北欧初夏，学术启航。2026年欧洲血液学会年会（EHA 2026）于6月11日至14日在瑞典斯德哥尔摩盛大召开，汇聚世界顶尖专家学者，引领血液学发展新方向。本届大会上，北欧淋巴瘤协作组（NLG）主席、瑞典隆德大学Mats Jerkeman教授接受《肿瘤瞭望-血液时讯》现场专访。作为欧洲淋巴瘤指南制定的重要参与者，Mats Jerkeman教授结合其丰富的指南撰写经验与北欧独特的真实世界数据优势，深入剖析了循证证据与现实临床之间的桥梁构建，并围绕套细胞淋巴瘤治疗格局的快速演变，探讨了新疗法如何重塑年轻与老年患者的治疗路径。此外，Mats Jerkeman教授还就“动态指南"与人工智能在指南动态更新中的广阔前景分享了前瞻洞见。本文特整理采访精华，以飨读者。

《肿瘤瞭望-血液时讯》：Mats Jerkeman教授，您作为欧洲指南制定工作的核心成员，在指南制定的实践中，您如何看待真实世界证据相对于随机对照试验的补充价值？特别是在将循证证据转化为适用于日常临床实践的可操作推荐时，真实世界数据能够提供哪些独特的视角？

Mats Jerkeman教授：真实世界数据在指南制定中具有不可替代的重要价值，其中一个关键用途是构建合成对照组（synthetic control arms）。通过这一方法，我们能够将随机对照试验中获得的疗效数据置于更广阔的临床背景中进行解读，与既往标准治疗的真实世界结局进行直接比较——这是我们利用北欧登记数据的重要方式之一。北欧国家拥有覆盖全民的医疗登记系统和长期随访数据，这为我们提供了独特的科研基础设施。此外，真实世界数据还可用于不同治疗方案之间的直接比较，尤其是在罕见疾病领域，其中开展大规模随机对照试验往往面临患者招募困难、成本高昂等现实挑战。

以套细胞淋巴瘤为例，正是借助真实世界数据的比较分析，我们得以确证R-Benda方案在一线治疗中相较于R-CHOP方案的优效性——这一证据对临床实践和指南更新产生了实质性影响。可以说，真实世界数据与临床试验证据形成了互补关系，前者提供了外部有效性和临床可推广性的关键信息，后者则确保了内部严谨性和因果推断的可靠性。

Oncology Frontier-Hematology Frontier：Prof. Jerkeman, as a core member of European guideline development, how do you view the complementary value of real-world evidence relative to randomized controlled trials in the practice of guideline development? Specifically, what unique perspectives can real-world data offer when translating evidence-based findings into actionable recommendations applicable to routine clinical practice?

Professor Mats Jerkeman：One important use of the real-world data is to provide synthetic control arms so we can put clinical trial data into context to compare to previous standard of care—this is one way how we use our registry data. But it's also possible to compare different treatments in rare diseases such as mantle cell lymphoma, where it has actually been used in showing that R-Benda is superior to R-CHOP in first treatment for mantle cell lymphoma.

《肿瘤瞭望-血液时讯》：您的报告聚焦于套细胞淋巴瘤的指南更新。BTK抑制剂的引入正在重新定义年轻患者的治疗路径，并对自体干细胞移植的传统地位构成挑战；与此同时，老年患者的最佳治疗策略仍未形成共识。在这一快速演变的治疗格局下，新版指南如何为临床医生提供清晰且可操作的决策框架，兼顾不同年龄和风险特征患者的个体化需求？

Mats Jerkeman教授：在新版指南中，我认为最具变革意义的进步来自欧洲的Triangle试验。这项具有里程碑意义的临床研究证实，在一线治疗中联合BTK抑制剂伊布替尼可显著改善套细胞淋巴瘤患者的总生存期，同时更为重要的是，研究提示在采用伊布替尼为基础的治疗方案时，自体干细胞移植似乎不再是必不可少的巩固治疗手段——这一发现对年轻、fit患者的治疗路径产生了根本性影响，标志着套细胞淋巴瘤治疗策略从"化疗联合移植"的传统模式向"靶向治疗主导、移植选择性省略"的新模式转变。

值得关注的是，这一治疗方案的可适用范围扩展至70岁患者，意味着其临床应用不再局限于传统意义上符合移植条件的年轻患者群体，而覆盖了更为广泛的套细胞淋巴瘤人群。然而，对于70岁以上的老年患者，我仍然认为最佳治疗策略尚未确立。虽然部分老年患者可能从BR方案中加入阿可替尼中获益，但同样存在另一部分患者采用无化疗方案（chemo-free regimen）可能获得更优的疗效与生活质量平衡。因此，老年患者的个体化治疗探索仍是未来研究的重点方向，需要在疗效、耐受性、生活质量及治疗便利性等多维度之间寻求最佳的平衡点。

Oncology Frontier-Hematology Frontier：Your presentation focuses on guideline updates in the field of mantle cell lymphoma. The introduction of BTK inhibitors is redefining treatment pathways for younger patients and challenging the traditional role of autologous stem cell transplantation. Meanwhile, consensus on the optimal treatment strategy for older patients remains elusive. In this rapidly evolving therapeutic landscape, how do the updated guidelines provide clinicians with a clear and actionable decision-making framework that accommodates the individualized needs of patients across different age groups and risk profiles?

