good morning， doctor matters。

good afternoon。

all my colleagues。

it's my very a great pleasure to welcome you to attend this international multiple meloommeeting。

today's topic about the treatment of multiple meoma in new new area in immotherapy。

we all know that all， though we have learn more more about the disease biology of a smmoderly multiple melomma。

there are still a lot of debates on how to treat the。

more淋smsmmomata patience and how to do the best。

on the other hand， in the area of new agents。

we the all all all of survival of multiple melomma pentience has been pronged with。

which make patients management through the multiple line of treatment become important。

we will have to。

interesting presentation today。

one is about the treatment and management of a smallly mettaba eloma in the new area。

欧洲。

when will be multiple mumultiple of treatatment multiple， my uoma in china， including the kiys sharing。

a of patience management for the from the sun jasine you university cancer center。

first will。

we would like to introduce doctor metals。

uh， she is associate professor of medicine and consultant physician on the hematology department at the university of salalmona spam。

she has many title and play active role in many international associate such as the MWG。

MS一号and h。

it's our honor to have a doctor metals today to share her。

expertise reshes。

doctor betters。

did you like to see hello to our chinese colleagues？。

孙悟痛。

are you sorry because i ashing in a goal？ yeah， yeah， ok， no problem。

哎，otomattices。

did you to see呃，hello to our chinese colleagues？。

yes， of course， say， hello， good afternoon on you。

good morning for me for for me for me to。

yeah， thank you。

we呃would like to also introduce another speakers today dodoctor wway da h。

he 's the attending physicians in the department of hematchology in saanyassan university cancer center。

we also introduce some。

呃，the top chinese hamatololost st jojon today's panel discussion。

first of all， professor李欣欣欣，she is the director of department hamatology um from the。

third湘雅hospital。

呃，central。

nornorthern university。

呃，she is a chief physician professor and doctor uh supervisor。

we also introduce professor。

魏永强。

呃，who is the呃，deputy director of hematchology department and the director of a informer and呃。

placeman seattle disease。

from the南方hospital and呃professor。

钟丽叶。

she， he is a deputy didittor a hamatchology oncollege committee from the广州province。

anti cancer association association。

and another呃professor is a doctor呃。

将倒之。

呃，the director。

himattology department from the人民hospital of武汉university， and the last professor is a coway。

呃，he the associate tive ysiciicifrom， the呃，south china hospital of shingdi university。

ok呃，let's welcome to doctor metals to share with us。

documenters。

hello out to everyone a， thank you， body matself for the kind invitation to participate in this matital。

and my topicc will be how to threat the smthder in multiple my laoma in the ira of uniunitherapy。

in this slide that you can see my this closure res， and i will cover the topic， starting with a clinical case。

this is a fifty five years old of women completely assytommaticin were elemerged twenty eighteen in a routine analysis， though because was was was was or north obceilior of the hospital。

we obsered that how they thther same proteins。

ers were elevated appopoint to grmseparate facitor。

the algumenal was also normal because impincipal， the immogram mambao chemistry were normal。

the next step was was to do a seconden protein electrc， four asasa and AM component IGA carapa。

one poicits gram separate facilitor was a detect by them。

according to to those spespeover over plasmasself disorder here to consider recommend the world cappa。

and this is what we dether with this fasacsion。

the medical history and physical examinations were normal。

assysycribly told you in the immogram were normal。

absolute new trophal counts。

some platholates were normal by the chemistry was a normal creacin in learance， as well as as the costume levels。

the aromment was normal and interproin。

in studies asygcripwas saw you， the am spiking， the bonregion i gcaapa was detected on point six gramseperpersiliicbenjum protety indiia was negative for a normal by preprety ratio were normto were proceded with bond。

maro was setected on the twenty five percent of the plasmasers ort dedetetein by moflogy。

and。

a pet city was done as part of the recommended workcapa under the patiently did not show any litiication。

and a no positive uptake。

with this information in principle， the fact i odein in in in in in in spof facfacfacthe perent， ent， ent and and compone any perpercent。

however， as said， you know， the definition of my eloma was recently ablated in ourteen to include as a my elma defined in event。

the person of this by your irer than more than one for bass masself mcter higher sixpercent involved with uninvolved and and ate ate higher than hundred der and more than one for colalision on ammarright。

if you remember these specision the blast asmywere mowas to to to and three three to great to twenty twenty。

but what about perperent of vocalitions on a maiin？ the assessment was not in principal donor in seassion。

and in the reason why we decision in implement the adorii studies and addition within the some additional evaluation in principle， al the mmorivvvin， the maaliicior the detect geso。

so i said that the diagnosis was more than n most conermain。

the leleshare， with with some additional information， this， the the arition of was deteority in the in more gglobance level。

and in the bonmarrow was studies within the edishare to identify that the maurity in the masmcells， the dinine percent。

so i had dia。

finsh fish analysts in selected plass massels showed applitiation ation of one QA society geneity。

with this information， the moderderi will me that acthe next， the next p。

we to to an to to roup to to mamaybe， be is the reretion to to perquestion to inforform to rereto to to to to to to to inforform to correct to the rectly， because because basally tly risk of the basically because you ally that the correct。

on of these paence and especially to focus on the high rise to group of patients with this modern， those in which the risk of preparation to my loma fifty percent at two years， how to evaluate the risk of preparation in the presinic model， publish seven years ago， in which the risk of maryer and higher than percent ent highten higher than ten eight， ten， ten to five or highten one five or higher ten， nd this seconent years model， this in the resresent in these moperor， the million time to ressimaary two years。

