近日，中国医师协会第十一届中法血液学学术会议在天津顺利召开，吸引到数百名国内外血液学领域的权威专家和学者齐聚一堂。会议期间，《肿瘤瞭望-血液时讯》特邀法国马赛Paoli-Calmettes研究所Christian Chabannon教授畅谈欧洲视角下的个性化免疫治疗策略。现将精粹整理成文，以飨读者。
《肿瘤瞭望-血液时讯》：在欧洲，免疫治疗在哪些类型的血液癌症中取得了最显著的进展？这些进展是如何改变这些疾病的治疗格局的？
Christian Chabannon教授：若将免疫治疗视为一种治疗手段，那么无疑，它在淋巴恶性肿瘤领域，包括淋巴瘤、多发性骨髓瘤、霍奇金淋巴瘤及急性淋巴细胞白血病中，已展现出显著的进展。过去二十五年来，此领域的成就尤为瞩目。
而当免疫治疗聚焦于细胞移植层面时，异基因造血干细胞移植仍然是应对髓系恶性肿瘤需求的有效工具。然而，在髓系恶性肿瘤的治疗上，我们仍殷切期盼着新型药物能带来突破性的进展。
值得一提的是，CAR-T细胞疗法近年来备受瞩目。然而，在欧洲，目前我们仅能应用针对B细胞淋巴恶性肿瘤表达抗原的CAR-T细胞治疗。因此，我们热切期盼着未来能有更多针对髓系恶性肿瘤高效的新型产品问世。
Oncology Frontier-Hematology Frontier：In Europe, which types of blood cancers have seen the most significant progress with immunotherapy? How have these advancements altered the treatment landscape for these diseases?
Professor Christian Chabannon：If we think of immunotherapy as medicinal products, then definitely lymphoid malignancies, lymphoma, multiple myeloma, Hodgkin's disease, and acute lymphoblastic leukemia. I've seen significant progress over the, let's say, 25 last years. If we think of immunotherapy as cell transplant, then allogeneic stem cell transplant still remains an efficient tool to address the needs of myeloid malignancies.
But for myeloid malignancies, we are still waiting for significant improvements coming from newly introduced medicinal product. The CAR-T cell field has been very much publicized. In Europe, we only have access to CAR-T cells that target antigens expressed in B cell lymphoid malignancies. We are eagerly waiting for products to come to be efficient in myeloid malignancies.
《肿瘤瞭望-血液时讯》：欧洲在血液癌症免疫治疗的研究和临床应用上，有哪些个体化治疗策略？这些创新如何促进了治疗效果的提升？
Christian Chabannon教授：在免疫治疗的背景下，乃至更广泛地，在患者整体治疗方面，我们正逐步迈向更加个性化的治疗策略，这一趋势无疑愈发显著。当前，为患者选择最为适宜的治疗方案时，需要融合海量信息，这些信息详尽描述了患者个体特征、疾病诊断情况、复发状况，并致力于更精准地预测各类治疗方法的疗效，以及如何在考虑患者意愿的基础上，为每位患者筛选出最佳治疗方案。
此外，我们日益重视生活质量标准，并深入探究患者对不同治疗方案的期望与诉求。因此，个性化治疗不仅融合了临床信息与生物学信息，还兼顾患者的个性化需求。以淋巴恶性肿瘤为例，影像学技术的飞速发展极大地提升了我们对疾病治疗反应的监测能力。如今，我们已采用早期影像学评估手段，如在淋巴瘤治疗中，根据评估结果调整后续治疗周期或针对初始治疗的反应进行个性化调整。
Oncology Frontier-Hematology Frontier：What are the unique individual strategies employed in Europe for immunotherapy research and clinical application in blood cancers? How have these innovations contributed to improved treatment outcomes?
Professor Christian Chabannon：I would say, definitely, this is true of immunotherapy, but more generally caring for those patients. I would say we are moving to more and more personalized approaches to treatment.So, using, selecting the most appropriate treatment strategy for a patient now integrates a huge amount of Information that describes the patient himself or herself, that describes the disease that diagnosis and the disease that relapse, and is trying to better predict the efficacy of one given category of treatment and how we can select the most appropriate treatment for every patient, taking also into account what patients wants.So increasingly, we also use quality of life criteria. And again, the expression of what patient expects from getting one treatment or another. So I would say personalized treatment that integrates clinical Information, that integrates biological Information. Imaging has made huge progress to monitor, as an example, the response of lymphoid malignancies to these various categories of diseases. We now use early imaging evaluation, for example, in lymphoma to tailor the subsequent cycles of the treatment or to the response to the original sequence.
《肿瘤瞭望-血液时讯》：免疫治疗在血液癌症中常伴随一定的副作用。欧洲在管理和减轻这些副作用方面有哪些经验和最佳实践？
Christian Chabannon教授：多年以前，我们曾普遍认为，相较于传统细胞毒性药物等治疗手段，合理开发的治疗方案在安全性上应更胜一筹，不会伴随同等程度的安全隐患。然而，事实并非如此。这些新型治疗方案在某些情况下，可能伴随着极为显著的副作用，甚至可能危及生命。因此，这要求医院组织结构必须严密且高效。首要条件之一，便是确保我们拥有经过专业培训的医护人员，包括护士、医生以及其他类别的医疗专业人员。这一现状催生了对专业培训的迫切需求。
当前，这一挑战不仅面向大学，它们需要培养年轻的医学生、护士，同时也考验着诸如欧洲血液与骨髓移植学会（EBMT）、欧洲血液学协会（EHA）等专业机构，它们需在医疗人员的职业生涯中持续提供培训支持。我深感自己有责任参与这一知识传承过程，致力于指导年轻一代如何适应不断变化的治疗领域，确保他们的专业知识能够与时俱进。
Oncology Frontier-Hematology Frontier：Immunotherapy for blood cancers often comes with certain side effects. What are the experiences and best practices in Europe for managing and mitigating these side effects?
Professor Christian Chabannon：I think that many years ago, we thought that rationally developed treatments would not carry such safety issue than all treatments like conventional cytotoxic drugs. And this is not true. These treatments come at the expense of, in some cases, very significant side effects, possibly life threatening side effects. So this requests very tight hospital organization. And one of the first requirements is that we have properly trained healthcare professionals, nurses, doctors, and other categories of healthcare professionals. This results in a very significant need for training.And this is one of the challenges at the moment, both for universities, training young people, young doctors, young nurses, and also for professional associations, such as EBMT, such as the European Hematology Association, and others that contribute to continuous training during the professional life of these individuals. And I am very much involved in that transmission to young generations and how to adapt the knowledge of people to an ever changing therapeutic landscape.
专家简介
Christian Chabannon教授
医学博士、哲学博士
法国马赛艾克斯马赛大学 (AMU) 医学院细胞生物学 医学教授
法国马赛Paoli-Calmettes研究所和法国马赛综合癌症中心
法国马赛生物疗法临床研究中心成员
自2017年起担任欧洲血液和骨髓移植协会 (EBMT)、细胞治疗和免疫生物学工作组、(CTIWP) 主席，并担任国际细胞与基因治疗协会 (ISCT) 2020 年年会联合主席。