2023年长城血液论坛主会场

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uh，

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probably you do the young age。

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on the other hand，

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uh recrecall suteinlizes of the mmd h。

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the only only mejneactivevely are ly norst previous terms up and find。

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now i'll go to response se treatment。

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you can see that bld argiments，

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where were ite piasble and泰t fair outcomes still in the i arly argument before。

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uh。

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jure a fundry send them three，

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three years or sixty，

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six flowing two percent。

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and the significance was seeen uh in HH ethink，

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very good part generation and economy，

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removing three birds，

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ten，

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two point seven，

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seven，

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perth，

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right memeanthe overall respond rate。

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including calification between response，

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more than about eight percent immal。

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curing in the same day are joining at excepssiment leads to better outcome，

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especially reaching more comly responded。

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and very good parks of respondance。

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regarding the proversion three survival um PFS to PFS seven FSS mili at at patience，

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where at their first thirthird。

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and then we memedip PFS twenty three monmonmons even better than than the in the twenty twenty twenty six months。

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and also，

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we see uh that patients in by二力graditor overall survival，

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the medions where seven six point，

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six six month and in patients uthere first milary，

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the medium overall survival uh overall survimons。

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if we looked at the other groups，

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you can see that in majority of the prespecified groups。

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uh，

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the additional exeneficial a good life，

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just stress。

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a few of these groups。

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one of them are patients each over their patient，

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but also did benefit，

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but the benefit of younenefit as in young deervations。

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on the other hand，

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we saw the best benefit innovation through within their first and second line of treatment。

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but extra regular ary园prespresent extra员斯拉鲁胺。

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uh，

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both negative progranolotic factor and adtitience did not that at all from your treatment。

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unlike una。

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i fght uh，

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i just uh i show you some of the differently。

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so uh。

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move from the of my the monind drive from from organzzes previous ous sencstance did not come come my the outtimes for the i idegenererman。

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and in our noy，

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cied，

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patients were treated，

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IRE had better outcome regardless of clear than such than such。

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but would did not benefit that all the diation reject trlular release and their outcomes uh，

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by cor symbol corlers。

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regarding the adverse events，

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you can see that the sttribution is quite similar across the lines。

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uh here is just easier good continuthis uh there sisimilary of benefty even move。

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materiity tical great green entire，

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adversity effeincluincluding a political CCD。

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but there was no significficsigficdifference with ving been the difference，

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ence eeopinia among the arms。

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in the other legigiman，

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there was significant in more infections，

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but infection very free entitier uh similar inmove arms。

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the IR agagement also has slitly more breakken new eberty，

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but europety rate ray and higher was recorded in prepatience only。

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and most of the cases that already president new previs between men order eemind。

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the area year have also seeking king canaddate more prequent in the early arm at only volunitation。

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great free your higher that yeyear。

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so do some it all up to confirt of IRD over RD remmrereding proprogression al resul t the ref s transforforthe benefit in the real compupulato，

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the resusullto even susect even exceeded。

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before the eduficacy of hir d even in adadvcpage，

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meaning and third d higher realizes。

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and i like the original turn line and rdiile be found better effect in the first real than in following realities。

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patients who livented it more。

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who had the most beneficial results of our patient ent ge undunder seventy five years。

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we alarn at the ge and not not the factory at the previous aliline。

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previous sensor transflanant，

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our analysis did not deteriorate the outcome of i idethe ggleman。

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however，

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the itient did the presence for extra new，

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where easy did not enefit from additional ecdeomment。

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thank you for attention。

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i would like to thank to take a that phone m for the basation program vehicle time，

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chocurity to managers for tiny and acsure the record of day down the the of the teties。

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we also banked to all likeity doctors involved into treatment of titience ts monooorities。

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and of course，

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small banks are to our dition of eearlier who do our hands。

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and i would like for a chilroute to thank you all for real attention。

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thank you。

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哦，

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感谢我们杰克的教授精彩的演讲，

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下面进入，

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因为是有其他。

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那么可能这杰克现在是早上早上时间。

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因为我们就是。

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讨论嘉宾进行讨论，

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是大家都非常熟悉了我们三位国内著名的专家。

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第一位是我们新疆医科大学第一附属医院江宁教授。

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像这种大家非常熟悉的。

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姜老师，

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您先来。

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首先，

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谢谢明教授和安刚的主席主持。

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首先呢我特别祝贺，

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陈明教授，

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这个今天主持这个会议，

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他们因为这次成决会非常大，

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所以最近大家都出来，

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那么尤其新的选举祝贺。

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也感谢高峰教授，

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张罗很多这个这个去实很多人，

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非常羡慕。

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今天特殊原因，

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我就献场，

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那么就这个话题嗯。

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其实艾尔也就是伊沙唑米联合拉多胺加这个伊塞米松，

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我们已经做了非常多的一些临床。

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这世践也好，

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前期研究之后的研究临床自己的一些感受。

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特别我知道在陈明教授，

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我们中国我们自己的MM五MM六的治疗也是取得了非常不错的一个对难症复发的疗效。

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杰克的这个这个教授基尼教授，

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杰瑞巴这个教授呢应该说他们非常大众的一个病例，

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一个多重型的，

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在中欧的这么一个结果，

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我觉得是更加的证明了，

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应该是在嗯没有随便侵犯的情况下，

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即使接受了自己造血肝活移植，

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在后线的三线四线治疗用IRD仍然受益。

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那么这一点确实是让我们觉得也也是非常的非的的这个。

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这个不容易，

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这个这个结果我觉得能够取得这个结果。

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因为他家比的虽然是IRD吧，

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比的是RD是吧，

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比的是这个南方和那个，

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但他这个病例虽然说但他不是后象，

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那些都是一些被迫的。

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总之，

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他虽然年轻一些病，

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我感感觉伊沙米米在南复发，

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我想随外复发。

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总之外他虽是相对年轻的患者，

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小于75岁，

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他说是那么这个年龄之下呢都可以受益的。

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因此呢当然这里边呢他是实还有一些很多的这个细节，

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就是这个选择的细节。

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当然我个人认为伊沙唑泌，

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应该说作为难治复发，

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尤其是在MRD或者深化复发这个阶段早点用上去，

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我自己的感受也是这样。

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我想教授你们有很多，

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我们你之后和包括二线的病线，

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那些都是可以有效。

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在这点上呢，

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当然有耐心，

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至少得做一个疗法艾肠治道问题。

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因此说我个人觉得在难治复发的多发性骨血瘤，

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我们也不要太急于上一旦复发，

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就就就给他各种性药，

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各种猛攻作这种因为这个病他是慢性病，

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所以我经常我也在我们采访里说，

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我们说先耐心一点，

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先用用看，

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尤其是他并没有随便复发，

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他并就是病是治鼻之后，

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那我们治理几个疗，

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1~2个疗疗三疗看一看。

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我认为他是多数病人会受益，

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如果能继续受益，

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我们就往后推推延，

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等到他不受益，

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我们再来用其他的方法，

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就像前面教授说的更高更低，

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还有他的危险度分层也根据具体情况来来来来看特别高危的病人呢，

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当然我们早点去用是吧？所以对那种相对不是特别高危的，

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中低危的，

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或者说这个没有太危险度打击这样的一些病人，

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我认为以上作弊仍然是有非常好的，

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很难的说法利疗，

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我我就讲这么多梅教授，

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谢谢阿谢李教育非常好的一个分享，

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其实我是觉得。

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这个药如果用的好，

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一定你有很大的帮助。

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那么在我们中心呢，

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刚才看到今天看到的，

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我们刚才结合教授讲到很大的一个重要的反应是腹泻。

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的确，

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当我们尽量在试毫克的时候，

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的确有很多病毒性性腹泻，

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我们常心可能比较保守一点。

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我们中心是全国用2.3mg用的最多的中心。

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那么但是二级仓库这个可能病人的腹泻明显会下降，

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这也是我们一些经验的体验，

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那么非常好，

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感谢我们教内教授还有一个也是大家非常熟悉的我们车内教医车内教授。

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同济同济院的博导主任医师教授，

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但是他熟悉的村委。

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咦，

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没声音呢？

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优水，

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那行嗯嗯。

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米老师，

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我我在现场。

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好好好，

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谢谢谢谢谢谢谢我我们米老师的这个介绍，

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也感谢我们陈明主任，

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还有们高高老师师对我的这个邀请学习了非常多的支持。

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那么我才我们这个讲座，

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其实我是非常赞同我们江明教授的这样一个观点，

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包括我们刚才那个教授讲的也都说的非常好。

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这个因为这个纯口服的这样一个方案，

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尤其在在前段时间疫情期间，

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这个方案发挥了很大的作用。

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我觉得不管是伊沙卓泌还是这个兰拉多。

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我们在用下来有这个这个世界这样一个数据支持，

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还有临床研究的数据支持，

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使我们在个病人这个谈话的时候，

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我们都底气非常的足。

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因为最早的时候，

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其实我们还在想这个硼替治接换成这个这个伊沙卓敏行不行？后来他也有一系列的研究来证实是可以的。

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所以这一块的话，

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除了就像我们刚才我们江老师也说了一些亚型，

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像他说到的这个水外的患者，

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可能对于这样的患者可能还在一些别的帮。

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办法可能这个方案还是有点差，

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但是我们也用下来有有这种恶性呕吐的这个消化道反应有，

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但是不多。

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所以一般病人来了之后，

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我就让他第一天住院，

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在医院就是吃着药观察1~2天没事了，

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那就出院带药问，

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因为我们的病人很麻烦，

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就是有很多不是武汉市，

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他不能双通道，

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他要在医院内拿药才能报销。

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所以说一般我们观察一下，

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没有啥事就让他带回去吃了。

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所以很多患者从这些方案当中都受益了，

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所以咱们们于刚刚复发的，

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也可以考虑先用这样一个口服的方案。

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因为毕竟CMI什么的抓的非常的紧。

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好，

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我就说这么多，

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谢谢。

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好，

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谢谢，

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谢谢陈明教授。

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那么第三位是大家非常熟悉的我们的。

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换一下哎，

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杨平哲说，

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杨欣哲现在是。

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福建医科大学附属医院学科的主任。

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那么其实我们对他互相了解，

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就在医究方面非常有经验。

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好，

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杨军教授。

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非常感谢尼金天教授的介绍，

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现上常建也是非常激动高兴。

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然后同样呢，

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我也非常高兴，

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也加入我们这个第二届招股会议的这个大家庭。

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然后热立祝贺，

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因为陈明教授主任委员高文教授，

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这个秘书长，

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然后也也是综合我们的这个招委会谈。

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那今天这个会议呢，

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就是听下来真的是内容非常丰富，

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也非常高大上。

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那刚才我们这个专家呢给我们带来的这个ID的，

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特别是真实世界的数据，

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我觉得更有说服力。

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因为他的讲座当中也提到了临床研究，

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我们可能会有一些顾虑，

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特别是挑选的优质的人群。

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那但是我们在临床当中可能面临的必难呢是千变万化的。

00:15:24 - 00:15:27

那那么他拿出了一个真实世界的数据呢，

00:15:27 - 00:15:30

就对我们来说是更有帮助的。

00:15:30 - 00:15:35

在在临床当中的指导意义更更加的这个强大了。

00:15:35 - 00:15:35

那那我。

00:15:36 - 00:15:37

就简单说这么多，

00:15:37 - 00:15:39

为前面嘉宁教授车委教授的点，

00:15:39 - 00:15:41

那我也收获很多哈，

00:15:41 - 00:15:42

谢谢谢谢。

00:15:42 - 00:15:42

好，

00:15:43 - 00:15:44

谢谢，

00:15:44 - 00:15:48

非常感谢我们杨平教授精彩的点评。

00:15:48 - 00:15:52

那么我也再次感谢我们陈明教授组织这样的活动，

00:15:52 - 00:15:54

每年都是这样一个非常好，

00:15:54 - 00:15:57

下次次我们能够聚集在北京。

00:15:57 - 00:15:59

那么同时热热祝贺贺们，

00:15:59 - 00:16:05

陈陈明教授再次获得协会的主任委员以及高文主任的秘书长。

00:16:05 - 00:16:06

好，

00:16:06 - 00:16:08

那么我们下面呢进入下一个环节，

00:16:08 - 00:16:16

我把主持交给我们山西白球医院的马良宁教授和浙大医院的同务院教授，

00:16:16 - 00:16:17

两位教授请。

00:16:25 - 00:16:26

马这特督建。

00:16:45 - 00:16:47

能听见吗？李教授可以了，

00:16:47 - 00:16:48

现在可以。

00:16:58 - 00:16:59

能听见吗？

00:17:00 - 00:17:01

可以听见，

00:17:01 - 00:17:02

马上准备开始。

00:17:02 - 00:17:03

哦。

00:17:03 - 00:17:03

好好，

00:17:03 - 00:17:04

那童主任，

00:17:04 - 00:17:06

我先开始了童主任。

00:17:06 - 00:17:09

首先感谢倪教授的介绍，

00:17:09 - 00:17:13

也感谢陈诺斌教授和高隆教授的邀请，

00:17:13 - 00:17:16

能够参加这个第二届长征血液论坛，

00:17:16 - 00:17:20

那个也祝贺陈诺明教授的连任主任员。

00:17:21 - 00:17:26

前面内容呢我看见的都是关于骨髓瘤和淋巴瘤方面的，

00:17:26 - 00:17:32

接下来我们这个讲座呢是关于骨髓结育化这个。

00:17:32 - 00:17:40

这个来自英国和伦敦的著名的学习专家的莱尔fashian，

00:17:40 - 00:17:43

这个教授给我们讲解，

00:17:44 - 00:17:50

关于骨髓纤维化的科体化治疗计划和最优的这么一个治疗，

00:17:50 - 00:17:53

下个教授大肯肯定是很知名，

00:17:53 - 00:17:58

这的重点是在于卢克替尼的骨髓纤维化当中应用，

00:17:58 - 00:18:00

做了很多的大量的工作，

00:18:01 - 00:18:05

以及呢在进展性多巴恩组织病个这个维奈克拉，

00:18:05 - 00:18:08

联合这个卢克替尼的治疗，

00:18:08 - 00:18:09

他发表了很多的这个研究，

00:18:10 - 00:18:14

下面我们有请科尔艾森教授，

00:18:14 - 00:18:15

有请。

00:18:18 - 00:18:20

thank you for you're chaning to see at the seen mentology day，

00:18:20 - 00:18:23

my name slares s worat london。

00:18:23 - 00:18:29

and it's my presure and privilege to give you the store concerning individualizing treatment plans are not termissing outcomes。

00:18:29 - 00:18:32

our patients with mallofabbriis。

00:18:33 - 00:18:36

this is my conflictive interest disclose a side。

00:18:39 - 00:18:43

now i think that this lide，

00:18:43 - 00:18:49

which basically suggest that we should be personalizing therapy an ongoing fasfashion，

00:18:49 - 00:18:52

keep about red ratification。

00:18:53 - 00:18:58

starting a treatment evaluating response considering disease progression。

00:18:58 - 00:19:02

this applies to all of them millibelieved to the dozen。

00:19:02 - 00:19:03

and indeed，

00:19:03 - 00:19:05

the vast majority of medical therapies，

00:19:05 - 00:19:05

of course，

00:19:05 - 00:19:14

four malifiy brses patients seare us some concepts that i consider when i treat them when i talk about the diagnosis。

00:19:15 - 00:19:16

how to frame it，

00:19:16 - 00:19:19

which means do i use the word cancer。

00:19:19 - 00:19:23

i definitely do for this condition underdeed for all empim。

00:19:24 - 00:19:26

i tried to provide the patient with accurate，

00:19:26 - 00:19:30

verbal and written information guiding about the use of the internet。

00:19:30 - 00:19:36

and i will connect the patient with patient advocacy also tried to cover freququenilth questions。

00:19:37 - 00:19:40

such as diet inheritance pregnancy，

00:19:40 - 00:19:43

travel and symptoms in signs to watch chereful。

00:19:44 - 00:19:46

i also try to mention symptoms，

00:19:46 - 00:19:51

which we know are common in our patients with malphfibruary system。

00:19:51 - 00:19:52

such as says，

00:19:52 - 00:19:53

highlighted in yellow，

00:19:54 - 00:19:55

a teee abdominal discuunfort，

00:19:55 - 00:20:01

we would recognise as being more preprevalent with mdify brazes patients and others，

00:20:01 - 00:20:04

such as pririiters more in keeping with PV。

00:20:04 - 00:20:06

but if you look at the landmark study，

00:20:06 - 00:20:10

you can see that actually there's a particular pattern that ands out。

00:20:10 - 00:20:11

an individual disease，

00:20:11 - 00:20:26

and that symptoms are very common with those patients were the ninepercent experiexpericing symptoms in the previous twelve months in this and up these symptoms do have an impact on a patient state today lilife from their ability to work。

00:20:27 - 00:20:29

as well as enjoy a family live。

00:20:30 - 00:20:31

in the same study，

00:20:31 - 00:20:42

you can see here for one hundred and seventy four patients with mallifiy braces out of a total of just under seven hundred patients that a fifth patients had reduced hours at work。

00:20:43 - 00:20:47

untiten percent had either taken early retirement gone on disability，

00:20:47 - 00:20:51

living allowance or voluntarily stopped working。

00:20:52 - 00:21:00

this demonstrates the wider impact of this condition on a patient and importance of trying to address the issues in all centre。

00:21:00 - 00:21:05

we use the MPM ten school or a difficult verof of it，

00:21:05 - 00:21:07

are to assess our patients。

00:21:08 - 00:21:12

it's a validated tool and esspecially uneaszy to use。

00:21:13 - 00:21:14

is easase ful for patient education。

00:21:14 - 00:21:20

and i find out that actually it speats up marther consultations in the UK。

00:21:20 - 00:21:25

there is an online tracker that developthink clubtion with patient advocacy，

00:21:25 - 00:21:27

susugestition information atter。

00:21:28 - 00:21:29

so i'm important pointas，

00:21:29 - 00:21:31

if you are using。

00:21:32 - 00:21:36

AMPM symptom truacker patients are internally consistent，

00:21:36 - 00:21:37

but between patients，

00:21:37 - 00:21:38

say，

00:21:38 - 00:21:39

maaby variability。

00:21:39 - 00:21:43

so it would be important to understand the story behind the school。

00:21:44 - 00:21:45

a data from ruden mther，

00:21:45 - 00:21:48

who is of calused to at the field in this setting，

00:21:48 - 00:21:56

suggest a total symptoms score of of twenty or individual symptoms scoring five out of ten or more may need intervention。

00:21:56 - 00:21:57

but again，

00:21:57 - 00:21:58

this is rary individual。

00:21:59 - 00:22:02

so when we then think about the burden of diseason goals of management，

00:22:02 - 00:22:07

we can think i've shown hear about the very medical aspects of managing mallifiy brosis。

00:22:08 - 00:22:14

we also have to put it in the round of the whole patient thinking about emotional family，

00:22:14 - 00:22:17

relational producvity and economic impacts。

00:22:18 - 00:22:23

so many of more medical thouts about managing and individualizing our managements of malphpha brerues。

00:22:23 - 00:22:28

this light is taken from the european and lekemia antt guidelines，

00:22:28 - 00:22:32

but equally is very similar to those from the NCCN。

00:22:34 - 00:22:35

adforcatits obviously，

00:22:35 - 00:22:40

ly important to determine an accurate proagnosis and accurate diagnoses。

00:22:40 - 00:22:41

you know，

00:22:41 - 00:22:48

to do that for some patiency much tuestic extended genetics for all patits would be measuuring symptoms，

00:22:48 - 00:22:59

and then deciding where on the spectrum of low or intermedia or high risk that they lie for all ththaatiutic on prognostic。

00:22:59 - 00:23:04

schools include this one that amid seventy which tended diversion two，

00:23:04 - 00:23:05

there's amid seventy plus，

00:23:05 - 00:23:07

which include such genetics。

00:23:08 - 00:23:13

this includes for the first time by marified braces is grade，

00:23:13 - 00:23:22

and also acknowledges y impact of genomomic screening with a tackle of four schools being available form allecular profile of if we take a look at this figure，

00:23:22 - 00:23:26

which came from the original paper for the miid seventy school。

00:23:26 - 00:23:33

you can see that for patient's original IPS score as indicated by the colors。

00:23:33 - 00:23:38

that there were some patients who had low or immediate one ririk disease，

00:23:38 - 00:23:43

he would have been reclassified as high risk disease using a limit seventy。

00:23:43 - 00:23:45

so thinking about using this，

00:23:45 - 00:23:46

your halilifiy rsis patients，

00:23:46 - 00:23:51

you are age less than seventy a really may help used in the context of transplantation。

00:23:51 - 00:23:51

hence，

00:23:51 - 00:23:56

the age lesson sevenseventy may help you to refind from gnosses a little more。

00:23:56 - 00:23:59

what happens in the real world。

00:23:59 - 00:23:59

well，

00:23:59 - 00:24:02

and here is some data from the united states，

00:24:02 - 00:24:03

but actually than similar ata。

00:24:03 - 00:24:06

a recently published earfrom，

00:24:06 - 00:24:06

the UK。

00:24:06 - 00:24:11

this is data from sege of stop states in just under hundred hundred patienty。

00:24:12 - 00:24:18

recorded that a third in received risk sattemizzation had diagoniszed noses undof。

00:24:18 - 00:24:24

those who did it was based on clinical judgment without the use of a formal reratification system in fifty percent。

00:24:24 - 00:24:26

and that this restrustification，

00:24:26 - 00:24:29

which was designed by the physician，

00:24:29 - 00:24:32

was frequently wrong and often underesstraated。

00:24:33 - 00:24:45

now one of the main reasons for thinking about restrustification other them having conversation about proposals with the patients is to determine whether patients should have alalalute an allogenate stem cell transplant。

00:24:45 - 00:24:48

i'm innocent to meet you。

00:24:48 - 00:24:54

still the EBMT earland IWG cricrevvto later year。

00:24:54 - 00:25:05

so any patients with immediately or risk disease and age lesons and seventy are consideers potential candidates on those with low risk disease school，

00:25:05 - 00:25:07

if they have particularly high risk features，

00:25:07 - 00:25:11

such as refracerory transtusion dededent dent anemia，

00:25:11 - 00:25:13

increased circulating gass at center。

00:25:13 - 00:25:18

sometimes i'm will expeact with a molecular risk classification，

00:25:18 - 00:25:20

putting an intermedia on tips。

00:25:21 - 00:25:21

plus，

00:25:21 - 00:25:22

for example，

00:25:22 - 00:25:24

patients are are higher risk。

00:25:24 - 00:25:27

whether i would then take a patient to transplant younwers。

00:25:27 - 00:25:28

generally，

00:25:28 - 00:25:31

i would wait for more clinically relevant。

00:25:31 - 00:25:33

risk factors such as transfuient dependence to occur。

00:25:35 - 00:25:38

transsplantation is not the main subjected today's talk。

00:25:38 - 00:25:40

it could be a whole talk on its own，

00:25:40 - 00:25:43

but fact is affecting successful outcome。

00:25:43 - 00:25:47

after allegenates thecells transplant a very complicated。

00:25:47 - 00:25:53

and these patients wpped sent a very challenging greed to our colicies in the translant set。