and in this patient， you can see how perperent ent two milof three risk factors。

this finunise， my deoma group decided to a valuate in different model， basically， based on the identification over abbarn luass massales within the plast masell on mara apartment。

because in know that in is moderl， both the clonel and polling clonal pluass masells for exisst。

and in addel， we decided to incorent ent of the noparsia。

this means that when a is modern in my laoma， patitience perperent said， with majority than ninety five percent of the plass masells as a ranant together， the uninoparsea， the medium time to propossion was going to be of approprimately two years。

and if you remember， this was the situation for the bastiwe are treated that because twenty nine percent of the patience ts with the and because in dition， this spacent percenent also in the unior parassia， and in probably know that they in。

international maoma working group model in order to identify high prsmoden in my lama and del three， three situation for the cgher ten three in vacor， higher three free acmin factors higher than prepercent predict facfacors prepredict predict facma。

and if lof of of vfactors predictiof predict facfacor of my percent， and this was the situation for the acent。

and the asassituation and plasmac ma to twenty。

and and i can compplement this model with the perent。

and and you relof mber this spacent percent。

brification of one q and a definitely this means that this sptiwill be at a higher risk whther ther progression risk at two years of approximately six titers center。

it's to that new rik k models are emerging new prosilltic。

or is the llinto more cells？this has rerecently presented pahigher mses to the modeine， with more than one identify patients。

idetifically is able identifpapaenence with the higher riybe of motito to to ltibband dedeinmmof perperor。

we are going to moderate mommpapaence with the finier， my of mpaperperperent with involther to the dela repamy whther ther to risk of proltiresto a perpersier hihigher。

maybe we are going to combine with more than ic。

markts， together with it， these genomicc markers in order to ensure or noted to acculate， much moral the risk conversion to multiple my looma。

if we don't wanted to uticize， these modeers， it's also possible to evaluate。

these risk is forore also endorsed by the international meloma working to a and i talk into the paramamthoters。

we observve looking this space， and i can say that this space and a was the premediate high risk from apgroup of patients with the approgation ation of statduor from approrouof patima。

the final diagnose is for this space in a worse risder in my loommat high high rik k of peration to multiple milomma， how to proceed them to waied through the hair as multiple milomma through the hair with the linerthe midthan examina， a or finally include the hair in a clinical trial。

and we can discuss about is the optimal possibility。

but maybe you agree with me that there is any clinical trial active。

the best approach is incluincluthis this basin in clclinical trial， but about the clmmin modern in modera in general， imagine that there is not any clinical trial active。

it is possible to treat high rsin in in lama in according to the two twenty twenty model。

to twenty twenty plus psychogentic tic normalities， but is too that it is also possible to utilize whatever of the models。

i showed you in my presentation， and whatever model able would to identify patients witha progression prisst of a presssimately fifty percent at two years。

is in principle eligible to receive every treatment in every every treatment。

a highst is modern my lama。

because if we go to the own collegy perspective， maybe you know that the early of vor， the early interdeation is is addeant even we wanted to plan a potential cude， or at every eadication of the diason in adaddiwhen， we reatment every treatment in a high rist st。

modern perspemtive。

what we are going to avoid is is dedevelopment in demal definine events， and you know that the lomal definine events impour padepresof impplly the broken bones， impearly corvenal evenent。

and whether the early treatment we are going to impact in the quality of life of our patience ts in advtion， because every ely lar parthogengenisis from is deatment into my。

has been investigated when we planned every every three thther we going going treat at agises less complex from the biological from the geneic ic point of ilm。

so maybe they a eradication of the disease will likely much more possible。

and what is the evidence in order， the plan and the with the high reeevience ence is the first evidence is dededein in evidedein ace， ace clclinvof， the consisiin， the a eneffeof dedein in dema resulted into sigsignificant proconvation， a observation of of time time， a consusidin， the bconsidy and the transefit triwas laenface clclinical study develocomppared by this sppah， the mdein mobmthis。

我was quite compartable to that reported in this fan is my normal group。

and in addition， when the benefit of linearly， the minder was evaluated that you guguys here had how high reasent is modern in alloma benefit， the most from every every treatment。

in this case with the larly， the minder under larly， the mindder has been indeed， they start in point in order to generate。

three reacthe commacation， in order to improve the communacand。

this is ccase to sumable dededex ort conful dedex were let me share with duthis preliminary titience acacthe， the the the the the vvvplete cycles to in prsiin in in perty。

ty percent， eighty percent of the patients were included。

the primary object， tive minminimmciable disease activity complete rrate， and i susiacin perthe seventy percent of the patients achieved and minminsitive and minactivvity complete cccrate。

and in in suspetly eighty percent of the patients achishare with。

this finfinis be is the。

intermatity and and high reassimore in my lama basin and different dims eevaluwere evalvalated。

and you can see here how， in principle， the intense apeneitinto into much， much more enefefespeciininties ties， the precan three， three， multiple， my lama as well as also biological progressive dia facace。

the preface ace three ingal studididirect mumaa is been prepared with observation in the face three， a curious study。

i will you lalaon， but there are another face three clinicical study like this indedededex in the index is been compared with the land for survival， premary emploines for survival。

and here you can see another face。

clinicical study in which linary study， and the ammata is being compared with linary ommother， the ammea asass direct impimportant remarmarimpfor。

the primary ininical study， as as well as quality of life。

there are another different tempproaches basically， based on the potential cure over high rismomon in miloma throughout the nearly interventure。

this is the case for the gening fish study in which high risis modern in eloma patients had been treated with the k transplant KRD rethree with such intenance。

