Behind the complexity and concealment： who is pushing the change of myeloma treatment era？
Complex, concealed, easily misdiagnosed and incurable, multiple myeloma has long been a "hard bone" in the field of hematological tumors.
Multiple myeloma (MM) is a kind of malignant tumor that occurs mostly in middle-aged and elderly people. At present, the incidence of MM ranks second among hematological tumors, which has surpassed that of acute leukemia. With the acceleration of China’s population aging process, multiple myeloma has increasingly become the focus of attention, and it has also put forward a new proposition for promoting healthy aging in China.
In the face of difficulties and challenges, there are always people who face difficulties. Wu Depei, director of hematology department of the First Affiliated Hospital of Soochow University and director of hematology branch of Chinese Medical Association, and Lu Jin, chief physician of Institute of Hematology, People’s Hospital of Peking University, as experts who have been deeply involved in the field of hematology for decades, have experienced the changes in the treatment era of multiple myeloma in China, and frankly said that the progress in the treatment field of multiple myeloma in the past ten years has made "cure" no longer empty talk.
A place that one has never set foot in.
In 1982, 24-year-old Wu Depei was still a trainee in Suzhou Second People’s Hospital. One day, his attending physician excitedly brought a patient’s skull X-ray. When the light was turned on, it showed a beaded osteolytic change. At the same time, the results of serum protein electrophoresis showed that γ globulin was high. It was the first time that he came into contact with the real case of multiple myeloma. "Not only did the university teacher never teach it, but even the teaching teacher who was already an attending physician in hematology at that time felt extremely rare."
Director, Department of Hematology, First Affiliated Hospital of Soochow University, Hematology Branch of Chinese Medical Association.
Chairman of the Committee, member of Chinese People’s Political Consultative Conference Wu Depei.
In 1994, Lu Jin, who had just joined the work, encountered the dilemma of multiple myeloma. Compared with the foreseeable development space and various treatment methods of leukemia, myeloma is dwarfed. Practical problems such as lack of treatment methods and incurable patients are placed in front of clinicians and medical students, which leads to the extreme shortage of clinical talents in the field of multiple myeloma.
At the beginning of their commitment to the treatment of multiple myeloma, both Wu Depei and Lu Jin experienced a difficult time, and they could only rely on limited drugs such as Maffalan and prednisone for treatment. "This scheme can’t achieve complete remission, and the recurrence rate of patients is also high. The survival time of myeloma patients at that time is only about 3 years." Wu Depei recalled. Even though there are many problems in front of the two professors, they still choose to stick to it in the field of myeloma.
Develop and build together, and work together.
The turning point appeared in 2005, when bortezomib, the world’s first proteasome inhibitor, was approved to enter China, bringing a ray of light to patients.
"It turns out that the complete remission rate of multiple myeloma is below 10%, and bortezomib has raised this data to about 30%, which is a big step." Lu Wei said.
Lu Jin, chief physician of Institute of Hematology, Peking University People’s Hospital.
The advent of bortezomib made Wu Depei feel that the whole society has paid more attention to multiple myeloma: "The higher the attention, the more doctors engaged in this field, which is a good signal for patients and the development of the industry."
2005 is just the beginning. In 2007, the second generation immunomodulator lenalidomide was approved, and the era of new drug treatment represented by proteasome inhibitors and immunomodulators came. In July 2017, 36 kinds of drugs, including bortezomib, were included in the national medical insurance catalogue, which greatly eased the patients’ medication embarrassment. In 2019, daretouzumab was approved to be listed in China, which pushed multiple myeloma into the era of immunotherapy.
For more than ten years, breakthroughs have been made in the field of multiple myeloma. Wu Depei said, "No matter from the diagnosis or treatment, the progress of multiple myeloma is a model in the whole field of solid tumors and hematological tumors. Precise treatment’ will become the key word for myeloma treatment. "
With the continuous spread of good news in the industry, Wu Depei and Lu Jin, a number of pioneers in professional fields, are also using various forces to promote patient treatment and industry development.
The public awareness of multiple myeloma is low, and the incidence is hidden. The first symptoms are often bone pain, easy fracture and foam urine, and these symptoms often make patients transfer to orthopedics or nephrology, resulting in a high misdiagnosis rate.
Wu Depei believes that "to improve the early correct diagnosis rate of myeloma requires the joint efforts of many departments." Therefore, Wu Depei has been promoting the establishment of multidisciplinary joint diagnosis and treatment mechanism, so as to improve the awareness of interdisciplinary doctors on the disease and facilitate patients’ consultation.
Nowadays, many hospitals, including the First Affiliated Hospital of Suzhou University, have carried out inter-disciplinary cooperation with different modes. For example, hematology department actively cooperates with physical examination center and laboratory to establish a more accurate screening mechanism-as long as patients with high globulin are found, they will be transferred to hematology department for further examination. "This screening mechanism is also a kind of public education to make everyone aware of the connection between globulin indicators and multiple myeloma." Wu Depei said, "In this way, the diagnosis method and process of multiple myeloma are clearer, and more patients can be included in the system management earlier, which is of great significance to disease treatment and prognosis."
Side by side with the industry, pioneering and co-constructing, experts in the industry, represented by Wu Depei and Lu Jin, have made the systematic diagnosis and treatment of multiple myeloma a reality step by step, bringing more hope to patients.
To be a giant’s shoulder
China Multiple Myeloma (Revised Edition, 2020) points out that although multiple myeloma cannot be completely cured at this stage, many drugs and therapies have been developed to control the disease. Nowadays, the emergence of immunotherapy has brought a new dawn to the treatment of multiple myeloma.
"Darretouzumab, which entered China in 2019, is the first real immunotherapy drug for multiple myeloma, and CAR-T, as a cellular immunotherapy, is a revolutionary tumor treatment method. It will make the patient’s own T cells undergo gene editing and in vitro amplification and then return to the patient, so that it can automatically locate and kill tumor cells." Lu Jin said, "China is in the same position as developed countries for the first time in the research and development of CAR-T, and is no longer a follower."
"CAR-T therapy has achieved real immunotherapy. We are currently in the clinical research stage and we are very much looking forward to it bringing better news to patients. " Wu Depei said, "In addition, the innovative therapeutic drugs are still used in patients with multiple-line recurrence and refractory diseases. It needs to be studied whether early use in patients with first recurrence or high-risk patients will have greater benefits. At the same time, we need to work hard to make patients reach the remission depth of residual lesions that can’t be measured even by molecular science, and strive to achieve radical cure. "
An old horse lurks, aiming at a thousand miles. As a "giant" who has been seeking for many years in the field of multiple myeloma, Wu Depei hopes to remain childlike and become a "giant’s shoulder". Now, as a member of the Chinese People’s Political Consultative Conference and a doctoral supervisor, he insists on being a "responsible member", actively making suggestions for the whole industry, encouraging industry innovation, promoting the capacity building of primary medical services, and leading his team and students to make progress, so that the "back wave" will surge and strive to truly solve the problem of multiple myeloma.
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