00:25:54 - 00:25:58

this is certainly in area where improevece in our medical care of practice。

00:25:59 - 00:26:00

in the last decade，

00:26:00 - 00:26:08

we have uncovered the benefits of targeted therapy with jack volunteer inhibition using rots a little neelbourn。

00:26:08 - 00:26:09

recently，

00:26:09 - 00:26:12

we've been exploring other jack inhibiors。

00:26:12 - 00:26:16

these images come from one of high patients in the comfort，

00:26:16 - 00:26:16

too，

00:26:16 - 00:26:17

as studdy，

00:26:17 - 00:26:19

which was under the registrational trials。

00:26:19 - 00:26:22

you can see the benefits or sleam reduction。

00:26:22 - 00:26:25

a quote relating to quality of life。

00:26:26 - 00:26:34

and you can also see some hint to side effects here with significant weight game at the seventy two weekpark from my patient。

00:26:37 - 00:26:42

now this patient lived always a decade of the stoorsing rocks listening。

00:26:42 - 00:26:44

and as we did a lunmark analysis，

00:26:44 - 00:26:48

combining the two comfort studies，

00:26:48 - 00:26:55

we noted that the risk of death was reduced by thirty percent with the genval survival for luxias and tretitiaans。

00:26:55 - 00:26:57

affect three years years three。

00:26:57 - 00:26:59

we we take years for control。

00:26:59 - 00:27:02

this is despite gross savor of the control group，

00:27:02 - 00:27:06

raising the question about whether earlier treatment with roks litten，

00:27:06 - 00:27:08

it might be more beneficial all patients，

00:27:08 - 00:27:11

and we will return to this scene later。

00:27:13 - 00:27:14

in the post decade。

00:27:15 - 00:27:21

emerging evidence suggests that there have also been improvements envable survival，

00:27:21 - 00:27:25

which enhances the data from the comfort studies。

00:27:25 - 00:27:35

and here you can see an analysis performed on always fourteen hundred patients with mliphabsis treets that emty anderson cancas center between nineteen ninety，

00:27:35 - 00:27:39

five and twenty when roforteen the the time when rock sorelation，

00:27:39 - 00:27:40

it was used。

00:27:41 - 00:27:48

and you can see that focolationary therapy the the decade。

00:27:48 - 00:27:52

with rocsolution of therapy was associty ated with survival benefit。

00:27:52 - 00:27:53

and in the time，

00:27:53 - 00:27:54

after twenty ten，

00:27:54 - 00:27:57

those patients who were treated with rock solution。

00:27:57 - 00:28:00

it also had a survival enhancement，

00:28:00 - 00:28:03

as represented by the coloured red capitin me blood。

00:28:06 - 00:28:10

in a european registry cycled earnest alcoo alto，

00:28:10 - 00:28:15

a patients treated with hardrok sera were pretensity school matched。

00:28:16 - 00:28:27

i'm shared to superior survival that come from luxlutiononate socicidrops syria treatment until the media avval survival was seven point seven years with roxlitionent tretreated patients。

00:28:27 - 00:28:32

a history could inform patienttrewith her drogs syria again enhancing this。

00:28:33 - 00:28:39

the strength of data supporting supparbbenefit with soxtionship does this is the current patients，

00:28:39 - 00:28:42

regardless of their molecular risk profile。

00:28:42 - 00:28:42

i think，

00:28:42 - 00:28:47

highlights to the importance of testing molecular genetic s emutational analysis。

00:28:49 - 00:28:51

we did this analysis across the comfort。

00:28:51 - 00:28:55

two study showing that patients had enhunt survival regardless，

00:28:55 - 00:28:57

their lelecular orist group，

00:28:57 - 00:29:00

said high moleculararists roks，

00:29:00 - 00:29:08

a little tretreated papatients in yelge did better than than the best available therapy treated high moleculararist patients in yellow，

00:29:08 - 00:29:13

but the high molecularorist patients still overall did worse。

00:29:14 - 00:29:22

there's another way assessing the risk of additional mutations on benefits of rocks listening。

00:29:22 - 00:29:27

and in this analysis published seven years ago from the empi yanderson。

00:29:28 - 00:29:32

not only the highlight killorisk mutations associated with worse outcome，

00:29:32 - 00:29:38

but those patients you had three or more patienans overall to any mutation，

00:29:38 - 00:29:38

for example，

00:29:38 - 00:29:40

including DNMT three，

00:29:40 - 00:29:40

a in tch，

00:29:40 - 00:29:40

too，

00:29:40 - 00:29:45

which are common mutations and are not highlight like cular risk。

00:29:45 - 00:29:50

so those patients who have three or more mutations had a nine foilld reduction in a chance of clean response，

00:29:50 - 00:29:52

short ter time to treatment。

00:29:52 - 00:29:54

continuation and reduced overall survival。

00:29:54 - 00:29:55

it is these patients。

00:29:55 - 00:29:59

we should be thinking about when we are individualizing auerapy。

00:29:59 - 00:30:02

and where we should be looking for better。

00:30:02 - 00:30:05

treatment combinations the treatments。

00:30:06 - 00:30:13

a further factor to consider when individualizing response and will come to some cases shortly to discuss this。

00:30:13 - 00:30:24

is that screen response appears to be a mark of overall survival benefit with rugs listening i'are shown here in this lanandal analysis？

00:30:25 - 00:30:36

this has also been shown in the face voarunteers on me by palepation of the spleen by patients with a fifty percent more reduction in clean ppupation had a better overall。

00:30:38 - 00:30:53

just predictive of scleen response to luxxlstnathis is is eeevidence gathered in northern ec suggest that early treatment lesson two years from diagnoses is smalllest leleen less than ten center meters。

00:30:53 - 00:30:56

so don't wait the scleen to be huge。

00:30:56 - 00:31:00

and earlier stage of disease said intermediate two versus high risk。

00:31:01 - 00:31:03

it was associated you with better seam response。

00:31:03 - 00:31:05

and also，

00:31:05 - 00:31:05

of course，

00:31:05 - 00:31:11

not waiting before the patients is too ily ly called from the side to being it linking to do。

00:31:11 - 00:31:15

which e's also important and here's a univariity panel，

00:31:15 - 00:31:17

a motivariity analysis。

00:31:18 - 00:31:21

of logistical regression of baseline factors，

00:31:21 - 00:31:23

a predictive to steam response at six months，

00:31:23 - 00:31:28

highlighting the data that i have just spoken to bed。

00:31:30 - 00:31:34

now i also elluded to dose and further data has come from a third，

00:31:34 - 00:31:37

another four hundred eight patients in italy，

00:31:37 - 00:31:43

suggesting that slee response in the first twelve weeks was linked to higher datas of rock，

00:31:43 - 00:31:46

listening ing with thfresh or being at least ten millograms twice daily。

00:31:46 - 00:31:49

and if you look at the second bullet，

00:31:49 - 00:31:53

when you can see that this also correlated with lisimpto the benefit。

00:31:55 - 00:31:57

one of the important factors，

00:31:57 - 00:31:58

however。

00:31:59 - 00:32:03

in dosage relates to hemothological untarget effect from beside tuunior，

00:32:03 - 00:32:19

with the overall reduction of twenty to forty percent with the initial docing and also anemiia and notes that the dynamic of the human globe al response is important to think about in every day practice with the nadia at twelve eighty weeks，

00:32:19 - 00:32:22

returning towards and baseline。

00:32:24 - 00:32:28

how do we manage these early onsets side opinions？

00:32:28 - 00:32:33

while one option is to decrease or interrupt the days of of roxeltionabut myyif，

00:32:33 - 00:32:38

i would only do that for a patient who was netropeinicle severely from beside a picniic。

00:32:38 - 00:32:42

keep in mind the dynamic of the hemoglobal response or therever，

00:32:42 - 00:32:47

i would support lmia or premptively treat a patient with。

00:32:48 - 00:32:50

an ESA agent will daosaur，

00:32:50 - 00:32:51

for example。

00:32:51 - 00:32:58

and there's also important to check a formular camps or cbc more frequently the patients。

00:33:00 - 00:33:05

we asked question tion in the comfort ity study don't early on certinemiia。

00:33:06 - 00:33:09

associated with rocxilitionally linked to adverers promises。

00:33:09 - 00:33:11

and the ad come from，

00:33:11 - 00:33:17

this study suggests that i dropped him a globe in a thirty grams suggested litter。

00:33:18 - 00:33:21

in the first six months for patients with luxellation，

00:33:21 - 00:33:24

it was not prognostitically significant，

00:33:24 - 00:33:28

but for best available therericy treated patients in this study，

00:33:28 - 00:33:32

this was associated with a significant impact on survival。

00:33:33 - 00:33:39

let's take a look out at some patient cases and discuss some of the data we thought about。

00:33:40 - 00:33:41

this is say，

00:33:41 - 00:33:48

a five year old female patients he presents with a nemiere spunnamically undernuclear with the plastic blood film。

00:33:48 - 00:33:49

you can see the blood cir here。

00:33:49 - 00:33:51

there is a front deciside toes。

00:33:51 - 00:33:52

in addition。

00:33:53 - 00:33:56

a bone murabararsey was consisted with primary malefa groses。

00:33:57 - 00:33:58

there's a twenty key minus，

00:33:58 - 00:34:03

such genetic cabinality in the patients had an MPL mutation。

00:34:04 - 00:34:05

when we saw her，

00:34:05 - 00:34:12

she was diexplosed low risk and symptom assessment revealed very bothersome fatigue。

00:34:12 - 00:34:16

the story behind this was that she had registeher working hours，

00:34:16 - 00:34:20

and she echchher up two two hours after abbaath or shower。

00:34:20 - 00:34:23

the splean was four to five centieters。

00:34:25 - 00:34:31

i just wanted to emphasize here that it's important to understand the impact of fatigue for this patient，

00:34:31 - 00:34:33

which is clearly needs addressing，

00:34:33 - 00:34:40

and this would hit the criteria then as set out by rudons to which we spoke about before。

00:34:41 - 00:34:44

what could we do fanencation？ we could。

00:34:44 - 00:34:50

what weight use hydrops seria treat the from besisite tases with a lag liite each brox，

00:34:50 - 00:34:55

a litership a feasible or interfere on alpur。

00:34:56 - 00:34:57

in my sensor，

00:34:57 - 00:35:01

i choose to give this patient advice on managing fatigue。

00:35:01 - 00:35:08

we often utilize a fatigue service run by occupational therapist and canamzopysier therapies，

00:35:08 - 00:35:11

and we gave her undterhistorine for itching。

00:35:11 - 00:35:15

we consideeeiat interfere on a roxlibetween。

00:35:15 - 00:35:21

the knowledge that they was spend megally and bothers some itaching to can't get worse with interfere on。

00:35:21 - 00:35:24

we choose to consider rocclip for this patient。

00:35:26 - 00:35:29

here was another patient sexual gentlemen，

00:35:29 - 00:35:34

with police sythemial erer r for the past twelve years。

00:35:34 - 00:35:37

he he presented with progressive fatigue，

00:35:37 - 00:35:41

some weight loss and was no longer leading for bottery。

00:35:42 - 00:35:44

you can ceal the slide his m piand ten school，

00:35:44 - 00:35:47

physical examination and loolook rent。

00:35:49 - 00:35:54

his boy mariabarsei was consistent with a darknoses suppoposed p mmalifiy brosis。

00:35:54 - 00:35:55

the carry type was minus mine。

00:35:55 - 00:35:57

he was into mediate one risk。

00:35:58 - 00:36:02

say there were variety of treatment options are shown on this side。

00:36:02 - 00:36:05

i wonder what you would choose in your data。

00:36:05 - 00:36:08

we would watching wait for this patient。

00:36:09 - 00:36:14

but consider that standard risk sols in their setting perform poorly。

00:36:16 - 00:36:20

we cannot presribe roslilittening for intermediate one risk disease，

00:36:20 - 00:36:33

so might consider either waiting the further features to oher or or evaluating using a different prrognostitic school and in the setting of post peeld or post et malphiracis。

00:36:33 - 00:36:35

the myex school can be helpful。

00:36:36 - 00:36:42

if the patient was able to be given roclistening from reuniverse ment purposes，

00:36:42 - 00:36:43

i would be definitely。

00:36:45 - 00:36:47

now let's look at some cases，

00:36:47 - 00:36:50

considering management of complications of roxelittive。

00:36:50 - 00:36:57

this is an old dcaation with a long long history of ET under five year history of stage a zero AO。

00:36:58 - 00:37:00

she developed features，

00:37:00 - 00:37:05

which were confirmed be consistent with paste ET mullify braces。

00:37:05 - 00:37:07

she is currently taking one point by grampms of her dropsy，

00:37:07 - 00:37:08

calmmde，

00:37:08 - 00:37:11

and the plan is to consider switching her to rock a littering。

00:37:12 - 00:37:15

say that the first question is my patienty old。

00:37:18 - 00:37:18

actually，

00:37:18 - 00:37:24

if you look at this naughty center study looking in opaients over sixty five years，

00:37:24 - 00:37:28

you can can see that the benefit of rocks and itnib in terms of。

00:37:29 - 00:37:38

slean response and toxicity in terms of veneus from the sysyoppeeininfection and overall survival benefit was the same，

00:37:38 - 00:37:41

but patients who were very elderly。

00:37:42 - 00:37:45

saying the answer is no distcation is not too old，

00:37:46 - 00:37:50

but what's about this year out？is this a contrary indication to therapy？

00:37:52 - 00:37:53

in my opinion，

00:37:53 - 00:37:55

II do not think that this is the case。

00:37:55 - 00:37:58

i would come for the patient that there might be a risk，

00:37:58 - 00:38:00

a cecil could worsen。

00:38:01 - 00:38:02

she starts procolalation，

00:38:02 - 00:38:04

then benefits ity allow，

00:38:04 - 00:38:08

remained stable or she to developes as cancer。

00:38:09 - 00:38:13

i wonder what you do in yourth centre for patience such as this？

00:38:14 - 00:38:14

of course，

00:38:14 - 00:38:20

we did immediate management of the cancer er reviewing grade in severity，

00:38:20 - 00:38:24

as this was a low grade alignacy and the first one。

00:38:25 - 00:38:31

the patient continued drugs listeening since she is eltdly and has had a long history taking her droks。

00:38:31 - 00:38:32

the carbmind，

00:38:32 - 00:38:37

these are the two likely factors that contribute most two development to blame merself cancer。

00:38:37 - 00:38:42

but you are aware that rocelilition it is associated with increased risks，

00:38:42 - 00:38:47

say she has enhanced dermtology surveillance and had the allegion been highly aggressive，

00:38:47 - 00:38:49

we would have considered stopping rock。

00:38:50 - 00:38:53

i wonder if you were using rucsalitating for your patients，

00:38:53 - 00:39:02

what did your experience or plan with regard to dozing？ do you use the standard starting dose according to the plate that canant ton stick with that，

00:39:02 - 00:39:04

if it's tolerated？

00:39:04 - 00:39:09

think about the is heavy er data and aim to have your patients on at least ten millograms twice daily。

00:39:10 - 00:39:17

push the days up as much as possible or use the days achieve the target effecfications and then till trate down。

00:39:19 - 00:39:23

i would say that for me，

00:39:23 - 00:39:26

my answer would be some weabour to be two and three。

00:39:26 - 00:39:29

i would aim to push the days up as much as possible，

00:39:29 - 00:39:30

and in general，

00:39:30 - 00:39:31

it should be at least。

00:39:34 - 00:39:41

now one of the problems in data practice with this roclest is that the benefit。

00:39:42 - 00:39:48

is a limited for patients in terms of durability of response in clinical trials。

00:39:48 - 00:39:54

the medium duration of response was somewhere where between three and four years shorter。

00:39:54 - 00:39:56

as you see here for the black dogs，

00:39:56 - 00:40:01

representing the expenand study and from beside to penic patients。

00:40:02 - 00:40:03

in real life，

00:40:03 - 00:40:06

the situation may have cost you different because。

00:40:07 - 00:40:10

indications that the topic treatment may be deff。

00:40:11 - 00:40:11

trial。

00:40:11 - 00:40:18

but one of our problems when we are using this drug as well as the problem is imbalcing her。

00:40:18 - 00:40:19

and individualizing，

00:40:19 - 00:40:23

the therapy is had to identify when a patient is progressing or becoming resistant，

00:40:23 - 00:40:28

and we explore this some extent of this slide。

00:40:29 - 00:40:29

too，

00:40:29 - 00:40:34

for patients with progressily megly impossible to consider optimising the dose，

00:40:35 - 00:40:42

think about elenetly that some patients we in our centre might use on the radiation。

00:40:42 - 00:40:43

or if we have the autiapity，

00:40:43 - 00:40:45

we might switch to an auterm，

00:40:45 - 00:40:49

said jack hibit sometimes are more tricky。

00:40:49 - 00:40:52

you need to review the cause optimisze dose，

00:40:52 - 00:40:56

think about other treatitor or einemeral from the ererinia。

00:40:56 - 00:41:01

we need to remember whether the patient player developed an additional issue，

00:41:01 - 00:41:02

for example，

00:41:02 - 00:41:04

bleeding from the syerinies。

00:41:04 - 00:41:07

you can consider additional therapies，

00:41:07 - 00:41:10

such as an propotin agent danzzle or fliinmmid。

00:41:12 - 00:41:13

linucytos s is more tricky。

00:41:13 - 00:41:17

or when you choose to intervene is not evidence based。

00:41:17 - 00:41:18

and for example，

00:41:18 - 00:41:24

you might choose to optimize the zrusolilienate or as a agents such as hydropsc curbnight。

00:41:25 - 00:41:29

a celerated tive ace disease ase glass between ten and twenty percent。

00:41:29 - 00:41:34

all glass prices is associated with at first outcome forpaations，

00:41:34 - 00:41:37

with with ee fie bracis and here。

00:41:38 - 00:41:43

the therof people to end very much on whether you consider transplantation for this patient。

00:41:44 - 00:41:45

if you watch，

00:41:45 - 00:41:48

then a mell induction with a weather ages，

00:41:48 - 00:41:51

such as the anticlacks could be considered otherwise，

00:41:51 - 00:41:57

management is generally expect ant supportive that we might consider adding a hypermethlaating agagents。

00:42:00 - 00:42:01

just associated with rox，

00:42:01 - 00:42:06

listen of disiniuation were ascessing the study from italy。

00:42:06 - 00:42:09

and here you can see in a multivariable analysis，

00:42:09 - 00:42:12

the higher with disease transiition dependence wrong，

00:42:12 - 00:42:18

the side opinion and an unfavorable perireotype were associated with discontinuation。

00:42:20 - 00:42:24

so i'd like to end here with the summary，

00:42:24 - 00:42:28

we discussed in road terms of monitoring of monittiity about some patients。

00:42:28 - 00:42:30

and i shared with you，

00:42:30 - 00:42:37

some of the details of have sysystem stomy and and look forward to discussing this in more detail with you。

00:42:37 - 00:42:41

we explored a contemping the challengment of malphfibraries，

00:42:41 - 00:42:50

looking at how to individualize therapy with roxitiny and get the best response with patient for optimiszdotes。

00:42:50 - 00:42:53

we look looked at issues around disease，

00:42:53 - 00:42:55

progressision or loss of spondual roxitniy，

00:42:55 - 00:43:07

and i highlighted to the management of stopping and rechallenging and the thoughts around to watked out for the disuuation syndrome for your patients，