treatment of approproimatally， three years of colleasia and hear unansic， how， after a medium full part of apapproachmatally three years， the board of proposon， this survival and overus survival are quite ting patient， even we go back into this patient。

i decided to share with you today， we decided to blue the hair in a clinical trial， and the cltia was included in the face， three acqudious study in which， as i previous withtold， you dired to mumaa a montherapy was a compared with the therapy。

the patient was was fortunately allocated to the experiment talalment， and she started to receive a treatment darted to mumaa was monotherapy。

here， you can see how the incomponent evolved throughout the treatment， because this patient has already finalized the treatment that in component， significant tly decrease。

ed， the the pavation is was side effect over this final reaction of this patient。

the last evuation ation was not the invvority ty devatiis， but apapproimately one month ago。

and i can say that they am spiked disappear and the final response， high deatate one。

the treatment with that sad to one vaabtive is efect of the ccolabability reefect in patiation is the in pertive response。

so i would like to finish with this sliin order to try to answer how to treat high resmoderderin my lama in the。

so my first recommendation is first first to do the evaluuvery very risk of peration to multiple my loma conconsito。

the the ltiof of papamit is is i to llltification of concertly。

ct patients in crinal trial。

is it it ct derect is concontiation on the chemical trial conconbility， would the deaptitii lbpulaation it？ i possia a sigfificbbenefof patients？。

iphone to view the challenging situation， he said。

how did retake in mmmlike like multiple， my lammor this something that that can discucuss and my first reremendations tions dedepatient criinical tries， if they get active and don't get much for deatment delay or maybe will avoid definitely， they might lama define dedeppand for depapaent。

and i think think， and the prevery trein inand get。

呃，thank you呃，drop the matters。

for the excellent presentation， we have a some time to discussion。

according to the呃，sharing呃。

we have any quesent for the doctor matters。

our joam。

呃，二零一九。

呃，因为我们今天呢有很好的翻译，所以呢大家在讨论期间呢，你可以用中文，也可以用英文好吧。

呃哪位translation？。

夏教授，那我就先来提两个问题，对，好吧嗯。

uh respected an professor meters。

thank you for your wonderful um presentation。

so i have嗯。

two questions， i'm confused um first first ones。

you first trethe muumumultiple， my mmwith high risk to progress to active mthe n dedel。

the a lot of models to define which part of this kind of patients will progress， which exthe model prodel like spanisismodel， like the character or the recent model LII spthis model， l， the the spunish model or the character of model to define which part of patients will progress。

so i will will develop a tummol al to do the treatment of the treats to progrem mulof patience ts will design。

IIII have read through all the clinked trials。

i think a lot of that did there。

so many difference。

so that's the one。

yeah， yeah。

yeah， this is an extrellquestion and and correcand different race models in this model with the object tive mthe ithe model in my obsame。

and。

with fifty percent of progression riresk cuto two years。

and i would say that in each of these models in the mayear model， the impcomponent， the plass masl on marderinfgression and seven three like generation in the spanish one， the bren ass ass mcel in the bone marrow l。

last mml compartment together this modesiin， the in the to mamaoma working group to twenty twenty models。

and of these features reciite that as independent prognostic factors predict in progression to sytomatic disease in more variate analyses， this means that this this model， these different models do not have to be exclusive。

you can utilize whatever you want。

if you are able to identify is more than in malaoma patients with fifty percent progression riresk ct two years。

but concerning your specific quesquesfor， for example， we are involved with right now in the design， often。

new clinal facace， the momodel worin in DD in in interal al al in king romodel king king roal al al to avin se in a vin， a ammpapaations。

even。

to twenty twenty twenty in model。

but if you do a clinical trageis is momomodemand， and you want also to incorporate， they may make modedel dedeor this funnish model。

it is possible to be donor。

and in the first clclicical is study conducted by this spunish， my oma group with relinx verous observation。

we used the madium model or this spanish model， and we decided to evaluate the time to progression to my lama accord in to the madium model。

and according to the spanish model and is a decisure for time to progression was exactly the same。

and it's to that there are some patients with one or another model。

but at the end， what is important of identify patience with with perperent ent progression， sion risk to years。

ok， i see， thank you。

and the second question is， if you decide to treat the high risks multiple， my lmand， and you inintroduce ed lot lot clclk。

but in china， we don't have so ink practice。

呃，what kind of regimen will you recommend呃to treating this kind of呃disease？。

yeah， this is also an important question。

and this is something that you have to discucused with the patient because the stuarting polin， the multiple multious trial and in the ecoal trial in order， the most treated the significant benefit in time to progression to multiple my lama in the indelation and be optimal。

and i would select learally。

the madn mamadation alone， maybe for elderly population with high riace is modern multiple my lama in order to plan an real。

and i definitely tely， i have in front of me， a young patient， the high reassimodedermy lama and the patient wants to be treated in the dederhim or a induction transplant， consol ation and patient like inactive multiple。

my looma， because in the recent study in the james said， said stustudy， because percent of the patients and the lltimmy dema because。

high ghderally with one or more of the biommand。

i can i that outoutquite comcomcomtity benefa from the lltiple bbentii， if acation is going to get a significant benefit。

ok， thank you very much。

thank you。

这个需不需要这个呃翻译翻译一下刚刚教授的这个回答呢，他们已经在同步翻译了哦，已经在同步翻译了。

OK嗯，好，那老师我问个问题好吗？。

ok嗯，谢谢各位啊嗯。

i good morning， doctor mattials。

哎呀，哎呀，真靠哎。

actually， i finished my doctor chiney in germany um this morning ning。

i saw the time line i saw。

well， it must be quite late in the in spaacactually， the uh opposite way to uh。

thank you around for your uh excellent talk， i think um。

why raad your uh paper uh last year publish uh blood cancer journal？ i agree with you。

