hematology Frontier: Although overall efficacy and prognosis for B-cell lymphoma are better than T-cell lymphoma, the probability of relapse/refractory remains high for high-risk stratified B-cell lymphoma. As a senior expert in the field of lymphoma, could you please share your views and suggestions on the overall treatment strategy for such B-cell lymphomas? This could include initial treatment regimens, immune-targeted drugs, the timing of CAR-T therapy intervention, indications for transplantation, and opportunities for transplantation, etc.

Professor Aichun Liu: Currently, complete cure for B-cell lymphoma remains elusive, with approximately 40% of aggressive B-cell lymphomas progressing to relapse/refractory stages. To overcome relapse/refractory cases, it is essential to stratify patients into high-risk, intermediate-risk, and low-risk categories. During initial diagnosis and treatment, it’s crucial to clearly define the risk stratification, risk factors, and prognosis for each patient, thereby selecting induction treatment regimens accordingly. Previously, the CHOP regimen served as the cornerstone for treating B-cell lymphoma. However, with the development and utilization of new drugs, the cure rate for lymphoma has significantly improved, and we now have regimens surpassing R-CHOP. Under accurate diagnosis and stratification, combining new drugs with R-CHOP or employing specialized regimens for specific cases, typically involving targeted therapy combined with chemotherapy, along with small molecule drugs, or even CAR-T therapy, are becoming the norm. To reduce the incidence of relapse/refractory high-risk B-cell lymphoma, we must rigorously select induction treatment regimens at the initial diagnosis to minimize the number of patients progressing to the relapse/refractory stage.

For patients already experiencing relapse/refractory disease, we have many new drugs or approaches to choose from, such as the Pola+BR regimen, CAR-T therapy, small molecule drugs, and even autologous hematopoietic stem cell transplantation (HSCT). CAR-T therapy has been approved for second-line treatment, offering a chance of cure for some relapsed/refractory aggressive B-cell lymphoma patients. Of course, the application of these approaches should follow a priority order, tailored to individual patients, including sequential treatment with autologous HSCT and CAR-T therapy. The use of these comprehensive approaches has further improved the cure rate for aggressive B-cell lymphoma. Compared to T-cell lymphoma, B-cell lymphoma has more targeted drugs, small molecule drugs, and effective CAR-T therapy options, providing more choices and better treatment options for relapsed/refractory B-cell lymphoma patients. Accurate prognostic stratification, standardized induction therapy, and new treatment modalities and comprehensive treatment plans after relapse/refractory all contribute to the potential cure for some relapsed/refractory B-cell lymphoma patients. Therefore, there has been a significant improvement in the cure rate for B-cell lymphoma, offering patients more hope and options.

Oncology Frontier – Hematology Frontier: Could you share with us any ongoing research in lymphoma conducted by you and your team, including basic research, clinical research, and future research plans?

Professor Aichun Liu: Lymphoma is a major disease in our department, and we are particularly concerned with the treatment and cure of lymphoma patients. First and foremost, on the basis of standardized treatment and management of lymphoma as a whole, we focus more on diffuse large B-cell lymphoma (DLBCL), which has a higher incidence rate, including accurate prognostic stratification and management of relapse/refractory cases. We categorize lymphoma mainly into three parts: aggressive DLBCL, indolent B-cell lymphoma, and T-cell lymphoma. In the realm of aggressive DLBCL, we are primarily involved in various clinical trials and self-initiated clinical trials, including CAR-T therapy, etc.

Regarding indolent B-cell lymphoma, our focus lies in the application of new drugs and long-term management of patients. For T-cell lymphoma, we pay more attention to the study of the tumor microenvironment, especially the occurrence and development of angioimmunoblastic T-cell lymphoma (AITL), and whether patients achieve long-term survival is closely related to the tumor microenvironment. Some T-cell lymphoma patients can obtain long periods of remission through maintenance therapy with immunomodulators or steroids, achieving disease stability.

Oncology Frontier – Hematology Frontier: In terms of long-term management of lymphoma patients, what experiences can you share from you and your team?

Professor Aichun Liu: As mentioned earlier, we categorize lymphoma into aggressive DLBCL, indolent B-cell lymphoma, and T-cell lymphoma, with designated personnel responsible for the management and long-term treatment of different types of patients. We conduct long-term tracking and follow-up of patient outcomes, providing regular feedback within the department to ensure that everyone is aware of the results and experiences of our patient treatment. This not only strengthens our management and treatment of patients but also enhances accountability to patients, allowing them to experience the standardization and professionalism of specialized treatment.

Chief Physician and Director of the Department of Hematology and Lymphoma, Harbin Medical University Cancer Hospital, Ph.D. Supervisor Member of the Chinese Lymphoma Alliance Committee of CSCO Member of the First Hematology Committee of the Chinese Women Physicians Association Member of the Second Clinical Oncology Committee of the Chinese Women Physicians Association Standing Committee Member of the Hematological Diseases Professional Committee of the Chinese Medicine Education Association Standing Committee Member of the Myeloma Branch of the Chinese Medicine Education Association Standing Committee Member of the Lymphoma Branch of the Chinese Medicine Education Association Member of the Pediatric and Adolescent Lymphoma Group of the CSCO Anti-Lymphoma Alliance Chair of the Hematological Lymphoma Professional Committee of the Heilongjiang Medical Association Chair of the Heilongjiang Province Multiple Myeloma Specialized Alliance Council Member of the Fourth Council of the Heilongjiang Medical Association Deputy Chair of the Hematological Disease Professional Committee of the Heilongjiang Physician Association Deputy Chair of the Blood Internal Medicine Professional Committee of the Heilongjiang Physician Association Deputy Chair of the Hematological Internal Medicine Professional Committee of the Heilongjiang Physician Association Deputy Chair of the Hematology Professional Committee of the Heilongjiang Physician Association