00:43:07 - 00:43:07

which，

00:43:08 - 00:43:11

as partilighly been a challenging in the cdeomic，

00:43:11 - 00:43:13

with worse outcomes for indiversal to patients。

00:43:13 - 00:43:15

when i stop bruck soliiny。

00:43:15 - 00:43:16

thank you，

00:43:16 - 00:43:18

then for your attention，

00:43:18 - 00:43:20

and i looked forward very much to our。

00:43:28 - 00:43:28

好，

00:43:28 - 00:43:28

谢谢。

00:43:29 - 00:43:32

刚才我们这个格瑞亚教授，

00:43:32 - 00:43:38

把这个一骨骨髓纤维化的这个非常专题的这么给我做了一个全面的讲座。

00:43:38 - 00:43:42

可瑞亚教授其实在全在国际上非常知名，

00:43:42 - 00:43:45

嗯他是一个国际上的癌片专家。

00:43:45 - 00:43:46

另外的话呢，

00:43:46 - 00:43:51

他也主导了这个康抗的这个诺克克尼的一系血病研究。

00:43:51 - 00:43:53

今天他讲的还是非常全面，

00:43:53 - 00:43:58

包括额骨髓纤维化的相关的一些临床表现，

00:43:58 - 00:44:01

以及密咪替尼，

00:44:01 - 00:44:03

这是一个最精准的危险评分，

00:44:03 - 00:44:06

尤其是影响内个激病评分的这些因素，

00:44:06 - 00:44:08

包括疫植的挑战也谈到了，

00:44:08 - 00:44:15

当然重点还是讲了目前我们对唯一的一个靶向药物是如可替尼一系列列康抗研研究，

00:44:15 - 00:44:20

包括还有一些治治疗程程中诺克替尼治疗失败的患者，

00:44:20 - 00:44:22

我们如何应对的一些介绍，

00:44:22 - 00:44:26

都是做了非常全面的这么一个介绍。

00:44:26 - 00:44:27

那么这里的话。

00:44:28 - 00:44:29

也和我们三位同道，

00:44:29 - 00:44:32

三位主任一起就这个专题再进一步的讨论。

00:44:32 - 00:44:35

我介绍一下讨论的嘉宾。

00:44:36 - 00:44:39

第一位是来自海南省人民医院姚红红教授。

00:44:39 - 00:44:45

第二位是是来自们中国中医科学院、县医院的晓明教授，

00:44:45 - 00:44:49

以及来自长治医学院附属和平院的张国湘教授，

00:44:49 - 00:44:53

我们就依次来进进行讨论。

00:44:53 - 00:44:55

姚主任先来好，

00:44:56 - 00:44:57

谢谢，

00:44:57 - 00:44:58

同。

00:44:59 - 00:45:02

佟医院童童院教授授主持，

00:45:02 - 00:45:04

还有我们马良明教授主持哈。

00:45:04 - 00:45:05

在这儿呢，

00:45:06 - 00:45:10

首先要感谢陈文明教授高文教授的邀请哈，

00:45:10 - 00:45:13

又能来参加我们肠层血液论坛，

00:45:13 - 00:45:17

还要恭喜我们的陈文明教授，

00:45:18 - 00:45:21

连任那个血液的专委会的主委哈。

00:45:21 - 00:45:24

今天呢今天一天的学术会议，

00:45:24 - 00:45:26

我也觉得收获颇多。

00:45:26 - 00:45:35

刚才呢听了英国的海瑞森教授关于骨髓纤维化的个体化的治疗也是受益匪浅。

00:45:35 - 00:45:36

对于骨髓纤维化呢，

00:45:36 - 00:45:42

我们在实际工作中其实就是遇到的那些问题还是很多的。

00:45:42 - 00:45:44

因为虽然是一个慢性病，

00:45:44 - 00:45:45

但是他是个肿瘤，

00:45:45 - 00:45:50

对会影响响生生质治论症症也变化化比比较大，

00:45:50 - 00:45:54

贫血压、髓外症状性髓外造血压等等哈，

00:45:54 - 00:45:58

所以个体化的治疗确实非常的重要。

00:45:59 - 00:46:01

刚才哈瑞森教授已经讲了，

00:46:01 - 00:46:05

也就说他说重点讲的就是卢克替尼，

00:46:05 - 00:46:05

还有强菌药，

00:46:06 - 00:46:10

还有众多的临床研究和他们自己中心的一些结果哈。

00:46:10 - 00:46:14

我们可以看到卢克替尼确实是效果也很好，

00:46:14 - 00:46:16

起到了很好的作用。

00:46:16 - 00:46:20

但是我们在实际工作中确实还是有很多的问题。

00:46:20 - 00:46:23

比如说遇到了一些副作用，

00:46:24 - 00:46:27

还有一些卢克替尼效果不好的这种情况，

00:46:27 - 00:46:28

我们还有预育，

00:46:28 - 00:46:30

还有其他的选择。

00:46:31 - 00:46:32

比如说造血干细胞移植，

00:46:33 - 00:46:38

造血干细胞移植呢对于根治这个肿瘤还是起到很好作用。

00:46:38 - 00:46:41

但是对于骨髓纤维化来说，

00:46:41 - 00:46:44

他的就是年龄也比较大。

00:46:45 - 00:46:48

有一些很多的并发症，

00:46:48 - 00:46:49

就体能也差，

00:46:49 - 00:46:51

移植后的并发症也会出现。

00:46:51 - 00:46:54

有的报道呢就是术后并发症，

00:46:55 - 00:46:56

术后的那个。

00:46:58 - 00:47:01

术手术相关的死亡那个死亡率达到30%，

00:47:01 - 00:47:04

一年的OS也只有一半的。

00:47:04 - 00:47:07

所以在我们中心实际工作中，

00:47:07 - 00:47:10

可能选择的就比较少，

00:47:10 - 00:47:14

这是有有时候担心的还有一个切皮。

00:47:14 - 00:47:17

当然今天那个艾瑞森教授没提到，

00:47:17 - 00:47:18

就是说切皮吧，

00:47:18 - 00:47:20

有时候也会遇到，

00:47:20 - 00:47:25

但是切皮并不能就是效果并不就并不好。

00:47:25 - 00:47:28

就是但是有时候看到有一些肌层，

00:47:28 - 00:47:29

什么，

00:47:29 - 00:47:33

他还是来来治疗的时候就把皮给切了。

00:47:33 - 00:47:39

所以我在这儿就是想的就是肯定肯定要严格的掌握适应症。

00:47:39 - 00:47:41

这是我自己的一点看法。

00:47:41 - 00:47:41

好，

00:47:41 - 00:47:42

我就说这么多，

00:47:42 - 00:47:44

再次感谢。

00:47:44 - 00:47:44

好，

00:47:44 - 00:47:44

谢谢姚教授。

00:47:44 - 00:47:47

看到你在现场，

00:47:47 - 00:47:48

对对，

00:47:48 - 00:47:49

我也是没有办法，

00:47:49 - 00:47:51

不能分身。

00:47:51 - 00:47:51

好，

00:47:51 - 00:47:52

谢谢姚教授。

00:47:53 - 00:47:55

第二位教授胡晓梅教授也在现场，

00:47:55 - 00:47:57

我晓要。

00:47:58 - 00:47:58

好，

00:48:01 - 00:48:02

李主任。

00:48:02 - 00:48:02

好，

00:48:02 - 00:48:02

你好，

00:48:02 - 00:48:04

谢谢唐主任，

00:48:04 - 00:48:05

谢谢唐主任。

00:48:05 - 00:48:08

综末也非常多高教授。

00:48:08 - 00:48:08

好，

00:48:08 - 00:48:10

刚才听了就是说了很多，

00:48:10 - 00:48:13

所以纤维化呢确实比较复杂，

00:48:13 - 00:48:16

这个跟他的年龄、病程，

00:48:16 - 00:48:18

这个颅何清理的这个耐受，

00:48:18 - 00:48:19

很多都是密切相关的。

00:48:19 - 00:48:20

当然了，

00:48:20 - 00:48:23

刚才艾瑞生教授也是讲这个颅核清理，

00:48:23 - 00:48:25

还是尽早的运用，

00:48:25 - 00:48:26

能效果比较好，

00:48:26 - 00:48:28

我们要早去判断纤维化，

00:48:29 - 00:48:30

早点应用，

00:48:30 - 00:48:31

这个颅何清理。

00:48:31 - 00:48:35

然后如果出现一些这个芦口性耐药的情况及时处理，

00:48:35 - 00:48:37

觉得这个还是比较重要。

00:48:38 - 00:48:38

好，

00:48:38 - 00:48:39

我也没有别的个时间关系，

00:48:39 - 00:48:40

我都说这这么多，

00:48:40 - 00:48:41

谢谢。

00:48:41 - 00:48:43

如果应应好，

00:48:43 - 00:48:46

我的看一个的个的讲授。

00:48:47 - 00:48:50

张教授在现场在现场，

00:48:50 - 00:48:52

非常感谢童教授的一个介绍哈。

00:48:52 - 00:48:54

我来自于山西长治，

00:48:54 - 00:48:58

我非常荣幸的能参加这么一个高规格的这样一个会议，

00:48:58 - 00:49:02

也感谢陈文明教授和高登教授这样一个精心组织。

00:49:02 - 00:49:04

本来呢听这个英文其实是有困难的，

00:49:04 - 00:49:09

但是呢非常体贴在下边呢都有中文这样一个字幕哈，

00:49:09 - 00:49:11

觉得呢接受起来还是非常好。

00:49:11 - 00:49:15

听完这个哈瑞森教授这个报道呢就是几点感受吧。

00:49:15 - 00:49:21

第一个就是这样一个MPN的这样一个骨髓纤维化的疾病呢是一个慢性疾病。

00:49:21 - 00:49:25

所以呢希望整个从诊断以及在治疗过程中，

00:49:25 - 00:49:28

对于治疗的选择要有患者的参与。

00:49:28 - 00:49:32

这一点呢让我觉得在临床中工作中呢受到一点启发。

00:49:33 - 00:49:38

那么对于MF这些患者的一部分是可以从卢克替尼受益的一部分呢，

00:49:38 - 00:49:40

其实是不能从中受益的，

00:49:40 - 00:49:45

尤其是在一些中末期的患者呢治疗起来就更加的棘手，

00:49:45 - 00:49:47

所以对于这种疾病肯定还有。

00:49:47 - 00:49:51

从它的机制治疗上有很多未来需要探索的地方。

00:49:51 - 00:49:53

刚才瑞森教授在讲解的时候呢，

00:49:53 - 00:49:55

讲到了很多的细节，

00:49:55 - 00:49:56

我觉得也特别受感动。

00:49:56 - 00:50:01

就是说也也鼓励我们在临床医生在这个工作的过程中呢，

00:50:01 - 00:50:03

要观察的更仔细一些，

00:50:03 - 00:50:06

比如说这个服用了卢克替尼尤匹应答，

00:50:06 - 00:50:13

那么他和haro s是不是相关服用了卢克替尼呢？它出现了贫血的这样一个副作用，

00:50:13 - 00:50:14

影响不影响他的预后，

00:50:14 - 00:50:16

这些都观察的特别仔细。

00:50:16 - 00:50:18

这就是我今天听了这个报道以后呢，

00:50:18 - 00:50:20

一些收获，

00:50:20 - 00:50:22

也非常感谢滕佳授。

00:50:23 - 00:50:23

好，

00:50:23 - 00:50:24

谢谢张教授。

00:50:24 - 00:50:27

确实我在英国在这个疾病管理，

00:50:27 - 00:50:29

我们就通过这么一个MF的管理，

00:50:29 - 00:50:33

我们就可以看到他其实管理的非常的规范，

00:50:33 - 00:50:35

包括患者的症状评分。

00:50:35 - 00:50:36

危险度评分，

00:50:36 - 00:50:39

包括患者的治疗，

00:50:39 - 00:50:41

我觉得谈话的充分性，

00:50:41 - 00:50:42

这个也能看得到，

00:50:42 - 00:50:44

我们还是有一定的差距，

00:50:44 - 00:50:47

那也是我们在这个甲肝科方面领域的专家，

00:50:47 - 00:50:52

未来我觉得在全国层面上应该也是要继续要努力去做的。

00:50:52 - 00:50:52

一个是，

00:50:52 - 00:50:56

那我己也是比较感触还是蛮深的。

00:50:56 - 00:50:59

那我们再次感谢我们三位的讨论专家，

00:50:59 - 00:51:03

那我也感谢陈明教授和高文教授的邀请的，

00:51:03 - 00:51:06

祝贺我们陈文明教授再次当选主委。

00:51:06 - 00:51:17

那么接下来我就介绍下一场的两位主持是来自首都医科大学附属北京有一王昭教授以及MMV的布景教授邀请两位主持。

00:51:25 - 00:51:26

能听见我说话吗？，

00:51:26 - 00:51:27

能听见能，

00:51:27 - 00:51:30

谢谢谢谢佟教授的这个介绍，

00:51:30 - 00:51:38

非常高兴在这个环节跟我们大名鼎鼎的那个陆陆教授授互同公司的一个环节。

00:51:38 - 00:51:44

那么在这里也感谢魏武的这个邀请和陆婷教授的这个邀请。

00:51:44 - 00:51:45

去参加他个会议。

00:51:45 - 00:51:53

那么下面一位讲者呢是来自英度迈克斯大学的这个教授叫redforford，

00:51:53 - 00:52:01

他今天给我们带来的是一个临床研究的幼儿园数据的一个这复续的一个一个数据经济报道，

00:52:01 - 00:52:02

好不好？，

00:52:02 - 00:52:08

那么下面有请我们这个瑞dford教授。

00:52:09 - 00:52:12

i come from manchester and the restaurant，

00:52:12 - 00:52:12

rence，

00:52:12 - 00:52:13

the manchester，

00:52:13 - 00:52:17

my crinical practice based the chcrizy energy sundays，

00:52:17 - 00:52:20

the trust and then very expointing。

00:52:20 - 00:52:23

but before getting out to that thing，

00:52:23 - 00:52:23

you，

00:52:23 - 00:52:30

you just succt the sea little bit with some commanments about hodkin an film itself。

00:52:31 - 00:52:34

so let's see five king one as funch。

00:52:34 - 00:52:40

so hocking ling funmer is arresvely uncommon and filmer。

00:52:41 - 00:52:42

having set that very，

00:52:42 - 00:52:45

very ortortant，

00:52:45 - 00:52:55

it afffects young people althe older people who don't say the dildisease and the individuals where care is possible。

00:52:55 - 00:52:56

viously，

00:52:56 - 00:52:57

if you're young，

00:52:57 - 00:52:59

you got many years，

00:52:59 - 00:53:01

the cd consease。

00:53:01 - 00:53:12

and so the manner in which you care is really informed because because want to mintimize the care of treatment notively control the elimination of disease，

00:53:12 - 00:53:20

but also the impact the care cancces in terms of culvacctidisease fertility and of lalacoconsance of disease。

00:53:20 - 00:53:23

so it's not only about the care。

00:53:23 - 00:53:25

the care are important。

00:53:25 - 00:53:28

the matter of care is is critical。

00:53:31 - 00:53:34

so if we look at the distribution of sates，

00:53:34 - 00:53:40

so almost half of the patients present with advanance disease。

00:53:40 - 00:53:42

so typically，

00:53:42 - 00:53:48

hohoking in popomer is stage ggo to the and a much of of tificsease ys，

00:53:48 - 00:53:50

one through four sage，

00:53:50 - 00:53:53

one plvant disease or two liloczdidisease。

00:53:53 - 00:53:54

once on the disease，

00:53:54 - 00:53:55

stage，

00:53:55 - 00:53:58

three is notal disease above a below diatfort。

00:53:58 - 00:54:03

and stage four is where btracancer science of cansease revolved。

00:54:03 - 00:54:07

and what we know that in common with most cancers。

00:54:07 - 00:54:10

the hyof stasay，

00:54:10 - 00:54:10

the worth，

00:54:10 - 00:54:12

the outcomso papatients stays，

00:54:12 - 00:54:16

one disease have much better outcome of patients disafor。

00:54:16 - 00:54:20

and you might say one much because people presenting late。

00:54:20 - 00:54:20

no，

00:54:20 - 00:54:28

that's not decades online with bad cancer lung cancer patients says with save disease sesected disease ase。

00:54:28 - 00:54:30

they present with with stage one。

00:54:30 - 00:54:33

it's not a function of delay dialysis。

00:54:33 - 00:54:38

it's a feature the biological characteristic of the disease。

00:54:40 - 00:54:51

so another call feature is that is critically in terms of um measelaccomes trying kill people first time。

00:54:51 - 00:54:55

because if we can see from these growth，

00:54:55 - 00:55:03

if people failerment that the success rate of a subsequent mletage is not right。

00:55:03 - 00:55:04

so ultimately，

00:55:04 - 00:55:07

we want to give an effective and。

00:55:07 - 00:55:21

a little toxicity treatment as possible first line and result in the high number reperes that we can with patients to as doubge as little as possible by the treatment leter receive。

00:55:23 - 00:55:29

so this is a historiical because it goes back to the start of baby VD，

00:55:29 - 00:55:40

which was develop by baby d lar in the land back the seventy five that from the publication was made than the althe time time shoshow that baby d is within a reminising，

00:55:40 - 00:55:50

the abbbabd DD and staning thererapy better than than um standard partilaating basy mok therapy，

00:55:50 - 00:55:56

which refused at the time and mock was pretty unpleasant because of the time they were。

00:55:56 - 00:55:56

and good，

00:55:56 - 00:56:00

the pretty reresiant and must be like people very，

00:56:00 - 00:56:03

very sad and a lot of patients stounin tolerable。

00:56:03 - 00:56:07

and have to stop protertible and eabid baby VD，

00:56:07 - 00:56:17

which tolbly in terms of analysts and pretty better better comitof diin controroble with a major set forward the time interesting in the right time BD。

00:56:17 - 00:56:23

and you'll see that lowas significantly more paralacy。

00:56:23 - 00:56:27

periverforal erorosy with the ABDD than the with the sorry。

00:56:27 - 00:56:31

that's one wrong with the mark of the AVD。

00:56:31 - 00:56:35

and that's because the christian is a component in mk，

00:56:35 - 00:56:38

and the blessing is the component naa，

00:56:38 - 00:56:38

VD，

00:56:38 - 00:56:43

and the blessing is less toxy and the bleonless。

00:56:45 - 00:56:46

since abb，

00:56:46 - 00:56:51

d keep me trying to develop a chemotherapy in a way that produproduce better outcomes。

00:56:51 - 00:56:58

and so the vehicle compcompany should developed by the german aution in celebrroom is ververal lanme。

00:56:58 - 00:57:07

and that um show that um in terms of comparison with copy BD changes，

00:57:07 - 00:57:09

a mple hyygragision，

00:57:09 - 00:57:10

then。

00:57:10 - 00:57:13

big ichope is superior。

00:57:14 - 00:57:16

and if you intensify特变高。

00:57:17 - 00:57:18

isolated vehicle，

00:57:18 - 00:57:22

then the result saw even better，

00:57:22 - 00:57:23

but the top city is greater。

00:57:23 - 00:57:26

and as you can see，

00:57:26 - 00:57:31

um the in the low panel right the amount to ay for for perainiand，

00:57:31 - 00:57:36

the isolated vehicle is extremely nice to certhe，

00:57:36 - 00:57:41

not not ereracm m reasreasof therpersethethat's a severe impact in terms，

00:57:41 - 00:57:45

the therapy on the milloic system。

00:57:45 - 00:57:51

and that raises or increases through the patitient into the obsesses，

00:57:51 - 00:57:55

and also makes it um less tolerable。

00:57:55 - 00:57:56

and certainly，

00:57:56 - 00:58:02

this is not a therapy is not a therapation because they simply calon tolerate。

00:58:03 - 00:58:07

and we talked about the conference of treatment，

00:58:07 - 00:58:11

and this slide just shows the impact of more intensive atduations。

00:58:11 - 00:58:15

and i destroy attention to the bottom line standard。

00:58:15 - 00:58:17

those of inintensive chemotherapy，

00:58:17 - 00:58:29

the own are the intitiity for point one wn to the developing ththerulated equimiy chemoerapy the chemotherapy。

00:58:29 - 00:58:30

so in other words，

00:58:30 - 00:58:35

the more intensive therapy that you give with conventional chemotherapy，

00:58:35 - 00:58:38

the great ereration of the serious complications of treatment。

00:58:38 - 00:58:39

and of course，

00:58:39 - 00:58:41

there are other complications。

00:58:41 - 00:58:42

well，

00:58:42 - 00:58:45

um such as inertility second cancers and so on。

00:58:48 - 00:58:53

so this is just draws together where we're up to the moment。

00:58:53 - 00:58:55

so in many ways，

00:58:55 - 00:59:01

advanced pocucular for resigthe treator with abbd or with isolated vehicle。

00:59:01 - 00:59:13

either as a baseline approach or using various additional therapy or guiding therapy for the descallauusing pentagy。

00:59:13 - 00:59:21

so what what mean by this is using pet after initial therapy to say somebody responapy well。

00:59:21 - 00:59:26

and if they dedeticulaating therapy subsequently ly，

00:59:26 - 00:59:42

which adresses or deeindresor of the lake therapies that we will talking about only earlier and also the a key toxicity associated with the triated tive cell from the baseline therapy，

00:59:42 - 00:59:45

other strategy to be employed to try get the sainty。

00:59:45 - 00:59:46

but with that，

00:59:46 - 00:59:48

emploacy unpotentially，

00:59:48 - 00:59:53

using with key toxity inspicaor with pepty one intiitity，

00:59:53 - 01:00:00

but with ilology theraches to enhance the the therapy of key ining therapy。

1:00:02 - 1:00:05

so that very nicely brises，

1:00:05 - 1:00:08

the interlittle one trial。

1:00:08 - 1:00:18

so this is the first trial comparing chemossity with chemotherity pof ity ity ties pawhich es，

1:00:18 - 1:00:21

the the city thirty talin in courof of dtation。

1:00:21 - 1:00:23

and so in this study，

1:00:23 - 1:00:28

that twenty hundred vertiple parients because of a thirty thirty tries，

1:00:28 - 1:00:29

ty rid，

1:00:29 - 1:00:30

which is ly ly。

1:00:30 - 1:00:39

local study patients were randomze between standard APD and acsectate protetic tic addpplus DD paour world，

1:00:39 - 1:00:42

the retetic addity replacing the ADD，

1:00:42 - 1:00:48

which is a good job to get rid of because it cause significant polsiity。

1:00:48 - 1:00:49

in of course，

1:00:49 - 1:00:52

patitits in some patience that have be fatal。

1:00:53 - 1:00:56

so in the studiation to realidize between those owns，

1:00:57 - 1:01:00

and there was a pet down the end ded example，

1:01:00 - 1:01:01

too，

1:01:01 - 1:01:04

um patient to had a pet store，

1:01:04 - 1:01:07

a diggle store of five or greater，

1:01:08 - 1:01:13

um there were the option to change trip that point。

1:01:13 - 1:01:16

but for the other patients continue ed in the event，

1:01:16 - 1:01:19

very few patients change digger。

1:01:19 - 1:01:21

they complete their six cmples。

1:01:21 - 1:01:24

they have enter treatment assessment，

1:01:24 - 1:01:28

and then they folfollow and the slar pist extrepoor。

1:01:28 - 1:01:31

so we can see what happens to the individual。

1:01:31 - 1:01:33

so a very simple face free design，

1:01:33 - 1:01:38

a lot of propertation across a wide geographic spread。

1:01:40 - 1:01:44

and this is the patient characteristics。

1:01:44 - 1:01:52

and as you can see slightly more males and females in the overal population of welbalance to the yarms。

1:01:52 - 1:01:58

that's just a reflection of a disease because a slighmore commcommamen and women meeting in age，

1:01:58 - 1:02:01

very similar mildithirty of the disease。

1:02:01 - 1:02:04

the didisease of younger people meeting，

1:02:05 - 1:02:08

there were some individuals over sixty，

1:02:08 - 1:02:10

but that run to be business small。

1:02:11 - 1:02:12

um in terms stage，

1:02:12 - 1:02:12

three，

1:02:12 - 1:02:24

four or two thirds of patient ts rule was saved for um undthe later with stage three um and in terms progralostitic score。

1:02:24 - 1:02:26

um this is a way of difference。

1:02:26 - 1:02:30

strady ying ing rilaway of the basic basic risk with a high high ore ore，

1:02:30 - 1:02:32

representing a worst outcome。

1:02:32 - 1:02:36

this can see that um sorry a stright。

1:02:38 - 1:02:39

the red doone，

1:02:39 - 1:02:39

yes，

1:02:39 - 1:02:39

agso，

1:02:39 - 1:02:39

sorry，

1:02:40 - 1:02:44

um so the um the highst goworwas welcome。

1:02:44 - 1:02:46

and so so you could see。

1:02:47 - 1:02:54

two to three percent that is seventy percent plus of the patients really in cagories。

1:02:55 - 1:02:55

in terms，

1:02:55 - 1:02:57

but the the forof of aces。

1:02:58 - 1:03:01

the people were stated were equal，

1:03:01 - 1:03:03

zero were warm。

1:03:03 - 1:03:04

and so as is quite commonly，

1:03:05 - 1:03:05

say，

1:03:05 - 1:03:05

patient，

1:03:05 - 1:03:09

presenting the poty lar foreveneevening that stage or not，

1:03:09 - 1:03:13

um critically unwell at the time，

1:03:13 - 1:03:19

well uteronicties thereable to function um reasonabwell。

1:03:19 - 1:03:19

well，

1:03:19 - 1:03:20

of course，

1:03:20 - 1:03:21

is not icate。

1:03:21 - 1:03:23

if people remain treated ated，

1:03:24 - 1:03:26

they continuue with annasases without treatment。

1:03:28 - 1:03:37

and so this is the this is the sort of culative outoutcome ms progression free survival。