i think it's the time to redefinite。

the on。

the the initiation of of the active multiple male ommer。

um i think you you guys did a lot of work。

um i just wondering about the uh um。

MRD testments uh um in the error of imunal therapy MRD tessments， or to evaluate the uh um treatment response becomes more and more important。

so what's your comments regarding the RD testment easering active， the smarting multiple， my lamger？ thank you。

yeah， so thank you very much for the exelelling question。

i think that this has to be eeffective， you have had the the opportuniity to to acacsitions and are many， the perperent of the patits are going to response。

and many patients are going to achive complete reverse。

so we have to be fintitiate of the tients on on acacacacpleplevlalaand。

we consithat that the hihiy tive activlaand。

we we consider that the hifiy vvva tivvvva a the a activin activertion。

KRD transplant after the are impimpof of ininininanant and diand， and the the of inininto be is infinfinate。

the studies。

thank you very much。

uh， for more question。

what what about the methodology for a imardi tassmman？what do you prefer next generation sequencing of loss？ auometry？ what what's your opinion？。

what i think that whatenacacval， if you d， because is to to the the to to DNNND， the DD to the sato to the ND， the sato for techlevity level。

is also very prpractical also a avuable。

but i understand that in order to reach a good sensitive level， it requisiit from some experties for the personal， who is analizc the minimum cival season。

but also， there is some important advantage advancation that you are going to be able to evaluate the whole siluicicof the bonnbut you is going going， be more than more important at the new era of inuninvapwhich， which we are involved， but because we can evaluate the the cells that these ells， the the cells and so one， but the bothe techniques are available。

you know that in the USFDA recognize only the the generation sequency as avvalate the techniques。

but i think that the boat are the able d technatory， because not all patients are going to be valued by exgeneration sequency。

if you don't have a the VDG reangerment is the connic。

but。

i think that you can complament the one， and i know that。

thank you very much。

thank you。

呃，next question。

so i have， i have another question。

the how about if you use the darrel monotherapy to do the treatment， how long will be the maintenance be？。

yeah， according to the clinic of ddiation of treatatment is is impimpant ant conceppaaccept unbe select cted in tresepuntil， progressisebut untidecreperseperinunt deperpert perperperyears。

and even in AA ccreative secerct papatits ts in therapy before three years。

so no， more than three years， we will definfinite should happhappen onwe。

we stoa treatatbecause。

maybe we can't select the prpreciy for presisibut。

the treatshould not indevate。

the proportion of patients should not be platment three。

evaluate the potential creduability。

ok， thank you very much a little bit different with mutitimm normal acacgood。

yeah， it's true， it's too。

and we don't know if we are doing the things same correctly or not， but the clinical trials will inform us。

ok good morning，对他们。

yes， so hi hi， good morning， uh， professor motors。

uh。

thank you for your a great talk， and uh， i am like to follow hatching by um professonally。

on lma阿tive predtation， there were um a lot of uh uh uh high risk um smile than like my lomal models in past a decade。

so i question is which one is you prefer to use in your practice。

and at the first question and and ok。

and now i should if the patients啊with the hair risis modern meloma， uh uh uh uh would be treated。

oh， which you we， which you kind of reddments you prefer to choose and how many cycles。

真的thank you。

yeah， thank you very much well concerning the first question in my clinic。

the first information i have from every bassion with this modern is the setteration， the settlement compband and perlamm l and populaand infpulation。

this means that first first protion and the tlelem mmmodel and adaddition， we evaluate the settlement of band pmmdel， i compbment and i complained with this plasm ML and m model， and II have a look to the model。

and i combined this five eleelements in prciciple， two， twenty pollul and the potisial， the high high rse population。

what is ans？my perperitm l eleand， the the lologal reglation and i utisse population。

all of are the sirfolfollow inpreis inerare。

othank you and uh， and the better way i wanna now and for high rise， come smallthan than my loma。

deeper's response is better or not for uh for这个benefit of the PFS or OS in piasons。

yeah， so this is a good question。

and impincipal h。

we don't have the information from the clinical study conducted with llearly， the iden examiners because because few patients indeed achieved complete to response。

and outoutcome was very， very， but but definitely with the most modern approaches like KRD transplant KRT。

definitely， the depest was sponsponthe better。

the outcome。

unindeed patients achieved the magdinant activity and maintained。

for at least one year， no bastions have so far proprogress to sysytomatic multiple。

so definitely， it is also concept in a high risce moderning。

thank you。

thank you very much。

thank you。

损海诺professor。

um just now you give us very excellent lecture in a lecture。

you mentioned there is a med DH。

that is the spanish model uemail parasis。

uh， i think concept for us。

this method for us is very new。

uh i think i want。

i think this concepspspcerish del HH clinical practice h。

how did perforforananalysis is very h？。

plus m sale comppartment by flu as i time triree。

i did sesect ct pgrect yeah ah reto to to to prosect ct lelect， the the the pulalafrom of ppological of ltiof siof llltimsisiof， the ltiof mamal。

because。

it translated in low levels over the uninvolved in monoglobalians。

okay， thank you。

my next question is monltial。

right。

uh uh， can you uh uh II uh as you as we know and smoother match my luma？uh do not have high tumor。

look right， direa h。

dara is eliminate eliminated many by the uh biding to the target， right？so at the intensive uh， intensive dara can have better outcome。