Professor Mats Jerkeman：In the new guidelines, I think the most important step forward comes from the European Triangle trial that showed that the addition of a BTK inhibitor in frontline treatment ibrutinib improves overall survival and also that we don't need the autologous stem cell transplant either if we use ibrutinib. So I think that's a very important step forward, and this treatment can also be used for patients up to 70 years, so not only those who were previously considered transplant eligible. For older patients, I still don't think we have found the optimal treatment. There are some patients who may benefit from the addition of acalabrutinib to BR, but I think there are also patients who may do better with a chemo-free regimen. So there's still a lot of work to do to find the optimal treatment for older patients.

《肿瘤瞭望-血液时讯》：血液肿瘤领域新药的加速获批使得传统纸质指南的更新节奏难以跟上知识迭代的速度。在此背景下，ESMO推出的"动态指南"平台是一种有益的探索。您如何评估这一模式在淋巴瘤领域的实践经验？此外，随着人工智能工具在临床决策中的逐步渗透，您认为AI在未来指南的传播与个体化应用中将扮演怎样的角色？

Mats Jerkeman教授：临床指南面临的一个核心挑战在于其知识更新的速度往往滞后于证据生成的节奏，尤其是在血液肿瘤领域——新药获批和适应证扩展的频率前所未有。实际上，我们已不再需要依赖纸质版本的指南，这为我们实现更频繁、更及时的指南更新创造了条件。一个具有代表性的范例是淋巴瘤领域的ESMO指南，它们在一个被称为"动态指南"的数字平台上每年至少更新两次，能够及时纳入最新发表的关键临床研究证据，使指南内容与科学前沿保持同步。美国NCCN指南的更新模式也与此类似，频率显著高于传统纸质出版周期。

关于人工智能在指南应用中的角色，我认为这是越来越多临床医生正在积极探索的工具。AI能够帮助医生在繁忙的临床工作中迅速获取当前诊疗实践的概况和最新推荐，它们实际上有望在未来取代传统的静态指南文件，实现真正意义上的知识即时推送。值得关注的是，我也观察到许多患者开始借助AI工具来更好地理解疾病和治疗选择，这在一定程度上促进了医患之间更为平等和高效的共同决策。当然，AI的临床应用仍需在信息准确性、证据质量和临床验证等方面建立明确的规范和标准。

Oncology Frontier-Hematology Frontier：The accelerated approval of novel agents in hematologic malignancies has made it increasingly difficult for traditional print guidelines to keep pace with the speed of knowledge iteration. In this context, the "Living Guideline" platform introduced by ESMO represents a valuable initiative. How do you evaluate the practical experience with this model in the field of lymphoma? Furthermore, with the gradual integration of artificial intelligence tools into clinical decision-making, what role do you envision AI will play in the dissemination and individualized application of guidelines?

Professor Mats Jerkeman：An important thing about clinical guidelines is that they can quickly become obsolete. We don't really longer need printed versions of these guidelines, which makes it possible to update them more frequently. One good example is actually the ESMO guidelines in lymphoma—they are updated at least twice per year on a platform which is called the Living Guideline, so I think this is a possibility to make them more up-to-date. The same goes actually for the US NCCN guidelines. And I know about artificial intelligence—I think this is a tool that more doctors also now use to get an overview of current practice, they may replace actually the previous guidelines. And I know also that many patients start using this as a help also to make it easier to discuss different treatment options with the doctor.

结 语

Mats Jerkeman教授以其丰富的指南制定经验和北欧真实世界数据积淀，为淋巴瘤的规范化诊疗提供了兼具科学性与可行性的决策框架。从北欧登记数据提供的合成对照组，到Triangle试验重塑套细胞淋巴瘤一线治疗格局，再到"动态指南"与人工智能驱动的动态更新，他勾勒出了一幅数据驱动、实时迭代的未来诊疗图景。正如Mats Jerkeman教授所言，老年患者的最佳方案仍待探索，而在新药层出不穷的时代背景下，指南的持续进化将成为连接循证证据与临床实践的关键桥梁。

专家简介

Mats Jerkeman教授

北欧淋巴瘤协作组（NLG）主席、瑞典隆德大学

欧洲肿瘤内科学会（ESMO）淋巴瘤诊疗指南编委

北欧淋巴瘤研究组（Nordic Lymphoma Group）主席

欧洲肿瘤内科学会-欧洲血液学协会（ESMO-EHA）联合指南制定专家

隆德大学（Lund University）临床肿瘤学教授