1:03:37 - 1:03:42

so this time to progressional debt from any courbecause，

1:03:42 - 1:03:44

because courcourse time time，

1:03:44 - 1:03:47

as we can see very stable，

1:03:47 - 1:03:49

different different betwely，

1:03:49 - 1:03:50

a different。

1:03:50 - 1:03:54

and the advantaty thing cthe that the the survival，

1:03:54 - 1:03:56

this find a progressial free survival，

1:03:56 - 1:03:57

a two point percent。

1:03:57 - 1:03:58

and for APD，

1:03:58 - 1:04:03

the comparred perpercent at a five point three percent。

1:04:03 - 1:04:09

so that is important um and we not uncommonly，

1:04:09 - 1:04:14

see progression free survival differences in facace three to ces。

1:04:14 - 1:04:20

the trick and unusual thing to see is a only al survivthat that because the every grow，

1:04:20 - 1:04:22

because if proactually saving and life，

1:04:22 - 1:04:28

more people remaining alive and life than that really。

1:04:28 - 1:04:29

it's very very问这个个就。

1:04:31 - 1:04:37

and so um this is going back to the original um the original analysts。

1:04:37 - 1:04:46

and you can see see right at the beginning um were more more deth in the ABV deal than in the icwhere，

1:04:46 - 1:04:52

where the deep that was no difference in survival from the tististial perspective of that time。

1:04:52 - 1:04:55

and the interesting，

1:04:55 - 1:04:58

if we look at the cause of death，

1:04:58 - 1:05:03

it was uh plua d group than in nine dedeth associated new uroropean。

1:05:03 - 1:05:12

and i think that that a talk of the point of making about the increasase risk of neuropepewith with this combination。

1:05:12 - 1:05:21

and when we learned that the multral that would when we um suggest the physiciiciis profect on mutificative project，

1:05:21 - 1:05:26

it was and since the intropection with that complication has been right，

1:05:26 - 1:05:28

can inuh liliminal。

1:05:29 - 1:05:31

in the AVV deep member concontained，

1:05:31 - 1:05:37

realizing you can see that eleven thirty deaths related with a power record。

1:05:37 - 1:05:44

so bymizing alvery somesomefeing this rather into into a drug is giving in this population，

1:05:44 - 1:05:46

significant number pasion。

1:05:46 - 1:05:48

so getting rided is point of that。

1:05:51 - 1:05:57

perforrence neuroracy is also uh was also reported in previous publications。

1:05:57 - 1:06:07

and what we know is that there is more perfect tly opathy in patients treated with retext dota and ABD than people receding ABDD。

1:06:07 - 1:06:11

but the recovery from that communication is pretty good，

1:06:11 - 1:06:12

but it is true。

1:06:12 - 1:06:16

and there is something that perfeictly datata was ring up，

1:06:16 - 1:06:22

but there is more perfect tly eroathy associated with with this combination。

1:06:22 - 1:06:26

but it is something that they get better over the time，

1:06:26 - 1:06:31

although even so there is a criquct diatity between the two alms，

1:06:31 - 1:06:33

you can see in the right something。

1:06:34 - 1:06:36

so that brings up to the present。

1:06:36 - 1:06:38

and so um tomorrow，

1:06:38 - 1:06:42

i'm going to be presenting these data in front，

1:06:42 - 1:06:44

the in front of people。

1:06:44 - 1:06:50

and we'll see what the responses this is the first as it were repeat ated。

1:06:50 - 1:06:56

the uh presentation with made lets go by sea anxl um and we'll see how it is presented。

1:06:56 - 1:07:04

and it's a great all how it be presented albealf the um um and time actually alwant want teum internationally。

1:07:06 - 1:07:09

so um think think i can clicick this libut。

1:07:09 - 1:07:11

it's already beginning。

1:07:11 - 1:07:13

that is a part of the reduction。

1:07:14 - 1:07:14

and in fact，

1:07:15 - 1:07:19

this is also um a repeat of the design。

1:07:19 - 1:07:27

so just pergreatly face for large and protiena simple parpersion between ADDD the siquaabity，

1:07:27 - 1:07:28

the accentous facety，

1:07:28 - 1:07:34

the with a digital dressing and progression fifacfor and oversurvival。

1:07:36 - 1:07:37

and uh，

1:07:37 - 1:07:55

these option characism you already seen um uuh just make the interinterneprototic tic ore uh for decedeny worthree twenty percent acroce their court uh in each on very well balance。

1:07:57 - 1:08:01

and the key fundder is。

1:08:01 - 1:08:06

the experience long bassquv dd producers，

1:08:06 - 1:08:11

a forty one percent reduction in a risk death compared baby vidd。

1:08:11 - 1:08:16

now that is an absolutely stunning result and practice changing。

1:08:16 - 1:08:26

and i think it's really important to understanably manitude all that of that result。

1:08:27 - 1:08:30

more people are surviving actually surviving，

1:08:30 - 1:08:31

not just prevacies，

1:08:32 - 1:08:39

but surviving um and the estimated six years about the rate is nine，

1:08:39 - 1:08:40

three or nine cfor。

1:08:40 - 1:08:41

the receiving comcomination。

1:08:41 - 1:08:47

the new compulation and eight nine were four cuh for very receiceding。

1:08:47 - 1:08:49

and as you can see，

1:08:49 - 1:08:51

the difference in events，

1:08:51 - 1:08:52

thirty nine，

1:08:52 - 1:08:53

sixty four。

1:08:53 - 1:09:01

so that is the difference indeserate between the two old that have been ruled about by treatment with the new theory。

1:09:01 - 1:09:05

the media followed through is just over six years。

1:09:05 - 1:09:12

the course se the time it will be interesting to see furintechanges over velop。

1:09:14 - 1:09:21

this is a applot d show ws the impact the oversursurvibenenefiting various suburb。

1:09:21 - 1:09:29

this comes to helpful because because the smsmaller er rout can be seared with uh danger。

1:09:29 - 1:09:30

and。

1:09:31 - 1:09:35

it's something that we really have to aware of when people say，

1:09:35 - 1:09:38

are to don't ve the effect of the figure or that in prow，

1:09:38 - 1:09:43

it was larger or whatever the key thing is，

1:09:43 - 1:09:47

the design was not meant to look at this。

1:09:47 - 1:09:51

this is a simply for information and reviite additional detail。

1:09:51 - 1:09:54

the key。

1:09:55 - 1:09:59

um designing the study was compare in two own between the say，

1:09:59 - 1:10:00

three say，

1:10:00 - 1:10:05

three and things population comparing ererity between uh to treatment。

1:10:05 - 1:10:06

and overall，

1:10:06 - 1:10:16

you can see that the the new treatment favors or subrus to a very degree with some exceptions，

1:10:16 - 1:10:21

which i don't think really the very important doctor。

1:10:24 - 1:10:28

so um this is another way of looking in the data。

1:10:28 - 1:10:31

this is we duto to risk of progression or that。

1:10:31 - 1:10:37

so here we talk about uh impact of the impquiement of preventing into progresascwhich，

1:10:37 - 1:10:43

which excse a demonstrative peececaswhich is the preattive a eof successful。

1:10:43 - 1:10:43

and so so uh，

1:10:43 - 1:10:47

definitely tely here，

1:10:47 - 1:10:48

the difference。

1:10:49 - 1:10:53

ces two point eight percent sevenseven perdifferent。

1:10:53 - 1:10:59

so there is a big difference when to get the medium followup is sitty ties。

1:11:01 - 1:11:02

也不会可可的坏，

1:11:02 - 1:11:03

适得。

1:11:03 - 1:11:06

people can see on top line，

1:11:06 - 1:11:11

och inforfincomcomicicthirty thirty dedes in the eight，

1:11:11 - 1:11:14

where VD or definine death in the APP deal。

1:11:14 - 1:11:21

i think we it could saying cancers very in mind that this is in poor conconrence of therapy that we wanted to try，

1:11:21 - 1:11:27

reduce where we can that want that in the squwhere videal eleven desk in the AP deal。

1:11:27 - 1:11:37

so there's are interesting in the raise certain hyposis about the modeor action of the inctreement。

1:11:37 - 1:11:45

and whether it is indeed the senated ated with less sad cancer as a result of the therapy itself。

1:11:45 - 1:11:47

in terms of courses，

1:11:47 - 1:11:55

unknown courses accident cobe to the the uinterprepretive teriage and retractive fections。

1:11:55 - 1:12:00

so that importortto general spread around dedest，

1:12:00 - 1:12:01

you lost at the time。

1:12:01 - 1:12:06

and um the everything i think is was say，

1:12:06 - 1:12:09

is in the unknoant of category。

1:12:09 - 1:12:12

so see are the following videal，

1:12:12 - 1:12:15

but two of those de foreign prorestions。

1:12:15 - 1:12:21

so don't say whether it was actually acacation rererethe profection people，

1:12:21 - 1:12:24

the detect ct foreign prorections。

1:12:24 - 1:12:29

so these are important to additional details。

1:12:32 - 1:12:35

in terms of suspect treating moment。

1:12:35 - 1:12:36

that was，

1:12:36 - 1:12:39

as you might expect let's common in the experiment law。

1:12:39 - 1:12:42

so um as you could see，

1:12:42 - 1:12:52

uhundred thirty five patients in the eighth grade y deal didificficulerapy very thousand fifty seven in the AV deal。

1:12:52 - 1:12:53

so that has two constments warm。

1:12:53 - 1:12:56

it means that those few patients。

1:12:57 - 1:12:58

oh，

1:12:58 - 1:13:00

no experiencing。

1:13:01 - 1:13:04

immension upfect他那个returns。

1:13:06 - 1:13:09

reading is going through difficulal treatment。

1:13:09 - 1:13:10

and of course，

1:13:10 - 1:13:11

secondly，

1:13:11 - 1:13:15

health care of of looking health fications tions，

1:13:15 - 1:13:16

they get repared。

1:13:16 - 1:13:25

so getting riding of the sees on ground is good for patience because not surprising implike it。

1:13:25 - 1:13:40

it also surgiase the impact on dowastream health care of suppoy or intecommsting or hesecongood therapy or ecommolaation or accommodation would give thererapy was common secona health therapy docommment。

1:13:44 - 1:13:47

if we look at the uh set milliances，

1:13:47 - 1:13:49

as you can say，

1:13:49 - 1:13:50

twenty three，

1:13:50 - 1:13:57

the intergovernment law was um body two in the sunday cancer，

1:13:57 - 1:14:04

there's a difference between the um hiythologic c nhiintethologc cancer。

1:14:04 - 1:14:10

and this just sounce to raise some point policity，

1:14:10 - 1:14:14

whether than transof producand transinctive idea，

1:14:14 - 1:14:18

whether it is preducing a more effective mission，

1:14:18 - 1:14:25

which might translate into better vivial and also eliminating cclems ourselves。

1:14:25 - 1:14:26

look susubsequently，

1:14:26 - 1:14:28

the susact cancer。

1:14:28 - 1:14:29

and so。

1:14:30 - 1:14:33

then we have no data to forthat that which such ideas，

1:14:33 - 1:14:41

but it does just raisy that it's intriguing to to speculate about what is the course them。

1:14:43 - 1:14:45

in terms of pregnancy，

1:14:45 - 1:14:48

propertly tly to indiandual world study，

1:14:48 - 1:14:52

upportuniity would not form assess，

1:14:52 - 1:14:57

but in terms reported pregnansystem by birwe can see from my data，

1:14:57 - 1:15:01

there was really the difference between the between two wls。

1:15:02 - 1:15:03

um internof eeurophy，

1:15:03 - 1:15:06

that's a high reasstance in the anyway video，

1:15:06 - 1:15:08

but a good rated recovery um in in both。

1:15:08 - 1:15:18

and as you could see on right right outside the number of um great free four year。

1:15:18 - 1:15:27

orthis is and the end of the follow period was really very low um free the europey。

1:15:28 - 1:15:29

was present at all。

1:15:29 - 1:15:30

it was usually very well，

1:15:30 - 1:15:32

all right iting。

1:15:33 - 1:15:41

so just can to this this bof of um ressitly presenentation出口the morning um。

1:15:42 - 1:15:50

someone is important because it's the first regiment show an improvement in repossible in didict，

1:15:50 - 1:15:54

ct part with the previous standard care APP。

1:15:54 - 1:15:56

and you know，

1:15:57 - 1:15:58

we look to the data，

1:15:58 - 1:16:00

but the act act is abtually tually huge。

1:16:00 - 1:16:08

and should should to the atatof that develoment ment should should be prwd for the result。

1:16:10 - 1:16:12

阿给替捧制的一个。

1:16:13 - 1:16:17

所以爱CY给个这根experiment ment。

1:16:18 - 1:16:20

development with sixty that，

1:16:20 - 1:16:20

that survival，

1:16:20 - 1:16:25

despite a whole rate self vivservice that were viting able people，

1:16:25 - 1:16:26

if they realize。

1:16:26 - 1:16:36

and so it asof the data touditherapies and then have something more and not underlined the importance curcuring，

1:16:36 - 1:16:39

the importrand not rely on survage age。

1:16:39 - 1:16:41

and despite ite itself，

1:16:41 - 1:16:45

they deoulneed to bring out they bring out the deficit in the survival rate。

1:16:46 - 1:16:49

因为赛性是counreally important。

1:16:50 - 1:16:54

um even would dicuculate death。

1:16:54 - 1:16:55

and as a result of the day，

1:16:55 - 1:17:03

i think we can that um eququity is is the first first line treatment for states。

1:17:03 - 1:17:04

four cllus four ortten，

1:17:04 - 1:17:05

a fincted result。

1:17:05 - 1:17:07

congratulations several。

1:17:07 - 1:17:09

thank you very much。

1:17:17 - 1:17:19

好，

1:17:19 - 1:17:31

这个谢谢我们这个关于这个CT三单抗在我们互县淋巴瘤间的这个艾省的六年的随访数据。

1:17:32 - 1:17:35

我想也不是一个特别新的一位是伊行，

1:17:35 - 1:17:40

2022年的这个咱们现在一行二023都已经开盘了。

1:17:40 - 1:17:41

那我们这个环节节呢，

1:17:41 - 1:17:43

有三位讨论嘉宾。

1:17:43 - 1:17:48

第一位呢是来自我们北京院院的刘辉任任，

1:17:48 - 1:17:51

是我们做淋巴瘤的大咖。

1:17:51 - 1:17:53

那好呢呢就请请刘辉教授，

1:17:53 - 1:17:56

就这个实验的这个随访数据，

1:17:56 - 1:17:59

那个进行一些讨论。

1:18:00 - 1:18:02

其实我自己也有一个理论，

1:18:02 - 1:18:05

如果要是比如说第二期他就不拓益了，

1:18:05 - 1:18:07

为什么非要三四期呢？

1:18:08 - 1:18:09

有泽。

1:18:09 - 1:18:09

好的，

1:18:09 - 1:18:11

谢谢陆婷教授的介绍。

1:18:11 - 1:18:13

那刚才然教教授呢，

1:18:13 - 1:18:21

艾斯兰的研究呢有仔细的非常详细的给我介介绍一下那个因为一二期的病人呢，

1:18:21 - 1:18:23

他ABBD效果就很好了，

1:18:23 - 1:18:26

所以可能就没有做到这种常识。

1:18:26 - 1:18:27

三四期的病人，

1:18:27 - 1:18:30

我们也有病人用的a把他病在一线。

1:18:31 - 1:18:35

还有的病人是因为柏兰霉素的副损伤之后进行替换的。

1:18:35 - 1:18:38

我们体会呢就是a一对15，

1:18:38 - 1:18:40

他的血血毒性中还是比较大的。

1:18:40 - 1:18:46

我们有个病人只能耐说对一a1010的这个CCC三年就没有用，

1:18:46 - 1:18:48

但是疗效呢依然还是很好的。

1:18:48 - 1:18:50

我想呢其实中国上市之后，

1:18:50 - 1:18:52

这些数据该那个收集一下，

1:18:52 - 1:18:54

把这个世界的数据做个报道，

1:18:54 - 1:18:56

然后大家会有更多的依据。

1:18:56 - 1:18:56

好，

1:18:57 - 1:18:58

我就说谢谢谢谢。

1:18:59 - 1:18:59

好，

1:18:59 - 1:19:01

谢谢刘主恩。

1:19:01 - 1:19:02

那么下面呢，

1:19:02 - 1:19:10

有请我们第二位讨论嘉宾来来自山西医科大学第二附属医院的毓婷教授。

1:19:10 - 1:19:11

好的，

1:19:11 - 1:19:13

谢谢我们陆教授的介绍。

1:19:13 - 1:19:19

其实我们从这个恩诺普教程讲座中呢也学了好多，

1:19:19 - 1:19:24

与ADVB相比呢确实AD pass AAB呢治疗晚期性淋巴瘤，

1:19:24 - 1:19:28

尤其是23期、34期的患者，

1:19:28 - 1:19:30

他的OS受益还非常明显，

1:19:30 - 1:19:33

尤其是他的风险也是很低的。

1:19:33 - 1:19:37

比如说他的死亡率呀、尿药、肿瘤发生率等等。

1:19:37 - 1:19:43

它的长期血管的数据呢确实具有非常重要的临床意义。

1:19:43 - 1:19:47

我我们可能对晚期性呼系淋巴瘤治疗，

1:19:47 - 1:19:52

也是希望他可能会成为一个胰腺的治疗方案。

1:19:52 - 1:19:53

好的，

1:19:53 - 1:19:55

我就讲这么多卢教授。

1:19:55 - 1:19:56

好，

1:19:56 - 1:19:56

谢谢。

1:19:56 - 1:20:03

那有请我们第三位讨论嘉宾来自广西医科大学附属第一医院的罗军教授罗转，

1:20:04 - 1:20:05

谢谢我们陆教授，

1:20:05 - 1:20:10

我就也在刚才其实说的其实是二零多年的一些东西，

1:20:10 - 1:20:15

那么这个是把这些数据曾新给我们做一个展现而已。

1:20:15 - 1:20:18

那么陆教授委滋刚才这个一个问题了，

1:20:18 - 1:20:19

那么刚才说一二期，

1:20:19 - 1:20:22

那么也就是说投在很好的效果。

1:20:22 - 1:20:26

那么另外他用的这个在医y的a15嘛，

1:20:26 - 1:20:27

这两个情况下，

1:20:27 - 1:20:31

那么在这个b一其实在那个结编的时候，

1:20:31 - 1:20:34

其实他没那么厉害的一个读副作用。

1:20:34 - 1:20:37

但是在这个h二里面，

1:20:37 - 1:20:39

刚才我们刘斌主任也提到的，

1:20:39 - 1:20:47

就是说那摄影师差一些是不是因为这个用的这个用了两季以后会引起这个相关的一些毒性作用。

1:20:47 - 1:20:49

我不知道已经陆教授你怎么考虑，

1:20:49 - 1:20:50

谢谢。

1:20:53 - 1:20:53

好，

1:20:53 - 1:20:53

谢谢。

1:20:53 - 1:20:55

其实我们也是这个体会，

1:20:55 - 1:20:57

尤其是神经系统副副作用，

1:20:58 - 1:21:05

这个出的还是跟我们其实我们骨髓瘤中间神经系统副作用并不少见。

1:21:05 - 1:21:09

但是这个出的神经系统副作用，

1:21:09 - 1:21:10

一旦出了之后，

1:21:10 - 1:21:13

进展的程度会更为迅速。

1:21:14 - 1:21:18

所以我觉得CD300单抗呢有他自己的一些特殊之处。

1:21:20 - 1:21:22

那个我也很好奇，

1:21:22 - 1:21:26

就是如果要是比如说二线，

1:21:26 - 1:21:26

我们是换，

1:21:26 - 1:21:30

他还是加上PD one会更好。

1:21:30 - 1:21:34

将来有没有这样的数据展示给我们。

1:21:34 - 1:21:37

再次感谢我们三位讨论嘉宾，

1:21:37 - 1:21:40

下面呢就进入到我们下一个环节。

1:21:40 - 1:21:42

我们下一个环节的主持呢是，

1:21:42 - 1:21:48

我们天津科大学的弗隆教授和上海瑞金院的普炯教授，

1:21:48 - 1:21:50

有请弗隆教授。

1:21:51 - 1:21:51

好的，

1:21:51 - 1:21:53

谢谢陆瑾教授的介绍，

1:21:53 - 1:21:56

也非常感谢陈明主委的邀请，

1:21:56 - 1:22:09

参加咱们2023年长城企业论坛这个环节呢非常荣幸和您和这个这个吴瑾教授来共同主持这个。

1:22:10 - 1:22:14

profect wendy wendy教授的讲座，

1:22:14 - 1:22:16

吴景教授大家都熟悉，

1:22:16 - 1:22:17

我就不过多介绍了。

1:22:17 - 1:22:21

那么我先介绍一下我们这个环节的，

1:22:21 - 1:22:22

讲者，

1:22:22 - 1:22:24

他是wendy利教授。

1:22:25 - 1:22:37

是加拿大迈克马斯特大学医学系的血液学和血栓血栓栓塞学教授在多伦多大学获得了医学博士学位，

1:22:37 - 1:22:40

完成他的内科专医师的学习。

1:22:40 - 1:22:47

在迈克马斯特大学完成了血液学的亚专业培训和血栓栓塞症的研究，

1:22:47 - 1:22:51

获得了临床奖学金以及健康研床方法学的硕术学位。

1:22:52 - 1:22:54

那么他的研究方向呢，

1:22:54 - 1:22:57

主要包括抗凝剂在特殊患者群体中的使用，

1:22:57 - 1:23:04

去铁平的最佳管理利用系统回顾、注注、分析以及指南制定的证据回顾，

1:23:04 - 1:23:05

这是，

1:23:05 - 1:23:07

我们今天的这位讲者，

1:23:07 - 1:23:10

我不知道他是在在线还是放录播。

1:23:11 - 1:23:12

那么。

1:23:13 - 1:23:17

他给我们的带来的题目呢是贫血，

1:23:17 - 1:23:20

全球的健康问题不能忽视，

1:23:20 - 1:23:22

有请温迪教授。

1:23:23 - 1:23:32

and india is defined as the condition of having less than the normal number around leyself or less than than the normal quality of fegengal women in the blind。

1:23:33 - 1:23:38

the brolof organization defines me as a singgbly concontratrathat that blow was douised。

1:23:38 - 1:23:42

that is a hundred definty graound to iler in the now。

1:23:43 - 1:23:44

um often time，

1:23:44 - 1:23:50

we think about ninea um in terms of male female e resforso for women，

1:23:50 - 1:23:51

a huma lesson，

1:23:51 - 1:23:52

one one hundred ter。

1:23:52 - 1:23:57

and and then i huof one hundred hundred one ader would be define at annia。

1:23:57 - 1:24:03

this is unimportant because the media is the most common human loge disorder that has scene in medical project。

1:24:05 - 1:24:14

now anemia is incredibly important because it is common the most um recent data um from the globbal burden of disease study。

1:24:14 - 1:24:19

so was that in twenty nineteen anemia affected one point eight billion individuals。

1:24:19 - 1:24:22

so that is the global prevalence of almost twenty three percent。

1:24:23 - 1:24:30

that translates to fifty point three million years of living with disability and in try in china。

1:24:30 - 1:24:30

and in east asia，

1:24:30 - 1:24:38

the prevalence of anemia was just over one hundred and thirty three million individuals in twenty nineteen。