uh， can you can you see something about this right？uh， i think。

yeah， your question is based on the three different regimes utilized in the in the clinical study， and in principally， it was planet， because as you mention is moderly and lama usually is with low to more ortder。

and maybe with just this deof， a modemattive schedule would be enough in order to a tischema。

i think that it was was very good to include to include the intensive schedule。

the conventive schedule we are utilize in right now。

and pripriy and reach to intensito schedule as well as the time to promosion to biological。

this is result significantly better for those patients will receive the intensive schedule。

so i think that these conference something that i pretensivescheduyou i think that high reasses moderate my mama is。

closer and close to to definventional convention。

III is is i mai think that is modering。

at high ris is quite similar to multiple my lama。

and in the future， i don't dn't know how how many years time maybe the definition of my lama will be expanded by the incorporation of more highriis more德in my lama。

ok， thank you very much。

ok。

thank you。

呃，召凯魏永强。

呃，maybe的。

he has another thing to do ok。

OK呃，let's move on next next呃，section。

thank you呃，the next next v will will come to doctor王芮达。

首先呃。

see us see us the page managerement of a in the三尔min university cancer center。

孙孙逸仙青年。

嗯，对。

ok嗯。

看斯达稻克，王韦达宁听喵。

平星敏。

那可以的，ok，对。

a good morning professor and more afternoon， uh their child and。

that's a in in neina。

it is a great owner to address such distinguish audiences during the next minutes。

i should put you in the picture about the treatment of marketmrooma in china um focus the past of the present in the future stuarting with the story of person of person fighting against marmartiple marchina during the last decay。

no， no， no嗯。

and then going through a journal of view of some ressuspected that are of our single center。

let's start with a limit case。

恩死安个。

it is a seventies。

uh， it is a thirty seven seven year old women admitted at november， two thousand two， demonstrated a typical sentence and science of limiar with。

anyway is salium gorouering and decrease the arming ed on the silum an forteen。

electron versis。

immunal fiction um eletophoriices and ommarrow asspirit。

the diagnosis of much for my omoma was make next flight。

the parar protewas was GG car ar uring sumone's dating three day， according to the slime um h crab。

great real， it was a symptomatic case and required treatment next night。

没甩。

the first line was a circle of MT， my friend， combined with um prepredenism。

thinly was merely ten years ago in the prepodetiomy here， MT was a federorirangement or multiple momoma。

next right。

sam cell was mobiliafter after momoerapity and harvest by reserve to relax。

for some reason， the maintenance celapty was striommined in two thousand。

and the generation was infinih and peer progression。

she related at two thousand nine night， a little man was priprior， then AA little mind was still on arvival till them。

themself transportation was conductive in consolidation and concrete remission was a hief after that。

next fly。

this is a sunny sunny up of the first two嗯line of salself。

in the front was an in alternative of maintenance cerity。

i ll chemical relaxforfirst。

as three years later and cricriic rerelave at four years later。

the third line was in sher。

resort ding说瘤under this time micersm。

due to once weekly， after tentenn's adadiiration of of lkate continues official myely was available possible next。

a pilel是伐dy in our center indicated。

once weeking succutainers adadminiration， who believe a reasonable response。

if is still the CR rate was about a forty percent， yes， a fifty percent。

next fly。

and without significant pray for real newal passing。

the any grade。

呃，advice event was about。

折迪sex负三也十迪CX负三。

it's very talleral after next night。

after the progresation， the patient was anrows in the vinicle trial， american nine seven o eight。

注缩能而术，激发肿。

我们班应位是在那里头卖，但是这上面是。

the best response was um PR and last seventeen part。

the fifth flline was also a criminal trial。

it is ATNF relative uptoses in using ing igm， combined with。

嗯，说了一段mind， under，这上面是。

in the rondermized blind control design。

might me know so famhere to you guys。

it is about呃，thirty to thirty five percent。

that's right。

to of objective response rate， but in this patient， only last three months with the best response of stable disease neteflight。

i'm tend to two thousand fifteen and patient was about fifteen years old。

we could still try some in。

bridgment see see her could bring her back to CR and to a second chance of themselves， transportation。

so we indolt and uh uh。

维利滴pay。

伊滴滴赔付瑞权。

the efficctes you have to tretreat to two cycles was PR next。

the response was reasonable， but was hard to maintained first time。

the year was was a year。

several noveral agents emerge touches are not mino start。

mino start。

those were unavailable here， but we got female and start in hibbor。

he amme。

we study to wonder whether equal performance well as anominous start， which demonstrated a sennogentic effect will combined with potato and and effect was moderate in this station。

and the most sting was another potential now agent in the year征。

seventeen with a呃response rate， twenty or twenty five percent， when examining in sevil green study。

on in this station， the best response was。

yah n， but last near one year。

心的优图调整a汀。

嗯，咖啡状面was casting ting china aneration tion。

as a heheavily treated RMN pertion， the best response was that much， and the caf fx was out them in seven months。

a interestingtly after refretory to all the other。

多泰心激病的。

咖菲桌面跟的嗯。

today for me emitation ation could feel response well with IR。

基般所需乐奈分别托益思合理。

the best response was TR and last almost one year。

and the mass line was DD thirty eight antiably language for my little my and disamiscessal。

this time， she achieve a long， lost the CR again and was still in remission较thedown。

那些什么？。

为什么？。

ok， i hope i hope show you a picture of evolution treatments of malomma in china。

next， i'd like to take a look and。

呃，身口是六十三可以接的。

we have an analysed seven hundred and five percent during the year two thousand eight。

呃，包真耐汀。

the PFS of m。

pi托o。

凹凸妖。

这说帮护医疗企业。

等一点。

PFS was twenty eight months for new diagnosgy station。

and twenty months for relax relacctation。

不能非常忙。

SY。

your survival was significant in into during the last case。

不耽误。

thirty nine months over five years and young。

三克。

it seems have no effect on in progress。

in the year， two thousand nineteen， sixty percent of new diagnosis meomomication was um were given。

威尔定恩。

请大声收集。

and with a theororiof for be back to them。

还有没有阿洲就。

in the future year by the summarize ed ining file， we have conducted ted and anticiparticipate several were mentioned before in the case report。

注意，那open锁音功能大。

嗯，发球。

sigattle class。

嗯，BCMA卡替CSLP。

brandcome a。

we are still are with building patience。

and in the future， more are waiting for open shes。

乌拜塞CC安排。

next friice。

this bring asked to the angle of the final section。

we still have unmaet needs and unanswer questions， such as when to start a shiatment。

嗯，we have right brognoal proagnostitic to when we that。

and with deill need noble agents overcome rejectiies。

last， my don't ma will eventually relax en the factory。

what do we have do？ and we have。

approaches to current。

i think we have many more questions to open for this。

背疼。

thank you。

thank you all。

嗯，thank you joctor王维达呃，吐司王维达呃。

in the treatment， vava，他mada。

嗯，next we will呃。

今天呃这个。

ok。

first view this second， a round of a panel is cotton。

first嗯，documatters do you have have any comments on this？。

呃，k。

嗯，教师，这会儿嘛teels掉线了，要不您先叫什门头嗯？。

嗯，mattese教授，这会儿掉线了，然后要不您先组织其他的教授讨论。

然后我再问一下，他这边网络是不是OK能上？好嘞？好嘞，那这个刚才这个韦达博士给我们介绍了呃，let's have now we have proprofesa AAA bringssso， let's have a very good casase。

so i'd like to and welcome all the penalysts to raise questions regarding a professor one way does case， and they seem that a very good cases been dropped from the life。

so let's have our domestic expert discussion first。

那个康维啊。

那人那谁先发言，我我先说女生优先，我我我要先发言。

好的，你发发言，感谢王博士给我们带来一个很精彩的病例。

like like for fefecase，获得了一个这个很好的环节，中间还入了几个临床实验。

就是夏教授那边的这个很经典的很精彩的病例哦嗯。

呃，我我想问一下，就是他目前的缓解深度啊，就是用DBD方的话是达到了一个完全缓解是吧？。

因为他既往的话，限速，也就是非常多了。

这个病的话，如果是DPD缓解以后的话，你打算用这个DPD的方案还搞几次。

然后的话后期的话，他这个下一步的这个维持治疗的话，打算是怎么样去搞呢嗯。

回答案。

哈哈哈我我讲一些，然后有有遗漏夏主任。

那个他现在的话DPD是到CR的，但是他其实也不可能再做一次年龄点。

五十多快六十，但关键是他身体跟那个患者的意愿不是特别强。

好像我们没有跟他谈到太多不离职的事情。

然后现在的话p是在出，然后zara的话是。

就逐渐频率延长转文词，因为待会太贵。

所以就是博马度啊，每个月吃，然后dara的话就按让他走维持的这个剂量去走两个月一次。

现在还到一个月的计量，就一个月一次。

就是后面如果就是你为他设计的，将来他的这个这个治疗，因为这个骨髓瘤他这么多次复发呀，就是的确这个我我也还是很担忧，他这个不知道这个方案可以管多久。

对，因为因为脱线了以后，其实呃zara能控制的时间大概也一一左右右至到。

所以他现在其实在线也开始也才半年多。

好的好好，谢谢。

嗯，好，谢谢李欣主任啊，其他专家呢。

赵老师好，哎哎。

那个非常感谢夏老师，今天下午又把我们聚在一起啊，跑到深圳来了。

但是那个呃仍然减不了我们呃在线上跟夏老师在在那个讨论我们这个骨髓瘤的热情，我觉得我也非常那个呃非常非常的惊讶，或者说哦惊奇这个病例简直太精彩了啊，这么多线的那个治疗。

我记得夏老师上次讲过，说有一个那个护长，也是过了那个十几二十几年，三十几年，是不是就是这个病人呢，还是另外一个啊？夏老师就是就是这个都是这个啊。

哇真的是啊真的是那个嗯所以我我觉得我们那个钟总的这个嗯骨髓瘤的这个诊治。

在我们夏老师这个带领下，真的是引领了我们不仅是华南，而且是站在我们全国的这个治疗的这个前列，所以非常非常的那个感谢给我们介绍这样一个经验。

不管到什么时候，虽然他骨髓瘤是始终是不能治愈的，但是我们始终是不放弃，而且我们看到。

就在钟总，你们这个组里还有这么多的clinical trials，可以可以加入啊，真的是那个充满了那个希望，我就想问问韦达。

就在我们现在的这个imnal erery就像我们今天那个matials他教授讲的这样一个时代。

那么在你初始治疗的时候，如果病人经济条件允许的话，你是给他传统的VRP三药联合呢，还是在基础上加上一个单抗或者其他什么药联合的初始的治疗呢？你你如果是或不是你自己的评论，是怎样的伟答，谢谢。