1:24:40 - 1:24:42

when we think about iron deficiency，

1:24:42 - 1:24:44

and we think about inunia，

1:24:44 - 1:24:48

um there are individuals in the population to our iron deficient，

1:24:48 - 1:24:50

but it is when iron deficiency is cool long，

1:24:50 - 1:24:54

it will affect a rivererpoeis that will then result in iron deficiency in nunia。

1:24:55 - 1:25:00

iron efficiency anineia is the most common cause of anineia worldwide。

1:25:01 - 1:25:03

if we go back to the global lobal al den of disease，

1:25:03 - 1:25:11

a study this um figure shows the prevallence of different types of anemiia in different parts of the world。

1:25:11 - 1:25:14

and if we highlight china，

1:25:14 - 1:25:17

you can see that uh diitterary iron efficiency，

1:25:17 - 1:25:24

as shown as the orange bar is the most common cause for aneia is uh many part of the world，

1:25:24 - 1:25:26

including china。

1:25:27 - 1:25:33

it is useful ththinabout iron deficiency and absolute or functional iriran deficiency。

1:25:33 - 1:25:37

absolute iron deficiency results from an invialance between the iron uptake，

1:25:37 - 1:25:40

the utilization and loss。

1:25:40 - 1:25:43

and result in a decrease in the total body iron stores。

1:25:43 - 1:25:47

so there's decreased iron in the liver and decreased iron in the spreen。

1:25:48 - 1:25:51

it is also usually think about iron deficiency in terms of larger categories。

1:25:51 - 1:25:55

iron deficiency can result because there's decreased intake of iron。

1:25:55 - 1:25:57

there's increased loss of iron。

1:25:57 - 1:26:02

there's decreased absorption of iron or there may be an increased requirement or demand for iron。

1:26:03 - 1:26:06

so we go back examples of decreased intake of irem。

1:26:06 - 1:26:12

we be because individuals have a lack of a balance diet or a low soustio economic status，

1:26:12 - 1:26:14

they observe a vegetarian or a vegan diet，

1:26:14 - 1:26:16

or they have it eating disorder。

1:26:17 - 1:26:23

increase loss um the most common categories would include women and girls who are having their periods demonstrating。

1:26:23 - 1:26:26

patient to have chronic gasoline testinamal or genital uranarary，

1:26:26 - 1:26:29

leading or individuals were regular blood donors。

1:26:30 - 1:26:33

there may be decreased absorption in patient to have malt sorort of disorders，

1:26:33 - 1:26:39

um patient ts have had gastered bypast surgery or are taking certain meduications such a proprompt headers。

1:26:39 - 1:26:39

finally，

1:26:39 - 1:26:47

you know that infants and children particularly goes under five years of age and pregnant women have an increasase need for onion。

1:26:49 - 1:26:53

with the other condition that can result in iron，

1:26:53 - 1:26:55

dificiency is consider functional iron deficiency，

1:26:55 - 1:26:59

or often time describe as anineium information。

1:26:59 - 1:27:00

and this occurs，

1:27:00 - 1:27:11

um h is a ststof impimpair iron metablization that arises in conditions associated of information infection or chronic disease and nornoral al thway and iron transport and iron metabolism is disrupted。

1:27:11 - 1:27:13

that tune in this figure here。

1:27:13 - 1:27:14

so normally，

1:27:14 - 1:27:20

iron is taken enough food absorved in the duedinal entrrosite through rought into the cell。

1:27:20 - 1:27:24

and will listed into the blood stream through transport in norspspir porortand。

1:27:24 - 1:27:26

so in a normal state，

1:27:26 - 1:27:28

there's normal levels of iron in the plasma，

1:27:28 - 1:27:33

um that can be used to suppsupport or rether policices。

1:27:34 - 1:27:36

in inflamatory conditions cytokinds，

1:27:36 - 1:27:39

such as i al six interlook consix up，

1:27:39 - 1:27:41

regulate a hmal known is helpsiin。

1:27:41 - 1:27:48

what happens is that happciden then blocks the um the fair sma uh transporter。

1:27:48 - 1:27:49

so in fact，

1:27:49 - 1:27:51

it internalize and degree that transport。

1:27:51 - 1:27:58

so the iron accumulate inside the antro site and is no longer able to be released into the clasasma，

1:27:58 - 1:28:01

where can be used to support with tranorses。

1:28:01 - 1:28:02

so these conditions，

1:28:02 - 1:28:04

there's retention of iron in the antro site。

1:28:04 - 1:28:08

and also retention of iron uh within nacropages。

1:28:10 - 1:28:11

so when we think about patients，

1:28:11 - 1:28:12

maybe at risk of iron deficiency，

1:28:12 - 1:28:14

it would be in all of these categories that we have discussed。

1:28:14 - 1:28:16

so i've listed all of these，

1:28:16 - 1:28:18

and we've discusmany many of these，

1:28:18 - 1:28:26

but is important to keep in mind because these are the patients that you should have a low fresresful for for thinking about iron deficiency and testing for iron deficiency。

1:28:28 - 1:28:32

now why is iron efficiency and iron dificficenty and indian important，

1:28:32 - 1:28:35

while many patients of iron efficiency have decrease quality of life，

1:28:36 - 1:28:37

they have weakness and faene。

1:28:37 - 1:28:43

they may have difficulty concentrating and then have difficulty or poor or productivity。

1:28:43 - 1:28:48

we know that peaceful age children have the highest preglance of an unimiate globally，

1:28:48 - 1:28:51

and this is associated with decreased cognitive and motor development，

1:28:51 - 1:28:53

and it has long stensing affects on behavior。

1:28:53 - 1:28:54

finally，

1:28:54 - 1:29:00

we know that iron deficiency and pregnant women is associated with increased risks of preterm labor，

1:29:00 - 1:29:04

low birthweight um an increased child and maternal mortality。

1:29:05 - 1:29:07

so western were setting objective。

1:29:08 - 1:29:12

we know that iron is available into the body in two ways，

1:29:12 - 1:29:20

it can come through dietary iron through the food that you eat or through oral iron replacement to usually in the final supplement。

1:29:20 - 1:29:24

iron is absorbed in the upper gaasterotestonal act in the duogenum um or ubdigenuum。

1:29:24 - 1:29:28

and for any disorder that affects that part of the stomach。

1:29:28 - 1:29:38

so saliet disease in fllanatorial disease or patient ts have undergone um aaact exterdty bypthat part of the stomach for weight loss may be be risk of iron on efficiency。

1:29:39 - 1:29:42

so that is the usual loote for um for bringing iron in the body。

1:29:42 - 1:29:44

the other way to bring iron into the body is blackpassing。

1:29:44 - 1:29:50

the gasterertetesle track directly delivering the iron into the bloodstream through introveneous or ivy iron replacement。

1:29:51 - 1:29:53

so let's start with world iron replacement。

1:29:53 - 1:29:58

this is usually our first sigline treatment for most cases of the iron efficiency。

1:29:58 - 1:29:59

however，

1:29:59 - 1:30:00

there are any limitations。

1:30:00 - 1:30:06

we know that only ten to perpercent of the iron for most of the common iron replacement that ability is absorb。

1:30:06 - 1:30:10

we know that um iron is better is absorb when the stomach is empty。

1:30:10 - 1:30:13

so maybe thirty percent of all the iron absorwork in that case，

1:30:13 - 1:30:17

compared to stomach that has school where there maybe only ten percent of the iron absorort。

1:30:18 - 1:30:19

their economly，

1:30:19 - 1:30:22

up to twenty percent of patients have uh gastrroroom tesmal side effects，

1:30:22 - 1:30:24

and that affects inheance。

1:30:24 - 1:30:27

so it hearces is estimated that may be forouring to sixty percent at best。

1:30:28 - 1:30:33

many patients who have nasia and epiagstric pain can be managed with loore doses or that's frequent ducing of oral ire。

1:30:33 - 1:30:37

but we know that because twenty percent of patients have these side effects，

1:30:37 - 1:30:39

the inheance is very low。

1:30:40 - 1:30:40

finally，

1:30:40 - 1:30:42

in patients with information，

1:30:42 - 1:30:48

the hormonal have ciden reduces the abproption of iron from this stommy and blocks iron released from liver stores。

1:30:48 - 1:30:50

and so using oral iron in these cases，

1:30:50 - 1:30:52

often times doesn't work at all。

1:30:53 - 1:30:56

so that's like we have intertrevenious iron products，

1:30:56 - 1:31:04

and these are products and are complex with a sosoul or some sort of carple hydrry carrier and these um formulations shield the iron。

1:31:04 - 1:31:08

so whether in a core or the iron is dispersed within a matrix carbble hydrry，

1:31:08 - 1:31:12

it can't blocks that iron from being released um quickly into the bloodstream，

1:31:12 - 1:31:21

because it is thought that this bioactive label iron and has been the cause of much of the reaction scene with IV iron in the past。

1:31:23 - 1:31:28

irv iron would be indicated when the oral iron either is ineeffective。

1:31:28 - 1:31:44

it's poorly tolerated or you need a rapid replacement or a ydese replacement um so exexample that we talk about would be in situations where absorption is impared papatients have had araatric surgery with gaasric bypass or any gasoline tesonal conditions that result in mveloortion，

1:31:44 - 1:31:45

such as silly act，

1:31:45 - 1:31:49

disease or gastraight us in sanmety bile disease or good examples。

1:31:50 - 1:31:55

women who have heavy means for bleeding where the losses exceeded their iron intake or painting with chronic bleeding，

1:31:55 - 1:31:57

usually from the gastro testiamal track。

1:31:58 - 1:32:00

in the carry opertitianings。

1:32:00 - 1:32:03

so either before a surgery or after surgery，

1:32:03 - 1:32:07

um the the iron is often indicated to try to rapidly increase stores。

1:32:08 - 1:32:14

um patient for severe of denetic anemiia as an as an alternative to blood transfusion。

1:32:14 - 1:32:16

it's probably better to give IV iron in those situation。

1:32:16 - 1:32:22

ah women who are pregnant and abboth to deliver would benefit from IV iron。

1:32:22 - 1:32:25

as we talk to go with uncil iron efficiency and flameatory conditions，

1:32:25 - 1:32:27

such as cancer or chronic heart failure，

1:32:27 - 1:32:31

pictions will keep the failure and inflameory ory bal disease would benefit from IV iron。

1:32:31 - 1:32:32

and finally，

1:32:32 - 1:32:37

patients who cannot tolerate oral iron would be another broroad category of patients。

1:32:38 - 1:32:40

if will compare IV to oral iron，

1:32:40 - 1:32:45

the advantage of IV iron is that you get a more rapid increase than the human movein IV compared to oral iron。

1:32:45 - 1:32:47

so as we'll loded it，

1:32:47 - 1:32:47

this，

1:32:47 - 1:32:50

this is helhelful ful situuwhere a rapid increases needed。

1:32:50 - 1:32:51

so before，

1:32:51 - 1:32:51

before，

1:32:51 - 1:32:55

bleeing patients who are very sympmaawith，

1:32:55 - 1:33:05

their paenineia as an alternative to transfusion patients were bleeding faster than you can replace them on oral iron or in situations for patient compliance and follow maybe challenging。

1:33:05 - 1:33:11

so you may see them in only one one interaction for exexple in an emergency department。

1:33:12 - 1:33:17

we also know that um IV iron has fewer gassero testonal side effects compare to role。

1:33:17 - 1:33:21

iron and IV iron is really the only option for patients with certain GI disorders，

1:33:21 - 1:33:23

where role iron is ineafffected，

1:33:23 - 1:33:24

for example，

1:33:24 - 1:33:27

that um gasser bypassword plandetory balil disease。

1:33:27 - 1:33:32

there are some disadvantages through interintervenous iron usually is more costly than that world，

1:33:32 - 1:33:39

and the IV iron will require as some sort of visit to a hospital or and to an exfusion clinic to give the on the IV iron，

1:33:39 - 1:33:42

the infusion times um will be very，

1:33:42 - 1:33:43

very sumer betwtwen，

1:33:43 - 1:33:48

um fifssof sinstaining comcompare red world world will take a little little bit monger ger。

1:33:48 - 1:33:52

there's always the potential for IV site infection or bleeding。

1:33:52 - 1:33:56

there's re's of iron solution may move out of the vessel and coused some skin staining。

1:33:56 - 1:34:01

there's a risk of hyper sensitivity reactions that we will discuss they are in this presentation。

1:34:02 - 1:34:04

if we compare the high dofie，

1:34:04 - 1:34:07

such such model comcompare to lodos s iron，

1:34:07 - 1:34:13

um the advantages that the hydose formulus perpermit fureplacement doses in one to two infusions。

1:34:13 - 1:34:14

so if imagine this very helpful，

1:34:14 - 1:34:18

um if patients are unable to come back to get repeated infusions，

1:34:18 - 1:34:29

and this will often i asassist with scheduling and and give more um infusion clinic space for other patients for other infusion or procedures，

1:34:29 - 1:34:31

if we only need to do one two infusions with the hydos。

1:34:32 - 1:34:36

ah there's re's more rapid increase and chemicgthan levels with the hydos compared to no londose iron。

1:34:37 - 1:34:38

and with the hydose iron，

1:34:38 - 1:34:44

we can give um motphher and fifteen minutes compared to to six hours with cosmor。

1:34:44 - 1:34:45

so again，

1:34:45 - 1:34:56

some of the disadvantage just the high dose uh irons may cost more because you're only you're giving a single dose um and there maybe some familiarwith uh health care providers with other lower dose，

1:34:56 - 1:34:57

iron and preparations，

1:34:57 - 1:35:01

and they may be more comfortable with the lower dose um just because the familiarity。

1:35:03 - 1:35:03

so finally，

1:35:03 - 1:35:08

we t's review some some of stastake data for IV iron and how to manage the infusion sion ary attenmpts。

1:35:09 - 1:35:09

so，

1:35:09 - 1:35:14

many safety concerns were i the iron d from the era when high molecular weight，

1:35:14 - 1:35:16

or each MW iron detran wawauum，

1:35:16 - 1:35:22

the low molecular weight ah HLMW iron defran is associated with lower reaction rates。

1:35:22 - 1:35:28

and it is important to know that the high molecular waate iron dexpan is no longer available and no longer used。

1:35:29 - 1:35:31

with the high molecular iron next plan，

1:35:31 - 1:35:34

immediate reactions were seen up to percent ent papatits ts，

1:35:34 - 1:35:39

the life threening reactions up up one point three percent and in AUS data bascity，

1:35:39 - 1:35:43

when they compared just over a million doses，

1:35:43 - 1:35:48

th IV low molecuway iron explan given to forty eight thousand five hundred nine patients，

1:35:48 - 1:35:53

which about twenty thousand five hundred and th of IV iron。

1:35:53 - 1:35:54

over sixteen months，

1:35:54 - 1:35:59

they found that life threatening adverse event was zero zero three five percent。

1:35:59 - 1:36:04

any adverse event was zero point zero three percent per exposure。

1:36:04 - 1:36:06

so with the low lecular way，

1:36:06 - 1:36:09

iron traneevate is extremely low。

1:36:09 - 1:36:12

exon products are very safe。

1:36:12 - 1:36:20

most of the immediate reactions that were seen were attributed to that free label iron that was released into the circulation，

1:36:20 - 1:36:23

um and many of the newer iron preperations，

1:36:23 - 1:36:27

um m have a titer binding to the iron left label free iron。

1:36:27 - 1:36:28

and as a result，

1:36:28 - 1:36:30

lower rates of infusion reactions。

1:36:31 - 1:36:39

this is a study that looked at the frequency of enouful lax that saw a very severe allergic reaction with IV iron preparations。

1:36:39 - 1:36:48

and what they found was that high molecular way ion on dexpan had a three of four time increase rate of leththreating adverse reactions。

1:36:48 - 1:36:49

and as i mentioned，

1:36:49 - 1:36:52

because these are no longer available if we exclude the high molecular way，

1:36:52 - 1:36:53

iron dectran。

1:36:53 - 1:36:56

and just look at the more um modern uh，

1:36:56 - 1:36:57

iron iron irons，

1:36:57 - 1:37:03

the enathactic reaction rates are very low at less than one in two hundred thousand interfusions。

1:37:05 - 1:37:13

this is also best represented in um ranandomzed control trial where they have examined raates of severe ypersensitive d reactions。

1:37:13 - 1:37:17

so this is an analysis of five randomize control trial that looked at intervenvenous iron，

1:37:17 - 1:37:21

um so nine hundred and um different different。

1:37:21 - 1:37:25

the irons are shown uh h uum，

1:37:25 - 1:37:31

moophuh or fair and terorizal mosoles representing just over two thousand of the patients in these this analysis。

1:37:32 - 1:37:33

what this uh，

1:37:33 - 1:37:40

what this uh analysis did was that they took the individual renandmic control trial that evaluated the incidents of moderate severe，

1:37:40 - 1:37:41

hypersensitive，

1:37:41 - 1:37:45

key reaction and use this as either a primary or secondary and point。

1:37:45 - 1:37:55

and so um what you can see with the various studies here is that when you pull all of the data so that you get a better statistical um and althth，

1:37:55 - 1:38:00

um the rate of higher of severe um hypersensitivity reactions with the nuwer IV iron was extremely low。

1:38:00 - 1:38:03

so zero point two to one point seven percent。

1:38:05 - 1:38:06

so to try to put that into context，

1:38:06 - 1:38:07

um you know，

1:38:07 - 1:38:10

a severe drug reaction or anof luxes。

1:38:10 - 1:38:12

the ivy iron is less than one in two hundred thousand。

1:38:12 - 1:38:22

so that's equivalent ent to zero point zero zero five percent um so that would be equivalent ent to being hit in your home by a crushing airplane。

1:38:22 - 1:38:24

so very unlikely。

1:38:24 - 1:38:29

as severe hypersensitive tive reaction within newer IV irons is estimated that point two to one point seven percent。

1:38:29 - 1:38:31

as i showed you in the last line，

1:38:31 - 1:38:38

that's probably similar to needing emergency treatment in the next year from injury by a can a glass bottle or a jar。

1:38:39 - 1:38:39

it finally，

1:38:39 - 1:38:43

the fish being reaction um which will go through in the next line，

1:38:43 - 1:38:46

but is a is a reaction um that is comprised the fish。

1:38:46 - 1:38:50

al fllushing technness in the chest are back upon a fusion，

1:38:50 - 1:39:01

which we feel is probably uh about one percent of the um has a frequency about one percent that probably similar to um dying in a road traffic action over fifty perent driving。

1:39:01 - 1:39:01

again，

1:39:01 - 1:39:04

these ate can only put it into some common risks，

1:39:04 - 1:39:06

um the the rate of reactions to i，

1:39:06 - 1:39:08

the iron are extremely low。

1:39:09 - 1:39:11

so i just mentioned the fish being reaction in the last。

1:39:11 - 1:39:14

so the fish being reaction is showing in this light，

1:39:14 - 1:39:18

it is a thoualt limited reaction IVV iron that consists of a hute chest or back tiindness。

1:39:18 - 1:39:20

and it might be accompaned by facial flushing。

1:39:20 - 1:39:21

uh，

1:39:21 - 1:39:23

it might be a company by arththougies。

1:39:23 - 1:39:24

but importantly，

1:39:24 - 1:39:27

there's no evidence of anthroxis and um there's no hyle tension。

1:39:27 - 1:39:29

there's no swalling of the little certime。

1:39:29 - 1:39:33

and this gentleman en here is experiencing a fish being reaction。

1:39:33 - 1:39:33

uum。

1:39:33 - 1:39:42

the intriveneous iron solution is just simpally stopped and and um can can here that um gengenal ally pppum，

1:39:42 - 1:39:43

he's spontteously recovers。

1:39:43 - 1:39:46

the facial flushing has uh disappeinted。

1:39:46 - 1:39:49

and and this comcompany ted in chechest baback ver reolved。

1:39:50 - 1:39:56

so let's turn to how to recognize and manage infusion or hypersensitive ving reactions to IV iron。

1:39:56 - 1:40:00

so this this shown um in this um graphic here，

1:40:00 - 1:40:05

but i would sort of take step by step through the uh through the algorithm。

1:40:05 - 1:40:07

so as a general overview，

1:40:07 - 1:40:10

um in approaching hypersensitive reactions，

1:40:10 - 1:40:14

it's important to try to anticipate the patients maybe at risk of these hypersensitive reaction。

1:40:14 - 1:40:23

and so patients that might have refacctor for developing hypersensitive rereactions that they might might have multidrurug allergies or previous reactions to IV iron。

1:40:24 - 1:40:29

those patients might be considered for having receiving their iron and slower rate。

1:40:29 - 1:40:32

so we consider slowing the IV iron and fufusion rate for these potential patients，

1:40:32 - 1:40:48

um the other important consideration would be to try to educate health care providers and patients of the science and symptoms of hypersensitive tive reactions so that the health care providers can sisist papatience can notify the health care providers if they get any of these symptoms。

1:40:48 - 1:40:55

it's important for health care providers to recognize what annihooxysis compared to a fish being reaction compared to does an isolated sympttom。

1:40:55 - 1:41:01

and it's important in these situations to remain calm and to stop the ivy iron infusion。

1:41:02 - 1:41:02

finally，

1:41:02 - 1:41:08

it's important to manage these appropriately and so managment generally involve monitoring the patients，

1:41:08 - 1:41:10

valdefines and their states。

1:41:10 - 1:41:12

and to administer antiisstinans，

1:41:12 - 1:41:15

if they develop the denantic ratiicriso tell the brought over view，

1:41:15 - 1:41:16

but let's go through this step by step。

1:41:16 - 1:41:19

so in the creininfusion things，

1:41:19 - 1:41:20

but leme，

1:41:20 - 1:41:21

as i mention，

1:41:21 - 1:41:22

it important to try to educate the patient，

1:41:22 - 1:41:26

tell the patient that severe infusion reactions can occur。

1:41:26 - 1:41:26

they're rare。

1:41:26 - 1:41:37

so less than one in two hundred thousand doses describe some of the common symptoms that might occur if they have an infusion reaction and tell the patients to inform their health care providers。

1:41:37 - 1:41:39

if these symptoms develop。

1:41:39 - 1:41:43

please assess the patient for a potential risk of reaction。

1:41:43 - 1:41:47

so we've had reactions to other druks to other IV iron appropriations。

1:41:48 - 1:41:51

initiate the IVY iron at a slow infusion rate。

1:41:51 - 1:41:54

so um for those patients may particularly be at rik，

1:41:54 - 1:42:02

considered using an even four rate of infusion monitor the patients uh vital signs at baseline and at regular intervals。

1:42:02 - 1:42:08

during the IVY iron infufusion and consider close er monitoring in the first couple of minutes of the infusion。

1:42:08 - 1:42:11

if the patients tolerate it well with the most with most patients do，

1:42:11 - 1:42:15

then you can increase the rate of infusion of the iron。

1:42:15 - 1:42:18

following um infusion of all of the other，

1:42:18 - 1:42:18

the iron measure，

1:42:18 - 1:42:26

the vital science at the end of the infusion and continue monitoring for at least thirty minutes following the infusion and um to ensure that the patient is saable。