嗯，好的。

我我个人是。

其实我们在临床操作当中也易VR力。

其实也有个别患者上一线主要的因素，还是考虑到他的复发风险，考虑到他的分层以及患者的意愿情况。

然后之前我们还有一线那个私药联合的临床协科，现在也是没有在开展，所以。

选择的话，还是按照自己来选择比较多。

一。

嗯，听得特别清楚。

还有什么问题嗯？。

嗯，其实其实我我我我个人觉得DD倍RD的话，它最大的好处就是它缓缓解来特特快快，而且缓解深度是显著优于传统的三药法，但是可能还是需要对它的不良反应进行一些微调。

比如说。

感染风险，还有主要还是感染风险。

所以的话还有这个肿瘤溶解的风险。

可能会需要对这几个药的，特别是贝阿利的剂量进行一个调整。

如果患者是一个老年耐受性差的患者的话。

夏主任。

哎，听到听到你说那个就我看那谁那个回答已经回答完了，我就继续问提问题吧。

不好意思啊，刚刚要主持一个死亡讨论，我就前面那半天都没在维维达这个讲座，我也只听后面一点点才才结束了，我就想那个。

那因为没听到吧，我想还是就问夏主任一个问题吧，就结合刚刚那个我们那个呃这个麦斯教授的讲座，还有这个赛维达这个病例。

我想问问，就像这这种冒烟性骨髓瘤的话，相当于我们把一个这个股石流提早治疗了。

那提早治疗之后呢，是不是可以提早结束维持治疗的话，是不时间是不是可以缩短，这是第一个。

第二个，如果是用这个伯马的维持的话，结合维达这个病例，伯马的维持剂量是什么样的剂量才合适？因为我们只用过治治疗剂量，没试过这个维思治疗。

呃，因为他那个公司他给的现在有当时有那个小剂量的，我们也没买过，就是这方面有经验，没有，就为这两个问题，谢谢夏主任。

好的嗯嗯，韦达，你先说。

第第一个问题，好像我记得刚才是不是李鑫教授问过嘛？ook就是好像他的意思就是在临床实验的设定里，他的那个model in的呃干预时间还是有限的。

然后大概是两年半到。

不知道李鑫教授，刚才因为我我刚才在忙着对台词。

辛苦了啊，维达你呃，是的，就是因为他说了他他他这个还是搞的一个fixed。

这个周期没有像我们这个呃active的这个这个骨髓瘤，他需要这个长期的一个维持。

嗯，然后他固定周期没有维持治疗了。

嗯，所以他是固定周期不算一个这个很那个的。

但是他往后走的话，他也会把他拉稀一点。

其实也有点像我们平时的这个维持的一个做法啊，哦哦所以他是考虑到这个第一个也是要延缓他的进展。

第二个还是要让这个病人的话，他本来他不一定会进展的。

然后你也不能够让他不停的去接受一个药物的治疗，还要保证他的一个生活质量。

他应该主要是这么考虑的。

嗯，然好好，谢谢李大师。

伯马顿啊，是维持这一块，到底应该怎么走，我也很困惑。

嗯，所以这个是不是要长期再吃下去？我们有一些反难子复发的，后面伯马顿啊有效了以后，他为是我最近有几个。

八期以后的后面就是在把它知道的比较深度的环节以后，我就用伯马多胺在走维持。

所以关于这个伯马多胺到底要维持多久？现在已经到了CR的一个状况MRD呢，我就觉得我们国内的话还没有来一家就是MRD做的特别好的这个地方啊，所以就是伯马端的话到底怎么走？维持我目前是给的病人三毫克已经吃了一年了，所以我也不清楚到底要走多久。