1:42:27 - 1:42:31

now should patients um developp reactions that this part of alalderthm。

1:42:31 - 1:42:36

so the vast majority of patients will have no symptoms that going to tolerate the IV iron without any issue。

1:42:36 - 1:42:42

so patients should just then um be uh told that should they develop any symptoms，

1:42:42 - 1:42:44

such as shorand of breath，

1:42:44 - 1:42:45

angel team up or rush，

1:42:45 - 1:42:50

they it should presented medical attention if they have any fever，

1:42:50 - 1:42:51

mildeleed or headaches，

1:42:51 - 1:42:54

they they have any fething of delayed and fusion reaction in which case，

1:42:54 - 1:42:57

um they should be um instructed to take a seden medphine。

1:42:58 - 1:43:00

and and that generally resolve the symptoms，

1:43:00 - 1:43:01

if it does not，

1:43:01 - 1:43:02

it should be far to seek medical attention。

1:43:03 - 1:43:04

now sure。

1:43:04 - 1:43:06

red papatient developed some acute sympmpoms oms。

1:43:06 - 1:43:11

the most important thing is to stop the infusion measure the patients，

1:43:11 - 1:43:13

vital science and atstasks for symptoms oms。

1:43:13 - 1:43:20

educatient has enough laxes that is they have hypotension and er a demm of the tongue or airway，

1:43:20 - 1:43:23

or they have involvement of two or more organ systems，

1:43:23 - 1:43:24

such as a early，

1:43:24 - 1:43:27

carry up the skin um chess pain。

1:43:27 - 1:43:30

uh strider or brockpain vitor or dominal pain，

1:43:30 - 1:43:33

then they would be recognizes having enough laxes，

1:43:33 - 1:43:36

and you should initiate enough laxes management。

1:43:37 - 1:43:39

if patient have to fish being reaction，

1:43:39 - 1:43:40

that is they have the fiial flushing，

1:43:40 - 1:43:41

uh，

1:43:41 - 1:43:43

the uh milologies or chest taghtness，

1:43:43 - 1:43:45

and they have no symptoms of anthluaxes，

1:43:45 - 1:43:48

then you simply need to just monitor and ah the patient。

1:43:48 - 1:43:50

and observe untiall those symptoms first，

1:43:50 - 1:43:50

all。

1:43:51 - 1:43:52

once the symptoms result，

1:43:52 - 1:43:53

in fact，

1:43:53 - 1:43:54

you can restart the infusion。

1:43:54 - 1:43:56

i would suggest starting to at ter，

1:43:56 - 1:43:57

reduce ly compared to previous。

1:43:57 - 1:44:00

and if the symptoms should happen to occur again again，

1:44:00 - 1:44:02

just not the infusion。

1:44:02 - 1:44:05

now fish have isolated symptoms that is the ID say，

1:44:05 - 1:44:05

is irritated，

1:44:05 - 1:44:08

or they just have isolated articararia，

1:44:08 - 1:44:16

isolated nosia or acdonala in then uh just valvalue aplipation to make sure that they're not evolving into antiful axum。

1:44:16 - 1:44:17

if they have earticararia，

1:44:17 - 1:44:20

then you can consider giving them anonydating antihistmum，

1:44:20 - 1:44:23

if help resolve some of those symptoms。

1:44:25 - 1:44:27

and then finally，

1:44:27 - 1:44:30

um if the patient has had an infusion reaction，

1:44:30 - 1:44:34

you can rechallenge the patient and so often times that involves discussion with a patient。

1:44:34 - 1:44:35

and usually，

1:44:35 - 1:44:40

i would recommend um initiating the infusion at at a sore rate rather a lower dose than previous。

1:44:41 - 1:44:43

um if you have access to an allergies，

1:44:43 - 1:44:47

you could consider having that ancient uh assesby the allergies。

1:44:48 - 1:44:48

and so finally，

1:44:48 - 1:44:55

i just wanted to uh go through how we introduce more efforto our hospital oppetient clinic。

1:44:55 - 1:45:05

and so why did our hospital decide to bring in um another IV iron？this was largely because the demand for IV iron was increasing in our clinic was unable to keep up with the request。

1:45:06 - 1:45:09

we had um iron ciccross or what we call beat of her，

1:45:09 - 1:45:14

and we were giving it as hundred hundred milgragram fusions done over thirty to forty five minutes。

1:45:14 - 1:45:16

and so generally，

1:45:16 - 1:45:19

most patients need irire at a grground fire in our clinic。

1:45:19 - 1:45:20

that methat。

1:45:20 - 1:45:23

we were giving five difusions of iron cross。

1:45:23 - 1:45:31

so that would take about three and half hours and forty saving time alone that does account monitoring the patient。

1:45:31 - 1:45:31

afterward，

1:45:31 - 1:45:35

it don't account t setting up the IV for the patient。

1:45:35 - 1:45:37

so we look at the numbers，

1:45:37 - 1:45:44

if more to give the equivalent one ground of monitor that would just take thirty forty five minutes in total。

1:45:44 - 1:45:46

so a lot of time savings alone，

1:45:46 - 1:45:49

both the patient and for our clinic staff。

1:45:49 - 1:45:54

we also new that there was clinical trial data that shows the safety and effeicacy mondeor。

1:45:54 - 1:45:58

so we were very patient t that decided to introduce this to our clinic。

1:45:58 - 1:46:02

so we did this by meeting with key stakeholders for the support，

1:46:02 - 1:46:04

and we developed the count。

1:46:04 - 1:46:09

we provided education to the nurses to the doctors to the furnasy，

1:46:09 - 1:46:10

and we use the preparted border set。

1:46:10 - 1:46:13

and created a occasion information sheet。

1:46:14 - 1:46:20

this is an example of the informationship that we gave to our patients explaining why patients needed iron。

1:46:20 - 1:46:22

what the product was canadadum。

1:46:22 - 1:46:23

um we all all a monopheric um，

1:46:23 - 1:46:24

but it is monophr。

1:46:24 - 1:46:31

we explained to patients um know what they needed to do how it was given and what some of the side effects might be。

1:46:32 - 1:46:35

and generally and for our experience for the patients，

1:46:35 - 1:46:37

it was very well tolerated。

1:46:37 - 1:46:40

we had experience a very low rate of infusion reactions，

1:46:40 - 1:46:52

and the patient were very happy because they needed to come to the hospital on fewer occasions to fully receive um the provion replacement this results in less interruption to their replacements。

1:46:52 - 1:47:06

um we noted the improvement in the irquincof life for this reason for the physician and nsing stastaff their experising in very raight for there's a rapid increase uh monitor that makes it easy to do，

1:47:06 - 1:47:08

and it was easy to administer。

1:47:08 - 1:47:13

um we notied a very rapid increase in the iron stores and very rapid increase um or correction in the patients in india。

1:47:14 - 1:47:29

um we experience on low rate of infusion reactions that require the doctors um to intervene and know ah this allowed us to um um provide treatments for our patients beyond our existing by the iron。

1:47:29 - 1:47:30

so we had to reactions。

1:47:31 - 1:47:32

so in summary，

1:47:32 - 1:47:39

iundefficiency is the most conic cause for an indiunior worldwide and has important short and long long terful conconences。

1:47:40 - 1:47:45

oral iron replacement is the first line treatment for oral for iron efficiency in most patients，

1:47:45 - 1:47:49

but ivy iron is indicated in patients where oral iron cannot be taken。

1:47:49 - 1:47:50

it is ineffective，

1:47:50 - 1:47:52

or there's a need to rapidly increase stores。

1:47:53 - 1:48:01

there are many staties that have demonstrated the safety and efficicacy of IV iron and treating iron efficiency and iron efficiency and india in a wide for idea of patience。

1:48:08 - 1:48:08

好的，

1:48:08 - 1:48:11

感谢这个陈维明教授的邀请。

1:48:12 - 1:48:14

今天来主持，

1:48:14 - 1:48:14

这个讲座。

1:48:15 - 1:48:19

那确实也是一个我们平时接触不多的，

1:48:19 - 1:48:20

但是又是很重要的。

1:48:20 - 1:48:23

因为这个贫血尤其缺体病，

1:48:23 - 1:48:27

在临床上还是非常常见的一个问题，

1:48:27 - 1:48:31

所以我们今天也真的难得有机会来系统的再学习一下。

1:48:32 - 1:48:36

那么今天我们这个讲座的环节有三位讨论的嘉宾。

1:48:37 - 1:48:45

我们第一位讨论嘉宾是这个我们冯建明教授来自于青海市人民医院的这个主任教授，

1:48:45 - 1:48:46

研究生导师，

1:48:46 - 1:48:50

也是之前的这个名誉的主任会员委员，

1:48:50 - 1:48:51

有请冯建明教授。

1:48:52 - 1:48:52

好，

1:48:52 - 1:48:58

这个首先感谢弗隆教授和霍俊教授的介绍，

1:48:58 - 1:49:02

也祝贺文明教授再一次当选我们学业。

1:49:03 - 1:49:07

专委会的主委祝贺高文秘书长，

1:49:07 - 1:49:12

刚才wendy教授讲了一个题目，

1:49:12 - 1:49:15

我自己觉得可能是大家都不太关注的，

1:49:15 - 1:49:20

但是确实是影响群体健康非常常见的一个问题。

1:49:21 - 1:49:23

他当然提到了很多基础的东西，

1:49:23 - 1:49:26

也提到了这个确铁性。

1:49:27 - 1:49:30

在人群当中的这个情况，

1:49:30 - 1:49:35

我记得过去大概有文献记载说我们人群当中缺铁的情况大概在20%，

1:49:36 - 1:49:38

甚至可能20%还要多一点。

1:49:38 - 1:49:41

确实是一个非常影响健康的问题。

1:49:41 - 1:49:42

对一些特殊的群体。

1:49:42 - 1:49:45

比方说儿童肾长发育期，

1:49:45 - 1:49:48

这个孕妇还有一些慢性病的情况。

1:49:48 - 1:49:52

当然他也提到了这个口服铁剂的一些问题。

1:49:52 - 1:49:53

口服铁我们都知道的，

1:49:53 - 1:49:55

可能是这个胃肠道的副作用，

1:49:55 - 1:49:59

还有他的这个补充的这个时间起效的时间。

1:49:59 - 1:50:01

那么这几年来，

1:50:01 - 1:50:06

这个静脉铁呢确实在临床起到了很大的作用。

1:50:06 - 1:50:09

当然静脉铁里面他特别提到了一个高敏的问题。

1:50:09 - 1:50:13

这个我过去是遇到过打优旋糖肝铁的时候，

1:50:13 - 1:50:17

我遇到过儿童提症的这种副作用。

1:50:17 - 1:50:22

所以对这种静脉铁虽然他说这个安全性已经很高了，

1:50:22 - 1:50:25

但是还是应该说还是有这种反应。

1:50:25 - 1:50:27

所以临床用的时候可能还是要。

1:50:27 - 1:50:28

需要特别注意。

1:50:28 - 1:50:28

当然，

1:50:28 - 1:50:30

贫血里边除了缺铁贫以外，

1:50:30 - 1:50:33

我们其他的一些贫血也需要特别注意。

1:50:33 - 1:50:36

比方说慢性病、贫血肿瘤引起的贫血，

1:50:36 - 1:50:38

感染性引起的贫血。

1:50:38 - 1:50:40

还有一些特殊的原因，

1:50:40 - 1:50:43

前一段时间我就遇到一个病人一个贫血。

1:50:43 - 1:50:49

结果后来最后一查结果临床发现是个吸汗湿疹引起的贫血，

1:50:49 - 1:50:52

就是内分泌病引题引起的贫血，

1:50:52 - 1:50:54

确实应该引起我们临床的重视。

1:50:54 - 1:51:03

我觉得这也是我们做血液工作者的可能科普上面或者给广大民众的宣传上面，

1:51:03 - 1:51:05

可能更应该注重的一个问题。

1:51:05 - 1:51:08

非常好的一个讲题。

1:51:08 - 1:51:11

从淋巴瘤、骨髓瘤、白血病癌平等等。

1:51:12 - 1:51:13

我们又转到这么一个题目，

1:51:14 - 1:51:15

受益颇多。

1:51:16 - 1:51:17

再一次的表示感谢，

1:51:17 - 1:51:18

谢谢。

1:51:21 - 1:51:23

谢谢冯建梅教授。

1:51:23 - 1:51:24

精彩的点评，

1:51:24 - 1:51:28

那我们接下第二位这个讨论嘉宾是。

1:51:29 - 1:51:43

崔丽娟教授崔立娟教授是来自宁夏医科大学这个学科的主任也在国内外有很多的这个介尤尤谢谢谢谢谢谢胡教教授的声音能听到嗯听到。

1:51:43 - 1:51:44

好，

1:51:44 - 1:51:45

谢谢胡俊教授的介绍。

1:51:46 - 1:51:50

谢谢这个环节付荣教授和胡俊教授共同的主持。

1:51:50 - 1:51:54

那么也特别感谢陈明教授和高文教授的邀请，

1:51:54 - 1:51:57

参加嗯非常高质量的长春雪论坛，

1:51:58 - 1:52:07

也庆祝我们陈文明教授和高文教授嗯那个第第二届我们专授授邀请。

1:52:07 - 1:52:10

立刚才才呢也是幸幸听到位，

1:52:10 - 1:52:12

这个文迪教授带来的关。

1:52:12 - 1:52:15

也感谢这样的一个话题，

1:52:15 - 1:52:19

刚才各位教授都谈到说是就是缺血贫血。

1:52:19 - 1:52:25

这个话题实际上是我们其实是荣誉很在各个会议上多忽视的一个话题，

1:52:25 - 1:52:28

那么其实温俊教授带来非常高，

1:52:28 - 1:52:29

刚才非常。

1:52:29 - 1:52:33

高质量的一个非常全面的一个学术报告，

1:52:33 - 1:52:36

那么我们我我前面我我记我听听过，

1:52:37 - 1:52:40

我我天天检选张张奎教授讲讲过次，

1:52:40 - 1:52:44

虽然在在前静脉血高效效安全，

1:52:44 - 1:52:47

静静脉血上市的这个情况下，

1:52:47 - 1:52:52

那么铁的这个代谢吸收和转运的过程，

1:52:52 - 1:52:55

也这个理论也进一步往前发展，

1:52:55 - 1:52:57

那么我们原来缺铁性贫血，

1:52:57 - 1:53:00

刚才冯建明教授也谈到，

1:53:00 - 1:53:03

就说实际上我们每个人做门诊的时候，

1:53:03 - 1:53:04

都能体会到缺铁性贫血。

1:53:04 - 1:53:06

他的这个发生率还是蛮高，

1:53:06 - 1:53:10

虽然是慢性失血是主要的因素，

1:53:10 - 1:53:13

但是它其他因素还是都都有的。

1:53:13 - 1:53:16

特别是刚才温迪教授也谈到，

1:53:16 - 1:53:18

也比如说炎症性因素，

1:53:18 - 1:53:21

那么在这个铁的这个整个转运过程当中，

1:53:21 - 1:53:27

目前来讲它口服铁吸数这个影响因素是非常多的，

1:53:27 - 1:53:29

那么静脉铁就解决了这样。

1:53:29 - 1:53:31

这的一个问题，

1:53:31 - 1:53:36

那么其实目前在安全高校的这样的一个静念体上市的情况下，

1:53:36 - 1:53:42

我觉得我原来的这个能口服不静脉的这个观念是要转变了。

1:53:42 - 1:53:45

那么这两年也是这样的学术报告有厅，

1:53:45 - 1:53:47

但是次数比较少。

1:53:47 - 1:53:52

那么再次感谢我们这个文迪教授，

1:53:52 - 1:53:55

我就说这么多胡鼎教授，

1:53:55 - 1:53:57

谢谢崔教授的这个讨论点评。

1:53:58 - 1:54:08

那我们这个环节的第三位讨论嘉评是来自我们河北省淋巴瘤肿瘤研究中心的这个柳立宏教授，

1:54:08 - 1:54:11

刘教授也是在临床非常有经验，

1:54:11 - 1:54:15

他也是这个我们这个有很多的学术任职，

1:54:15 - 1:54:17

有请刘教授，

1:54:17 - 1:54:19

谢谢谢谢胡鼎教授的介绍，

1:54:19 - 1:54:26

也非常感谢陈文斌教授和高文教授呢晶晶主持这个非常好的协术会议。

1:54:27 - 1:54:29

刚才温迪教授呢给我们。

1:54:29 - 1:54:30

做的这个报告呢，

1:54:30 - 1:54:35

它非常其实在临床当中呢非常常见，

1:54:35 - 1:54:37

而且呢也非常的重要。

1:54:37 - 1:54:41

但是呢经常也会被我们临床大夫呢经常忽视，

1:54:42 - 1:54:45

因为呢我们缺铁的发生率还是很高的，

1:54:45 - 1:54:52

缺铁呢也缺铁和缺铁性贫血呢都对患者的生活质量造成非常重要的影响。

1:54:52 - 1:54:59

因为铁呢它不仅仅呢参与我们血红射不血红蛋白重要的一个组成部分，

1:54:59 - 1:55:02

它同时呢也参与各种酶的代谢。

1:55:02 - 1:55:04

而我们体内酶的代谢。

1:55:04 - 1:55:08

因此呢缺铁呢在缺铁和缺铁性贫血，

1:55:08 - 1:55:13

这两大块当中呢都非常影响我们患者的生活质量。

1:55:13 - 1:55:16

那么这个补充铁的时候呢，

1:55:16 - 1:55:18

之前我们有一个概念，

1:55:18 - 1:55:20

就是说能口服我们不静脉。

1:55:20 - 1:55:22

但是现在呢口服的时候呢，

1:55:22 - 1:55:25

由由于口服这个患者呢，

1:55:25 - 1:55:27

这个铁不容易被，

1:55:27 - 1:55:29

比如由于种种的原因吧。

1:55:29 - 1:55:30

它不能被吸收。

1:55:30 - 1:55:34

比如有一些胃肠道的疾病呀、手术呀，

1:55:34 - 1:55:38

或者是一些慢性的炎症呀、肿瘤性的疾病，

1:55:38 - 1:55:41

让他这个口服的铁呢不能够被补充。

1:55:41 - 1:55:46

那么静脉的铁呢现在呢就越来越受到了关注。

1:55:46 - 1:55:50

以前呢比如右旋糖肝铁则在输注的时候不良反应高，

1:55:50 - 1:55:51

输注时间长。

1:55:51 - 1:55:54

但是现在有了新型的静脉的铁，

1:55:54 - 1:55:57

比如说医麦芽糖、肝铁，

1:55:57 - 1:56:00

他的输注呢非常的安全，

1:56:00 - 1:56:01

时间非常的短，

1:56:01 - 1:56:03

超过半个小时就可以了。

1:56:03 - 1:56:08

而且呢依次输注就能够有效高效的补铁。

1:56:08 - 1:56:11

当然了也这个我们温迪教授也讲到了，

1:56:11 - 1:56:14

在输注过程当中的不良反应哈，

1:56:14 - 1:56:18

特别提到了这个肺湿病病个异常这个反应。

1:56:18 - 1:56:21

那么这个反应呢实际上就是指的在输注过程当中，

1:56:21 - 1:56:22

病人就出现了，

1:56:22 - 1:56:26

比如说脸红、心慌、胸闷等等哈，

1:56:26 - 1:56:29

这样的一些表现现就去。

1:56:29 - 1:56:30

及时的处理哈，

1:56:30 - 1:56:31

暂停输血，

1:56:32 - 1:56:33

暂停输铁。

1:56:33 - 1:56:38

在在这个大部分的病人呢都能在15min左右的时候呢，

1:56:38 - 1:56:38

自行缓解，

1:56:39 - 1:56:40

还可以继续的输注。

1:56:40 - 1:56:44

只有少数的病人呢需要应用的抗过敏的药物，

1:56:44 - 1:56:52

以及呢需要应用这个还有其他的肾上腺素呀等等这些严重的不良反应的时候呢，

1:56:52 - 1:56:53

他才需要输注。

1:56:53 - 1:56:56

但是这种严重的不良反应发生率是非常非常低的。

1:56:56 - 1:57:01

他说了在0.0005%是非常的低的。

1:57:01 - 1:57:06

因此呢就是说呢我们应该高度的重视缺铁和缺铁性贫血。

1:57:07 - 1:57:08

在补铁的过程当中，

1:57:08 - 1:57:11

如果口服铁嗯不行，

1:57:11 - 1:57:15

那么就要尽快的去切入到这样的一个静脉体，

1:57:15 - 1:57:17

安全有效，

1:57:17 - 1:57:19

这是我今天有一点点的收获，

1:57:19 - 1:57:21

再次感谢苯迪教授，

1:57:21 - 1:57:22

也感谢胡锦教授。

1:57:24 - 1:57:24

好的，

1:57:24 - 1:57:27

谢谢刘教授的这个讨论和点评。

1:57:27 - 1:57:28

那么时间关系，

1:57:28 - 1:57:30

我们这个环节就到此结束。

1:57:30 - 1:57:33

我们进入今天的最后一个环节。

1:57:34 - 1:57:39

特别隆重介绍两位大重量级的这个会议的主持。

1:57:40 - 1:57:44

一位呢是来进来自北京大学第三医院的柯晓燕教授。

1:57:44 - 1:57:49

还有一位呢是来自苏州大学附属第一医院的陈舒宁教授。

1:57:49 - 1:57:52

这两位教授呢都是有丰富的临床经验，

1:57:52 - 1:57:57

也是这个在国内的学学界有非常多的学术任职。

1:57:58 - 1:58:02

卓有这个成绩的这个临床的大大牌的专家，

1:58:02 - 1:58:05

那我就把这个话筒交给柯晓燕教授。

1:58:12 - 1:58:13

柯老师，

1:58:13 - 1:58:14

您的麦克风。

1:58:17 - 1:58:17

对，

1:58:18 - 1:58:19

不不好意思，

1:58:19 - 1:58:22

非常感谢辅景教授授介绍绍，

1:58:22 - 1:58:25

也那个热烈祝贺陈文明教授，

1:58:25 - 1:58:27

再次选选主主，

1:58:27 - 1:58:29

那那么也非常常高兴，

1:58:29 - 1:58:32

那有机会和陈苏宁教授一起主持。

1:58:32 - 1:58:33

我们今天的这个环节。

1:58:34 - 1:58:38

那这个今天呢大咖云集，

1:58:38 - 1:58:40

我们从早上一直到现在，

1:58:40 - 1:58:43

听了很多很多新的内容。

1:58:43 - 1:58:45

那么我们这个环节呢，

1:58:45 - 1:58:49

是请到了美国的，

1:58:49 - 1:58:54

没有诊所的这个瑞andry教授。

1:58:54 - 1:58:58

那么kanderin教授他的主要专业的这个特长呢，

1:58:58 - 1:59:04

就是一直在免疫免疫治疗和异经移植方面。

1:59:04 - 1:59:08

所以呢他在这这个卡替的这个探索方面做了很多的工作。

1:59:09 - 1:59:11

他也是他们那个血液，

1:59:11 - 1:59:14

血液专业的这个顾问，

1:59:15 - 1:59:17

那么也是这个免疫学专业。

1:59:17 - 1:59:20

业的顾问还是这个分子，

1:59:20 - 1:59:25

医学的这个分子医学免学专的这个顾问。

1:59:25 - 1:59:32

那么下面面他就给们介绍绍是是零30年r帕替治疗，

1:59:32 - 1:59:34

我们在那儿好，

1:59:34 - 1:59:35

有请。

1:59:38 - 1:59:40

thank you very much msaself for day，

1:59:40 - 1:59:41

kind in introduction。

1:59:42 - 1:59:50

i think it's important to note that the concept of character sytherapy or kydic attition recepcacisal therapy is old。

1:59:50 - 1:59:56

the concept was first pioneered by ashhaa and colleagues in nineteen eighty ty，

1:59:56 - 2:00:01

nine at that time was referred to as AT body or a cymaric sector。

2:00:02 - 2:00:02

everybody，

2:00:02 - 2:00:03

this is that。

2:00:04 - 2:00:08

lee car is as synthetic protein。

2:00:09 - 2:00:14

that has a part of an monocoronneal antibity as enggoach ing variable fragment。

2:00:14 - 2:00:17

this is a part that buinston and tigen。

2:00:17 - 2:00:20

that is refuse to a。

2:00:20 - 2:00:22

transmitin domain。

2:00:22 - 2:00:26

and if you used to AD al domain and hance the in kymaric，

2:00:26 - 2:00:34

because it incorporate part of an outside part of a excel on the outside of excel，

2:00:34 - 2:00:40

um refuse to part of t cel l sigsing domain of t cl l on the inside excel。

2:00:40 - 2:00:41

and that，

2:00:41 - 2:00:47

that car went to the um clonic and uh in in the nineteen nineties。

2:00:47 - 2:00:51

and what we learned is that the efficanacy of this car was pretty modest。

2:00:51 - 2:00:53

and then later on，

2:00:53 - 2:00:54

we learned that the car，

2:00:55 - 2:00:58

the gicell actually use signals um to work。

2:00:58 - 2:01:03

and that led to what we call now as a second second generation car，

2:01:03 - 2:01:05

which is the car that is um currently，

2:01:05 - 2:01:10

i'm FDA approved that i will be discussing doing them on presentation。

2:01:10 - 2:01:17

so this car incorporate in addition to CD three um zatis in only domain and costing military um domain，

2:01:17 - 2:01:20

such AC twenty eight for one BB or any costing military domain。

2:01:20 - 2:01:23

um that um if you like。

2:01:24 - 2:01:25

and since then，

2:01:25 - 2:01:31

there have been efforts to improve on this car by adding additional signaling domains，

2:01:31 - 2:01:33

additional trafficking molecules psytokinds。

2:01:34 - 2:01:41

and something that um investigators called third generation poll generation thirgeneration um卡cuty。

2:01:42 - 2:01:46

um the concept of cararty is really synthetic biology as its best，

2:01:46 - 2:01:50

because the what you how you engineer，

2:01:50 - 2:01:55

the cell really direct how the cell behaves and vivo cararty cells are living cells。

2:01:56 - 2:02:01

and then molecule that is incorporated into the engineering dictates what happen to the cell，

2:02:01 - 2:02:04

they're going to be more side to toxic，

2:02:04 - 2:02:10

if they kill more effectiveveof or persist and more or the differentiate a certainty on type。

2:02:11 - 2:02:14

and we had to make a car t cells this car this car molecule。

2:02:16 - 2:02:19

is incertain into a tee cell by a virus or lantiviral vector。

2:02:19 - 2:02:20

so here，

2:02:20 - 2:02:22

in this car to mentionwn by a lantiviral vector，

2:02:22 - 2:02:26

this car molecules inserted into the tee cell。

2:02:26 - 2:02:29

through the lantiviral goes into the nucleus，

2:02:29 - 2:02:32

and then it gets expressed on the surface。

2:02:32 - 2:02:34

and now the kea cell express，

2:02:34 - 2:02:37

the car molecule on the surface that targets the engsion。

2:02:37 - 2:02:42

in addition to the native resector on the key cells and then that car molecule。

2:02:43 - 2:02:45

finds ones for their integen poinds，

2:02:45 - 2:02:50

their integen and gets their actis have to kill their i'm antigen to kill their human selves。

2:02:52 - 2:02:55

and the process today is an autologist process。

2:02:56 - 2:02:59

so by that means that to make card t ells，

2:02:59 - 2:03:03

we take t celof frontation through a process。

2:03:03 - 2:03:04

搞萝卜粉一起吃。

2:03:05 - 2:03:07

we isolathe key thousand。

2:03:07 - 2:03:08

the last olated，

2:03:08 - 2:03:11

the cells are isolated frountations send to the low。

2:03:11 - 2:03:12

the key cells are isolated。

2:03:13 - 2:03:16

and in the love over a period of sevento ten days，

2:03:16 - 2:03:18

the tesalls are stimulated。

2:03:19 - 2:03:20

so that they grow by several several falls。

2:03:20 - 2:03:23

and during this period of time，

2:03:23 - 2:03:27

they are engineered with either virus or non virus。

2:03:27 - 2:03:29

so that the esel is now a car ty cell。

2:03:29 - 2:03:33

they expressed the the party on the surface。

2:03:34 - 2:03:38

and then at the end of the at the end of this period of expansion。

2:03:38 - 2:03:44

now anywhere between twenty and one hundred percent of the cells of the tea cells or arartety cells。

2:03:45 - 2:03:49

and patients receive loaddos came on therapy for the bedding came on therapy。

2:03:50 - 2:03:55

this is to create a homeopstatic environment for the um adoctively transfused canacty cells。

2:03:55 - 2:03:58

if you like to make cream for the new chartecells，

2:03:58 - 2:04:00

so the purpose of this cheme motherapies，

2:04:00 - 2:04:03

not really to to attack that the patients cancer cells。

2:04:04 - 2:04:06

and and then follow ing，

2:04:06 - 2:04:07

the adking of their abity cells，

2:04:07 - 2:04:10

the the party cells told of ccarcells。

2:04:10 - 2:04:12

so the process today today，

2:04:12 - 2:04:18

the FDA approved the product is that the cells are collected are shishits to the company。

2:04:18 - 2:04:20

the company make carty cells，

2:04:20 - 2:04:23

and they shift back to us and that period of time，

2:04:23 - 2:04:27

it takes anywhere between three to four weeks of that，

2:04:27 - 2:04:32

about seven ten days is an actual manufacturing of carart ty cells in the and a lot。

2:04:34 - 2:04:35

and then sixteen，

2:04:35 - 2:04:39

nineteen is a target that is common ly solved after the field ld of union therapy。

2:04:39 - 2:04:41

and kattiy southerapy。

2:04:41 - 2:04:45

city nineteen is expresed on BE cells。

2:04:46 - 2:04:51

and expressed on all the cheming vessels and cancer vessels。

2:04:52 - 2:04:53

and therefore，

2:04:53 - 2:04:55

it sought thererea treatment of比，

2:04:55 - 2:04:55

塞仑，

2:04:55 - 2:04:58

磺茂or比沙that treaton for a plasstiful纪验。

2:05:00 - 2:05:00

be uh，

2:05:00 - 2:05:07

fifty nineteen is uniquely expressed on all cancer cells and is not expressed on normal cells。

2:05:08 - 2:05:09

therefore，

2:05:09 - 2:05:10

a safe ty target。

2:05:10 - 2:05:14

the only expression on cty nineteen is on normal b cells。

2:05:14 - 2:05:15

and therefore，

2:05:15 - 2:05:19

when you use see in lengching target of thirty，

2:05:19 - 2:05:21

the normal peis has articulated。

2:05:23 - 2:05:32

depleletion of normal ecells generally speaking is easy to deal with ecclonic for replacement of IV of imunal bloglms with IVID。

2:05:34 - 2:05:38

but that's why nxiin nineteen is ecommonly sought target。

2:05:38 - 2:05:42

and and that's a critical in the field of charty autherity。

2:05:42 - 2:05:46

so chararties that that targein and t ina refer to carcounty，

2:05:46 - 2:05:49

but that's critical is in the field of tarty authity。

2:05:49 - 2:05:50

because if your target，

2:05:50 - 2:05:56

if if the cararties are directed in engineer to target and antigento target，

2:05:56 - 2:06:00

eight one agent that is expressed and normal issusue，

2:06:00 - 2:06:07

that first reports often of successful carneity in the clinic was imppatients with the inmmer and amtience uceela。

2:06:07 - 2:06:09

this is one patient。

2:06:09 - 2:06:10

um in two thousand，

2:06:10 - 2:06:11

ten published out of that，

2:06:11 - 2:06:13

i each with learn former，

2:06:13 - 2:06:18

where patients has a lugular lomforma and the significant response。

2:06:19 - 2:06:22

lasting uh monmonth after party celererity，

2:06:23 - 2:06:26

but then their remarkable response with remarkable responses，

2:06:26 - 2:06:27

where，

2:06:27 - 2:06:33

after three patients treated at the university of pensylbanian patients had seallow and their beel lggancy。

2:06:34 - 2:06:37

and in these patients that receisust ten nineteen，

2:06:37 - 2:06:39

and she's complete permission，

2:06:39 - 2:06:41

including in one patient，

2:06:41 - 2:06:48

was thought to on half pound several pounds of this use prior to treatment went in complete permission。

2:06:49 - 2:06:52

and while it's only three patients that we learned from that，

2:06:52 - 2:06:55

we learn that the carkeies very important，

2:06:55 - 2:07:03

we also learn that they can differentiate into memory and persist that was referring earlier to the concept synthetic biology，

2:07:03 - 2:07:06

because these carories have four BB in and four one b，

2:07:06 - 2:07:10

drithe differentiof thecells into memory memory pecells。

2:07:12 - 2:07:16

uh so so we learn that they can differentiate who also learned that they very important，

2:07:16 - 2:07:18

they eradicated pounds of disease，

2:07:18 - 2:07:21

and we also learned about doxorcities would side to cand releassysyndmme。

2:07:22 - 2:07:24

follow these sitsations，

2:07:24 - 2:07:25

what can these？ so。

2:07:26 - 2:07:29

have been remarkably effective in acutfor for astical keeing，

2:07:29 - 2:07:32

especially in in children and youngedodo。

2:07:32 - 2:07:34

this is the first child。

2:07:35 - 2:07:37

no to went on establish her own foundation。

2:07:37 - 2:07:44

her name is analy ted that received carnine teteen for and give them for plasticical kemia。

2:07:44 - 2:07:44

and uh，

2:07:44 - 2:07:46

we we learn that she develop significficcan cycle，

2:07:46 - 2:07:47

kind release and much。

2:07:47 - 2:07:49

i go to touch on later and the presentation。

2:07:50 - 2:07:52

the ICU on moni organ failures。

2:07:52 - 2:07:55

we also learned about treatment outside tle，

2:07:55 - 2:07:56

tle and release centre，

2:07:56 - 2:08:00

and the patient ent was interintermission two thousand and fourteen，

2:08:00 - 2:08:02

and in this still lundereration，

2:08:02 - 2:08:03

as in point point，

2:08:03 - 2:08:03

one，

2:08:03 - 2:08:09

nine years after charactities are singsinginfufuhighlighting the similar to our previous pation。

2:08:09 - 2:08:16

see see highlighting that potential curcurative pocurtial potential of this therapy。

2:08:16 - 2:08:19

they they get t to the poasof this looking yet。

2:08:19 - 2:08:22

carrent nineteen have been unremarkably affected。

2:08:22 - 2:08:23

you see here on the left。

2:08:23 - 2:08:27

this is the outcome of patients that relaalives after。

2:08:27 - 2:08:33

um after after team of therapan and transplantation and accufor for last last little chemia。

2:08:33 - 2:08:42

and this is the outcomes of patients that are treated after cart celsing similar group of patients um that are treated after one infusion of cart sales。

2:08:43 - 2:08:48

with a complete responsorings anywhere between eighty nineninepercent and a adurable response rbetween fifty，

2:08:48 - 2:08:53

fifty and fifty uh perent suggesting potentially uum um curative。

2:08:54 - 2:08:58

uum nature of this therappean and in this group of patients。

2:08:58 - 2:09:00

and indeed，

2:09:00 - 2:09:05

that led to somehow um FDA on approval of convvon，

2:09:05 - 2:09:15

the d of the first PD patient that was was twenty seventeen to the FDA approval of ginin acual of of asc and and seventeen teen。

2:09:15 - 2:09:23

and and vvinof adult in cllinof gceral trial in acultial adult um this carried on um this，

2:09:23 - 2:09:36

every reason analysis that we publish shown that in the advacy y of asvof of last asticium is not necessarily specific that clinical trial。

2:09:36 - 2:09:42

but across multiple clinical trial that our single um center or seventeen。

2:09:42 - 2:09:58

and and this evaccand m seval al um a progresof of clclperent ent um a progression free survival and dverable responses in these patients。

2:09:59 - 2:09:59

similarly，

2:09:59 - 2:10:03

the result in in AA informer were quite um remarkable，

2:10:03 - 2:10:14

with about um seventy to eighty percent of patients achieving responses after kind eighteen therapy and thirty to forty percent of patients achieving durable responses。

2:10:14 - 2:10:15

importantly，

2:10:15 - 2:10:18

if patients receive achieve response，

2:10:18 - 2:10:29

they tend to well well reerin in complete response for long other period of time of highlighting the durative potential of of this um thery um this again，

2:10:29 - 2:10:33

um how the true across multiple um ltscenterre clinical trials。

2:10:33 - 2:10:35

these are there，

2:10:35 - 2:10:40

three monlticenal clclinical trials that were conducted for um long，

2:10:40 - 2:10:40

formal，

2:10:40 - 2:10:45

using a three different contracthis is was now called exxcell。

2:10:45 - 2:10:45

the therapy。

2:10:45 - 2:10:47

this is what called this sesel，

2:10:47 - 2:10:49

and this one wce called the therapile。

2:10:49 - 2:10:56

and showing that um overall response rate of about seventy to eighty percent。

2:10:56 - 2:10:59

and then a complete response rate of forty to fifty percent。

2:10:59 - 2:11:02

endable computer response rage of their beautially and percent。

2:11:03 - 2:11:05

important reasince，

2:11:05 - 2:11:06

the FD approproval。

2:11:06 - 2:11:14

we have learned about with what we call the real world outcome that is not on clclinical trial，

2:11:14 - 2:11:19

but i'm actually that FA approved ved therapy and important it。

2:11:19 - 2:11:28

we see compared to clclical rate acclall responroups that outcomes are quite sirouar across different responal al al，

2:11:28 - 2:11:32

complete similal to what we is quall response rate。

2:11:32 - 2:11:39

the toxiccities and they use of therapy for toxiccities to janggi jon later this on presentation。

2:11:39 - 2:11:47

this highlighting that the um the adaptation of this therapy beyond unclinic on trials。

2:11:48 - 2:11:49

in addition，

2:11:49 - 2:11:51

BCM may directed card，

2:11:51 - 2:11:56

he saw erapy BCN may is a different targets that heis some maturious integence。

2:11:56 - 2:11:58

so this is car BCN may。

2:11:59 - 2:12:09

and been developed for it for multiple my lama and um has been remarkably active inpatients with the relax and reflectory multiple。

2:12:09 - 2:12:14

my lawman was approved um earlier for multiple um my lama as well。

2:12:14 - 2:12:22

so now we have um carties so targeting ninenci for learform MM martities m muc MMCMMR ties as for multiple my omwer。

2:12:22 - 2:12:35

this is the um clinical trials again shown that i'm almost most all patients that receive one one hundred and and currentees es develop response and and um and develop responses directly。

2:12:35 - 2:12:37

and then that response last a median，

2:12:38 - 2:12:39

the median response was about a year，

2:12:39 - 2:12:43

and there could be at al end of of that survival care，

2:12:43 - 2:12:46

suggesting to asset patients could benefit from drubble response，

2:12:46 - 2:12:48

but is still early to tell。

2:12:50 - 2:12:50

so in somebody，

2:12:50 - 2:12:51

the gay approvals，

2:12:51 - 2:12:53

we have cannineteen and pegeatc young adults。

2:12:53 - 2:13:01

this is d cell this a and lforformer have have three three different products that are approved in learn former，

2:13:01 - 2:13:04

and including a as like modification。

2:13:04 - 2:13:09

that is the the brx cell that is approved in mantal celomformer or the cartist。

2:13:09 - 2:13:14

um so this is approved in mantal celomforms as light modification of the excess ell。

2:13:14 - 2:13:15

the contrct is the same，

2:13:15 - 2:13:18

but the manufacturing is a big different sewhere。

2:13:18 - 2:13:26

the the manufacturing diep CI nineteen to make sure that there are no lochemic cells that are being transstitused。

2:13:27 - 2:13:37

and so we have the three contracts um approve for alinformer and including this slightly um modified contrts as approve formatters of illinmmer。

2:13:37 - 2:13:41

and brxcsallis is was also approved for adult，

2:13:41 - 2:13:42

an eusiment ful，

2:13:42 - 2:13:44

plassc kkiman and ID cell。

2:13:44 - 2:13:49

the BCM aderct carity's therapy that was approved for um multiple miluoma。

2:13:49 - 2:13:58

um over the last few years in unon therapy has has become a nuclear and in the treatment of cancer。

2:13:58 - 2:13:59

in addition to keam，

2:13:59 - 2:14:05

a therapy radiation surgery and now came on therapy radiation surgery and just erapy。

2:14:05 - 2:14:09

that was highlighted in the science。

2:14:09 - 2:14:19

something was a break through of the year that was AA through ererp and was was a erpoint point heritor on revolution。

2:14:20 - 2:14:26

so where we are now and is that arty cells um in in lainformer and and in lukinia，

2:14:26 - 2:14:29

the majority of vtititions have responses，

2:14:29 - 2:14:32

but about thirty to forty percent have durable complete responses。

2:14:32 - 2:14:35

the liliititation of artitiass is that。

2:14:36 - 2:14:43

the gartting says issocisocisee do significant doxes cities named side dock can really ally centra neurdoxiccity inside opinions。

2:14:44 - 2:14:45

it works well，

2:14:45 - 2:14:47

but the drubal sponses ses are still low。

2:14:47 - 2:14:53

the drubor responses thirty percent forty percent we want to make this hundred percent。

2:14:53 - 2:14:56

it doesn't work very well in solar tumor。

2:14:56 - 2:15:00

in which is an area of i met are need。

2:15:00 - 2:15:08

and can we now capitalzze and harness the effect of details and move to non cancer applications？

2:15:10 - 2:15:12

and then once ly。

2:15:12 - 2:15:17

the um the current proprocess is ite ite，

2:15:17 - 2:15:18

complex，

2:15:18 - 2:15:20

costly and uh，

2:15:20 - 2:15:23

somehow results in limited access to acarity。

2:15:23 - 2:15:24

as i mentioned，

2:15:24 - 2:15:25

an ethologgist process，

2:15:25 - 2:15:29

patients have the souls manufacturers to the company。

2:15:30 - 2:15:30

come back it，

2:15:30 - 2:15:33

the four weeweeks extremely expensive，

2:15:33 - 2:15:49

the delivery of guacty sel and the care of guacticell and and the whole the whole process um in results in limited access of guacty sel to major institutions um um um。

2:15:49 - 2:15:54

i'm and too certain fit on patients who can who can tolerate therapy。

2:15:56 - 2:15:58

怎么才得到10c迪是阿丹法提升？

2:15:59 - 2:16:05

and we've learned that guarty souaskn was side to can i listen to and and with a neurrodoxicity。

2:16:05 - 2:16:12

and we have learned at the cdetle kind um releasing them of our charty cell is terteteroriarized by high vievers。

2:16:12 - 2:16:13

biog yes，

2:16:13 - 2:16:16

robot brossiure sitter toto fuill year。

2:16:18 - 2:16:27

and um patient can be in the intensive carrier and own process on the ventilater ter and associated with high levels of pdetle kinds。

2:16:27 - 2:16:28

it is，

2:16:28 - 2:16:30

if you like the cartises are living cells，

2:16:30 - 2:16:31

carticies are refused。

2:16:31 - 2:16:37

they see the cancer cells that prolierating and massive amounts intervival。

2:16:37 - 2:16:41

they are making their cancer kinds to kill the cancancer cells。

2:16:41 - 2:16:43

and patients are sick during this time。

2:16:44 - 2:16:49

we also learned that iyle six is important in this cdeof can lelease synron。

2:16:49 - 2:16:51

and that if we target，

2:16:51 - 2:16:58

i al six with an empty body that has been available that was available for the treatment of juveni romentdidirectanties。

2:16:58 - 2:17:03

we're able to prevent uh um syndrome or we're able to treat on cytle anallease syndrome。

2:17:03 - 2:17:05

um this is those。

2:17:05 - 2:17:07

it will smart the antibody that has become FDA approved，

2:17:07 - 2:17:09

along with party ties self for the treatment。

2:17:09 - 2:17:14

and it's currently is the main stday of the treatment or psytbangallease syndrome。

2:17:15 - 2:17:23

we are getting better and better and recognize cycle inry east syndrome early and a treating that also early with to solution。

2:17:23 - 2:17:27

but mortality ity has been seen in the past with cyccan release on syndrome。

2:17:28 - 2:17:29

neurocasses yhon。

2:17:29 - 2:17:31

the other hand is not very well。

2:17:31 - 2:17:34

understood patients can get confused and sypooopthit。

2:17:34 - 2:17:35

occasionally，

2:17:35 - 2:17:38

you can have eight typical finintics，

2:17:38 - 2:17:44

um is seen with other carty cells seen with cd ty nineteen targeted therapy with bites。

2:17:45 - 2:17:47

and that's have been reported，

2:17:47 - 2:17:50

especially associated with brain。

2:17:51 - 2:17:58

there are some um there are changes of them line on the neurrodoxity um can to be transient。

2:17:58 - 2:18:04

but if a brain in associated neurroassociity um has high mortality。

2:18:04 - 2:18:07

why did we learn new a找CCT？ we learned that。

2:18:08 - 2:18:11

is associsociated asstruction of blood brain brier。

2:18:11 - 2:18:16

so seems to follow psychokind relecerm patients have high elevation，

2:18:16 - 2:18:24

tional psytokines that blood brain barer is disrupted cells leaak into the into the ererprofinal socisociid with the cells，

2:18:24 - 2:18:29

the cells into a teccells sociells mild cells，

2:18:29 - 2:18:32

and that seems to be associated with neuron toxity。

2:18:32 - 2:18:32

um，

2:18:32 - 2:18:33

for example，

2:18:33 - 2:18:40

this the analysis of the one of the main clsociical al socities and to the f erroval sociccand t，