所的确这一个很开放的一个问题。

我觉得因为呃之前我们所集累经验，你比如说莱拉端的维持，沙六端的维持，呃，这个不用做，维持不做就博马端。

因为在国外，他是一家公司跟兰拉端一家公司的，所以他没做过相关的研究的，维持了根本就没有数据的。

所以我觉得可以借鉴向莱纳端的维持治疗。

就说如果这患者假如说毒性并不是很大，呃，患者可以耐受。

我觉得从治疗策略来讲的话，伯马端可以考虑你们说进行一个比较长时间维持的像莱拉端，我们认为至少长时间维持。

如果这患者没有疾病，进到到两年，真正停药吗？我肯定不会停药的。

所以我我我自己在临床过程里，我想啊如果伯马端的维持，如果疾病没有进展，毒性能耐受，我会给他进行比较长时间的维持，这是我们一毫克还是三毫克维持好一点。

嗯。

从维思上讲来讲呢，我可能降适当降低一定剂量。

你比如说来那端，他用二十毫克治疗剂量，他降到十毫克，那我来那端，我从四毫克降到三毫克，我觉得应该问题不大。

耐受性看耐受性情况，如果耐受性差，可以再降也可以这样，那没问题。

你经你比如说二十五降到十毫克，我把莱纳端这个有四毫克降两毫克，我觉得肯定没问题。

但是问题是你性价比来讲的话，你毫毫克那那端还不如四毫隔隔吃吃给药药来来那端。

其实我在临床上维治疗用的最多的是二十号隔天吃，这给患者可以省钱嘛。

因为他治疗不是一两天的问题，他是很长时间，你要跟从患者角度来讲的话，你尽量给他省钱。

所以其实莱那端我个人用的最多的是二十五毫克，隔天药药平均一天十二点五毫克，我觉得疗效这个也是能肯定的，毒性也是可以接受的。

好，谢谢夏主任哎哎。

好。

好，其他专家还有问题吗？。

哎，夏生任哎，先生好，先生是这样的哈，这个病人真是非常好。

这个病例啊，我感觉我感觉就是说话很大，这个病例中间呢治疗了非常非常多的线索啊，而且各个方案都用了。

哎，先生，这这个病例，因为我一开始没太注意他这个核型啊，包括那风险评估他评估了嘛。

就是那个哎哎哎好哎，王教授，因为他那个一线的时候治疗的那时候都没有这些东西，所以后后来也是没有治料。

后后的的话，印印象中问在在某一某几次复复是有做过有个EQ二十一的扩征，没有把它列出去。

但是再往后，他其实他因为散入临床实验比较多嘛，所以其实多了多做了几次。

再往后他这个也会消失的，他那个感q发个问他会他会消失，他会漂移，他也会改变，不知道是因为敏感性的问题。

这个人我想啊如果这么多年哈嗯这么多年，如果说把这个里边这个克隆演变这个过程也如果能把它列出来，那非常非常好了。

对对，之前是有这篇文章发表。

对对，如果这个今年这个学是因为我们没有那么前沿的去对这个这个也是一个标本留下对每一个每一个节点是吧？每个节点它那个基因分型啊，这个什么能测出来，它这个演变过程可以看出来啊。

嗯，非常好，非常好嗯，哎，这是意思。

哎，好。

还还有一个问题啊，请教你一下啊。

第二个问题就是这个病人，我看的一四年，它是呃一四年的第四线卡治疗费用了一个。

呃，卓米加一个雷那度胺是吧？呃，还有低塞米松，后来一九年也用这个方案，啥，第四项也用这个方案。

对，去年那个维持了一年半，呃，一九年就维持了两年左右了，接近一年。

对，他后边还维就长了，这是这是为什么？。

对我就觉得这显示我觉得很有趣的这个因素。

这个患者他他在所有的PI当中，他其实呃盆替卓瘤有效过。

但后来后来的话是进展，然后卡菲卓米他效果就就欠佳。

但是他对伊沙佐米的反应是是比较的好的。

他之前嗯那个一四年的实验那个MN九七零八是应该在宗教授那边。

开始么了。

那时候就已经维持的比较长十七个月，然后等到一八年再复发的时候，我们想了想这个版给拿出来了，结果还有效。

而且中间其实有几次他的这个情况是比较差的。

包括就我们当时在在用VDD配ase和那个其他美，就其达本癌的时候，他其实状态是很是比较差的。

但是经过这个IRD的这一段治疗，虽然是只有效的，但是他的整个情况能够好转，后面他又能够再能够有机会再接受这个dara等等。

他整个生活质量是有大大。

所以有点奇怪。

虽虽然说他们这几代的PI似乎没有太大的差别，但是。

偶尔也能看到有一些患者，你作为其中的某一个选择性的。

没有了这样。

你了解到他的背后的原因。

好好，我这边就就到这里，谢谢谢谢。

好的。

看其他专家还有问题吗？。

OK呃，如果其他专家没有问题的话，我想我们今天下午这个议议就差不多该结束了。

这个呃本来这个总结呢，应该用英文的。

既然这个mattal教师不在的话，咱们就不必要了，就可以。

中文简单总结一下吧。

呃非常感谢呃这个。

这个matter教授给我们做的很好的有关高危贸易性骨髓瘤的一个治疗相关进展。

大家看到其实对于贸易性骨髓瘤呢，高危制毒患者还是采用积极治疗的模式。

其实我当时很想问这个问题，因为时间的确很紧张，大家都问了很多问题。

你比如说。

他刚才提到的用r用单药的治疗可以，那是病人PF的改善RD治疗也获益了。

他有什么accent研究，还有其他的一些更强强研究究加钙钙胰植植。

那么他的目的呢，是从治愈角度来究嗯都冒炎性骨髓瘤，他认为是个骨髓早期病变。

那早期病变我们认为那早期的这个癌症我可以治愈的。

那么其实我真正想问他的问题，说对他来讲的话，对于冒性性骨髓的高患患究竟是个治愈愈角度考虑呢？还是说还是要按照骨髓的角度考虑，我们是个不可治。

治愈性疾病延长患者PFS其实我很想问他这个问题，因为时间问题，这个可能现在漫通神经不在线上了，其实我觉得对高危冒炎性骨髓瘤亡，现在看来治疗是越来越积极了。

呃，原来RD肝药r现在什么这个呃KRD什么DRDDKD等等都在做相关的研究。

的确是这部患者生存呢是得到明显改善的。

所以非常感谢这个metal教授，还有。

我们维达博士。

呃，就我们国内的呃多方性骨质疗性现状，尤其他分享这个病例。

这个因为这个病例是我们自己医院的一个护士，所以他呢这个联系跟我们联系比较密切，所以他没有每次有心药研究，他都第一次能参加性药研究。

所以你看他二十多年来，他当时得病的时候，我记得是三十六岁，现在他也这个患者已经退休了，这个折腾差不多二十年了。

我觉得到目前为止，哎，他生活质量还是蛮高的，他一直在上班的。

所以我觉得从这个角度来看的话，我们咱们作为临床医生还是有点成就感的。

你看我他二十年我都让他能能能够能工作到退休，那挺不容易的。

所以呃也非常感谢啊各位专家同道，大家都是老朋友就有关。

今天我们主要关注的话题吧，呃高危的冒炎性骨髓瘤的治疗策略选择。

呃，还有呢就是咱们国内的一些相关的经验吧，呃给大家。

做的分享，非常感谢各位，好吧。

因为可能马特教授他他们早什么，估计他要工作，所以呢可能最后就本来我想呃请他做一个叫做。

这个呃这个closing remark，那看来呃就不需要了，那么我们就自己用中文做个remark就可以了。

好吧，谢谢各位。

好，谢谢谢谢啊，谢谢谢谢。

啊，再见，夏老师。