2:18:40 - 2:18:47

and you can see that cytocum GMCSF was most significantly associated with moxicity with neuron toxicity，

2:18:47 - 2:18:53

and also infiltraration CD fourteen positive cells to presocites into the ceerprofinal fluid，

2:18:53 - 2:19:04

where significantly associated with the development uum toxity ity with neneurrooxity ties and to eral al al cells and based ally with uh several efforts to to target these cells，

2:19:04 - 2:19:07

preprevent dedevelopment or trethree neurooxicity ties。

2:19:08 - 2:19:13

the current time we don't have active um effectively treatformal。

2:19:13 - 2:19:13

so such，

2:19:13 - 2:19:17

there are b as i six IL one and GS yourself currently uum。

2:19:17 - 2:19:18

um this，

2:19:18 - 2:19:22

the other set of kinces are being studying the grass sgoing go to else。

2:19:25 - 2:19:27

so the said a doxiccity ties said um um the side，

2:19:27 - 2:19:34

the complete permission rates remain in slope after their car dem that a current limitation um as i。

2:19:35 - 2:19:39

mentioned earlier thirty to forty percent after a long form，

2:19:39 - 2:19:42

but important tly and solid tumor guarantee，

2:19:42 - 2:19:46

so are be easy quiet um limited devties。

2:19:46 - 2:19:51

and um i think there are three problems and solid。

2:19:51 - 2:19:55

one problem is the the acties also get into the tumor trafficking of the caacficking，

2:19:55 - 2:19:57

because it form solid masses。

2:19:57 - 2:20:00

and it does seem that it into the tumor。

2:20:00 - 2:20:05

but i think this is area that continue to need work to improve on。

2:20:06 - 2:20:08

um so i say that because for example，

2:20:08 - 2:20:10

and this um in this。

2:20:15 - 2:20:18

uh and and and this is study，

2:20:18 - 2:20:23

where is a ven car was used um to target me comum。

2:20:23 - 2:20:29

you see some part share responses may be stable disease。

2:20:29 - 2:20:35

but then if um i thouthat you think theourselves i they are just cancer or ourves。

2:20:35 - 2:20:39

you see the cancer are there are just inhait it by by the jmor。

2:20:39 - 2:20:44

so i think the main issues that inhibitves the inbitof mmelor，

2:20:44 - 2:20:46

i is linmthe inthe sesusubut。

2:20:46 - 2:20:49

the issues that target on finding。

2:20:49 - 2:20:50

and i mean，

2:20:50 - 2:20:53

i mention that story will hers to and be careful。

2:20:53 - 2:20:59

ffinding and arget y for cof are are cmbut not not on tissue。

2:20:59 - 2:21:00

but for example，

2:21:00 - 2:21:03

misshould thone is it is a great um farget。

2:21:03 - 2:21:06

um uthe teen are two car ar ties es ase report。

2:21:06 - 2:21:14

publishum medicine join that um this bastion and chief complete ternation of leablast，

2:21:14 - 2:21:17

which is quite any usual in the geangiy，

2:21:17 - 2:21:19

but complete highlighy，

2:21:19 - 2:21:24

but never the less highlighting the potential use of caghligsease。

2:21:25 - 2:21:28

um so we across the last five years，

2:21:28 - 2:21:31

we've learned about toxxities of cararty cells。

2:21:31 - 2:21:35

and and we learned about the elelementation of cartety cells，

2:21:35 - 2:21:41

including to assistance um and inhibition by the solid two mor by the two mmy gragracts，

2:21:41 - 2:21:41

clean，

2:21:41 - 2:21:46

basic key celeffects cts as well as the um the two，

2:21:46 - 2:21:47

many candies，

2:21:47 - 2:21:51

where two two or would escape um the carty ty ell effect。

2:21:51 - 2:21:53

so with that team，

2:21:53 - 2:21:58

the next to the current offerers and the next offerers are to address this limitation。

2:21:59 - 2:22:00

address the darxities，

2:22:00 - 2:22:05

specifically the nural toxicity uh resistance to cart cells，

2:22:05 - 2:22:07

develop strategies to make characty cells，

2:22:07 - 2:22:09

more inhibition and resistance。

2:22:09 - 2:22:11

if you like more importent。

2:22:11 - 2:22:19

to overcome day and to want micro vironment and also expand the engineer cells and two automtomnum diseases。

2:22:20 - 2:22:27

and multine target antigence to avoid the antigent negative urealise that we see after ararsa，

2:22:27 - 2:22:33

where the tumor on escape comes back with an antigen with an nenetitives and cannism moortcape。

2:22:34 - 2:22:42

um um also interesting the coursts and access to partisal erarity um uum，

2:22:42 - 2:22:46

attempting to move an an offal al logent apapproskipping，

2:22:46 - 2:22:59

this compleplex um um lovthis process um or using academic factory um factory um if you like um or um generating arteiss in people。

2:23:00 - 2:23:02

and over the next time minuminui，

2:23:02 - 2:23:07

i'm going to acture briefly on some of are and other efforts to expand characties salso，

2:23:07 - 2:23:12

which i think we're going to see more and more over the next um ten years，

2:23:12 - 2:23:15

more of services in the any trials and trial。

2:23:16 - 2:23:16

so for toxicity，

2:23:16 - 2:23:21

um this is some of the affairs of our group。

2:23:21 - 2:23:30

um what we have learned is um carteity so toxicity that psychobrelesten around develop three to five days and these xxity ls in mmodees。

2:23:30 - 2:23:37

um so if it is that we develop a mouse models and many this toxxicity after characity cells。

2:23:37 - 2:23:41

and we see in these mild month models，

2:23:41 - 2:23:47

the um mdevelovelothis psytpity models and women in three to five days，

2:23:47 - 2:23:50

and they have elevation ation ccvmations similwhat。

2:23:50 - 2:23:51

we see en patients。

2:23:51 - 2:23:55

this is using all human cells and human nice um models。

2:23:55 - 2:23:56

and also，

2:23:56 - 2:23:59

we see that in this cells and activous models，

2:23:59 - 2:24:01

we see um information of the brain。

2:24:01 - 2:24:08

someone similwhat we see in patients um also unfillaation these cells and activation of modelight cells，

2:24:08 - 2:24:11

ls the mice and um follow ing cartety cells。

2:24:12 - 2:24:14

so we um use this models，

2:24:14 - 2:24:23

and we decidid whether we could um colleague GNCS efforits a moil exside to plan ground your side mooside econy YA simulating factor。

2:24:24 - 2:24:27

we we could darget that in preprevent this m。

2:24:27 - 2:24:29

and so we used that。

2:24:29 - 2:24:34

and we tested whether if we combine and ending what we diue engting and CSF。

2:24:34 - 2:24:38

with carneting that prevent the synroroand，

2:24:38 - 2:24:41

what we see that when we use a combination，

2:24:41 - 2:24:47

and we depleay GMCSF that mice do not um lose uh way。

2:24:47 - 2:24:50

so mice that treated with treated al lenine，

2:24:50 - 2:24:58

they lose weight and development mice that associated with significant elelevtive multiple sysydroans multial mmum，

2:24:58 - 2:25:02

but mice um treated with the combination of sociated，

2:25:02 - 2:25:04

plus the GMSF intelrogc mice，

2:25:04 - 2:25:06

they maintain their weight，

2:25:06 - 2:25:13

and they have a significant reduction of sysynrorome that that associated with invelopment of the syndrome human。

2:25:14 - 2:25:16

in addition，

2:25:16 - 2:25:27

when we imagine mmice um we see that um in mice that are treated with ten teteen alone with the control antibody day develop。

2:25:27 - 2:25:31

this syndrothat is a infplmenation of the brain，

2:25:31 - 2:25:37

and we measure that we see significant um enhancment significant increase and in enhancy forma。

2:25:37 - 2:25:45

but we see that it's reduced when we use GMCS high enintalizing antibody ity similar to the basine。

2:25:45 - 2:25:46

and so in summary，

2:25:46 - 2:25:50

i think i'm not all like exparty cells currently approved and alone，

2:25:50 - 2:25:52

former and inisalia and my lama，

2:25:52 - 2:25:54

the initial sponcenent and are high，

2:25:54 - 2:25:59

where acfeabout about potential durble response and the corrective potential，

2:25:59 - 2:26:01

which is fifty sixty percent。

2:26:01 - 2:26:04

and the forpercent learn formy sigreforant in my lama。

2:26:04 - 2:26:13

the toxities were learning more and more how to manage age management of norwer toxity still remains an area of unmenant ity than motherapties are in the clinic。

2:26:13 - 2:26:14

the complex，

2:26:14 - 2:26:16

the platforms currently complex，

2:26:16 - 2:26:19

expensive um and it's time consuming。

2:26:20 - 2:26:25

i think what we lend to see more and more of these edited carard cells that enter into their clinic。

2:26:25 - 2:26:31

we want to make sure that to edit does not impmpir car cells does not make them more toxicand。

2:26:31 - 2:26:35

and less making them bledtoxic making them more effective。

2:26:35 - 2:26:41

and we 're not to see more engineer um sales far thers are humans as well as automntive diseases。

2:26:41 - 2:26:43

and hopefully ful，

2:26:43 - 2:26:45

she want more the office shelf，

2:26:45 - 2:26:48

um characty sales ls to adaddress the complexity。

2:26:48 - 2:26:52

and the answer issue don't think you all for um。

2:27:00 - 2:27:01

好的，

2:27:01 - 2:27:03

非常感谢主恩，

2:27:03 - 2:27:04

教授给我们。

2:27:04 - 2:27:08

对于canr t的历史现状，

2:27:08 - 2:27:12

包括未来的展望做了非常精彩的一个介绍。

2:27:12 - 2:27:14

那么接下来我们进入讨论环节，

2:27:14 - 2:27:16

我来介绍一下我们这个讨论环节。

2:27:16 - 2:27:21

几位讨论嘉宾第一位邓丽学教授来自解放科主任。

2:27:21 - 2:27:28

那么也是我们北京市医学会学习分会的心灵科主任任很多学术认识，

2:27:28 - 2:27:32

我想我们国内的学界同行都非常熟悉的一位专家。

2:27:32 - 2:27:36

那么第二位的讨论嘉宾是江松副主任，

2:27:36 - 2:27:40

姜主任是温州医科大学附属第一院的学内科科主任。

2:27:40 - 2:27:44

那么也是浙江省医学会学术分会的委员，

2:27:44 - 2:27:44

医师，

2:27:44 - 2:27:45

学会的委员，

2:27:45 - 2:27:48

也是国内知名的血液病专家。

2:27:48 - 2:27:52

那么第三位的讨论嘉宾是周辉主任。

2:27:53 - 2:27:58

那么周慧主任来自湖湖南省肿瘤院是淋巴瘤血内科的主任，

2:27:58 - 2:28:02

目前还担任吐鲁番市人民医院的副院长，

2:28:02 - 2:28:04

也是国内知名的淋巴瘤专家。

2:28:04 - 2:28:08

接下来我们首先有请窦丽萍主任。

2:28:09 - 2:28:09

好，

2:28:09 - 2:28:11

非常感谢陈主任的介绍，

2:28:12 - 2:28:13

也特别有幸能参加。

2:28:14 - 2:28:18

我们陈文明教授和高安教授组织的这样一个高大上的长城血液论坛，

2:28:19 - 2:28:24

这个讲的这个内容都是嗯在国际上非常的前沿。

2:28:24 - 2:28:26

那docttside的教授呢，

2:28:26 - 2:28:31

他系统的梳理了这个cart的，

2:28:31 - 2:28:32

包括他历史的严格，

2:28:32 - 2:28:35

包括他适应症。

2:28:35 - 2:28:39

因为CD19的这个开题主要是专注于CD19开题。

2:28:39 - 2:28:40

CD19开题，

2:28:40 - 2:28:41

大家也非常熟悉的，

2:28:41 - 2:28:43

咱们在国内应用的也非常多。

2:28:44 - 2:28:45

那它在b细胞里，

2:28:45 - 2:28:47

这个疾病里面，

2:28:47 - 2:28:48

因为CT19。

2:28:48 - 2:28:49

它表达是非常广泛的，

2:28:49 - 2:28:53

不管是在前壁还是在成熟的b细胞CD19，

2:28:53 - 2:28:56

其实都是还是有比较强的这种表达。

2:28:56 - 2:28:58

所以它呢在急淋白血病里，

2:28:58 - 2:29:01

因为我们是用的比较多吉淋白血病，

2:29:01 - 2:29:04

它的总体的这个治疗反应率还是不错的。

2:29:04 - 2:29:05

可以，

2:29:05 - 2:29:10

我看这个赛德教授报道的是50~60%的持续的这个CR率。

2:29:10 - 2:29:15

所以它的这个嗯无疾病生存率可以达到37%。

2:29:15 - 2:29:20

所以可能跟这个KT的质量其实区别还是蛮大的。

2:29:20 - 2:29:23

因为我们自己做的一些KT的这种临床实验。

2:29:23 - 2:29:26

我们发现可能尤其难治复发的这个疾淋白血病。

2:29:26 - 2:29:28

其实他的复发还蛮快的，

2:29:28 - 2:29:30

这个在咱们国内的专家，

2:29:30 - 2:29:32

大家还是有这样的共识。

2:29:32 - 2:29:36

所以可能对于这种吉林的高危的这种血液病，

2:29:36 - 2:29:42

因为毕竟能达到持续的这种嗯完全的无白血病的生存的患者，

2:29:42 - 2:29:43

单抗KT还是比较少的。

2:29:43 - 2:29:47

所以未来呢可能继续调节异经造血干细胞移植，

2:29:47 - 2:30:00

或者是我们对于KTT做植植嗯进一步的嗯这个多面或者是可能有持续性反应的这种KT的出现是我们未来的一个方向。

2:30:00 - 2:30:02

那它在b细胞肿瘤里嘛，

2:30:02 - 2:30:03

尤其在弥漫大壁里面，

2:30:04 - 2:30:08

它的这个持续的缓解率可以达到30~40%左右。

2:30:08 - 2:30:15

但是实际上这个数值呢对于一个难治的或者耐药的b细胞瘤弥漫大b三四指还是效果不错的。

2:30:15 - 2:30:21

所以现在尤其对于b细胞淋巴瘤这个KT的治疗也越来越多了。

2:30:21 - 2:30:25

很多的患者呢通过这个能嗯达到一个长期的这种生存。

2:30:25 - 2:30:26

另外呢。

2:30:27 - 2:30:33

赛德教授还介绍了BCMA的KT关于他呢其实治效果果还是可以无疾病。

2:30:33 - 2:30:36

平均的无疾病生存期是11.8个月。

2:30:36 - 2:30:37

但是总体来说呢，

2:30:37 - 2:30:39

可能能对于确实都是RT，

2:30:39 - 2:30:43

他是对于是一个细胞免疫的这种疗法，

2:30:43 - 2:30:45

它对于部分的这个患者是有效的。

2:30:45 - 2:30:48

但是部分的患者其实有一半以上的患者，

2:30:48 - 2:30:50

好像效果并不是特别理想。

2:30:50 - 2:30:56

所以未来我们对于KT如何能够使他嗯增强它的适用性和通用性。

2:30:56 - 2:30:57

现在好嗯，

2:30:57 - 2:31:08

我看黄黄教授授的那那文章它可用型的KT我们可能现在FDE批准的是字体的这种KT他可能未来通用型的KT或者用其他人的。

2:31:08 - 2:31:12

第三者来源的可能是一个未来的发展的这种方向，

2:31:12 - 2:31:15

也值得我们更进一步的来关注。

2:31:15 - 2:31:15

好，

2:31:15 - 2:31:16

谢谢。

2:31:20 - 2:31:20

好，

2:31:20 - 2:31:21

谢谢。

2:31:21 - 2:31:24

非常感谢窦教授的点评和分享。

2:31:24 - 2:31:28

那么接下来我们有请第二位的点评嘉宾，

2:31:28 - 2:31:29

讨论嘉宾姜松福教授，

2:31:29 - 2:31:31

有请姜老师。

2:31:33 - 2:31:35

谢谢苏宁教授的介绍，

2:31:35 - 2:31:36

那么非常荣幸。

2:31:36 - 2:31:38

那么加入我们这个大家庭，

2:31:38 - 2:31:41

那们又认识了很多新的朋友，

2:31:41 - 2:31:42

学习了很多新的知识。

2:31:42 - 2:31:44

今天一天内容非常丰富，

2:31:44 - 2:31:47

那么前面窦教授的点的点评呢，

2:31:47 - 2:31:48

我也完全赞同。

2:31:48 - 2:31:50

因为其实我们中国人在卡t这一块，

2:31:50 - 2:31:53

我感觉我们中国人做了非常大的努力，

2:31:53 - 2:32:00

尤其是这几年我们陈伟民主任的这个牵头的科技的那个BCM咖也应该已经获取上市了。

2:32:01 - 2:32:03

我们在卡替方面呢，

2:32:03 - 2:32:05

其实做了很多很多有益的探索，

2:32:05 - 2:32:06

包括我们中枢淋巴瘤的，

2:32:06 - 2:32:09

包括我们现在什么移植跟卡替桥接的，

2:32:09 - 2:32:12

其实这里还有很多很多的问题可能需要去解决。

2:32:12 - 2:32:15

那但是呢还有一个很多我们里面最重要的。

2:32:15 - 2:32:17

我们刚才前面杜教授提到的，

2:32:17 - 2:32:19

我们通用咖其实有个很重要的问题，

2:32:19 - 2:32:22

就是通用咖进属体内的存活时间太短。

2:32:22 - 2:32:23

所以有的时候呢，

2:32:23 - 2:32:25

可能就是起到了一个很短暂的一个疗效。

2:32:25 - 2:32:27

所以关于科发方面，

2:32:27 - 2:32:29

其实我们国国内的经验积累，

2:32:29 - 2:32:32

包括CSS处理ITS的观察与处理。

2:32:32 - 2:32:34

所以得出了很多很多的经验，

2:32:34 - 2:32:36

包括我们前文飞教授，

2:32:36 - 2:32:40

谢谢提出来的叫local CIS的这种说法，

2:32:40 - 2:32:42

其实这里面指的探索东西很多，

2:32:42 - 2:32:44

所以最后还是感谢一下吧，

2:32:44 - 2:32:46

因为时间不早了。

2:32:46 - 2:32:49

再次感谢我们高文教授这个经那个精心的组织，

2:32:49 - 2:32:52

因为短短的时间组织这么大的一个疗议。

2:32:53 - 2:32:54

我而且我们今天从早上到现在，

2:32:54 - 2:32:56

总共有10几个讲座，

2:32:56 - 2:32:58

所以我觉得非常的非常精彩，

2:32:58 - 2:32:59

谢谢。

2:33:00 - 2:33:03

谢谢谢谢姜教授的点评。

2:33:03 - 2:33:05

接下来我们有请周辉教授，

2:33:05 - 2:33:06

周教授在线上。

2:33:07 - 2:33:07

好，

2:33:07 - 2:33:09

谢谢谢谢陈老师的介绍，

2:33:09 - 2:33:13

也感谢我们崇明老师和高文老师的邀请，

2:33:13 - 2:33:17

来参加我们第22023的长城的血液论坛，

2:33:18 - 2:33:28

也重和我从崇明老师刚学的第二届的这个这个医药教育协会的这个血液血液管委会的主委再次导写。

2:33:28 - 2:33:32

那我们刚才我们赛层教授已经刚才我们杜老师已经讲到，

2:33:32 - 2:33:47

他把卡尼的这个发展是特别是讲到到CD幺求的抗尼在b细胞淋巴瘤症的像曼林呢淋巴淋巴瘤b齐淋呢还有是淋巴巴鼻细胞淋巴瘤的这这样的一个疗效和不良世界不良反应的进行了一个详细的教学，

2:33:47 - 2:33:52

也讲到BCM的的体在多动脉血瘤瘤疗效和不良世界。

2:33:52 - 2:33:58

其实他主要讲到的不良世界也是一个CRS真神经毒性癌血液血瘤性的，

2:33:59 - 2:34:01

特别是讲到这个个医疗研系的。

2:34:01 - 2:34:04

为什么运营机系来GMCSF的时候，

2:34:04 - 2:34:07

会导致这个CRS的增加的这样的。

2:34:07 - 2:34:08

的一个情况。

2:34:08 - 2:34:12

他也他也讲到未来我们发展的一些方向。

2:34:12 - 2:34:14

在2030年的时候，

2:34:14 - 2:34:15

我们怎么样抗体，

2:34:15 - 2:34:17

怎么样去运用的更好一些，

2:34:17 - 2:34:19

所以特别特别精彩。

2:34:19 - 2:34:21

我们也也也也做了一些临床研究，

2:34:21 - 2:34:25

相比m癌的抗体在多性性骨髓瘤程的还有CD幺的抗体，

2:34:25 - 2:34:30

在现在有一些征型也在做CD七、CD四，

2:34:30 - 2:34:32

还有是CD三零，

2:34:32 - 2:34:33

还这样骨骨血治疗。

2:34:33 - 2:34:41

所以我相信将来可能细胞治疗越来越让我们的更多的淋巴瘤患者和多块性骨髓瘤患者及血液系统疾病的患者，

2:34:41 - 2:34:44

或者一个更好的一个深层拓议。

2:34:44 - 2:34:47

谢谢谢谢我们陈老师的就是。

2:34:47 - 2:34:50

谢谢谢谢谢谢周辉教授的一个点评。

2:34:50 - 2:34:54

那我们这个环节三位讨论嘉宾的一个点评就结束了，

2:34:54 - 2:34:56

也非常感谢周斌老师，

2:34:56 - 2:35:00

高老师邀请荣幸参加长江论坛。

2:35:00 - 2:35:00

好好嘞，

2:35:00 - 2:35:02

我们周斌教授再次当选主委。

2:35:02 - 2:35:06

那么接下来我们把主持人交给现场，

2:35:06 - 2:35:08

有请主席来进行总结，

2:35:08 - 2:35:08

谢谢。

2:35:08 - 2:35:09

好好嘞，

2:35:09 - 2:35:11

谢谢谢谢我们各各位，

2:35:12 - 2:35:14

我们今天一天很辛苦，

2:35:14 - 2:35:15

从早晨到现在了。

2:35:15 - 2:35:17

大家一天很辛苦，

2:35:17 - 2:35:20

我们今天的会呢我也没什么总结的了，

2:35:20 - 2:35:21

因为明天还继续开。

2:35:21 - 2:35:23

所以呢我们今天的会就到这，

2:35:23 - 2:35:24

谢谢大家，

2:35:24 - 2:35:26

大家那个可以休息了。

2:35:26 - 2:35:28

我们线上的各位朋友可以下线了，

2:35:28 - 2:35:28

谢谢大家。

2:35:28 - 2:35:28

好，

2:35:29 - 2:35:30

那今天就到这儿吧，

2:35:30 - 2:35:31

谢谢嗯。

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