编者按：黄晓军教授，中华医学会血液学会（CSH）现任主任委员、中国单倍体造血干细胞移植的领导者；P. Sonneveld教授，欧洲血液学会（EHA）执行委员会委员兼财政长官、EHA多发性骨髓瘤科学工作组主席。在本届EHA年会现场，《肿瘤瞭望》作为中国专业的肿瘤医学媒体，现场邀请到EHA和CSH的两位高层及学术权威带头人进行了一场具有建设性意义对话。在此次会谈，两位专家不仅谈及了本届大会的亮点内容，还有关于新型药物时代下干细胞移植在血液肿瘤领域的地位的探讨；双方均表示未来将在促进合作研究方面做出进一步的努力。

　　《肿瘤瞭望》：EHA年会已经举办了二十届了，这是一个具有特殊意义的时刻。您认为本届EHA年会与往年相比有哪些不同？

　　Sonneveld教授：多发性骨髓瘤在药物方面涌现出三个非常有希望治疗复发难治多发性骨髓瘤的药物：一个药物是卡非佐米，最近联合应用卡非佐米、来那度胺和地塞米松与单用来那度胺和地塞米松的ASPIRE试验结果表明，三药联合可使患者的无病生存时间延长至26个月，明显优于两药联合（17个月）。有关卡非佐米的其他联合用药方案虽然还没有在欧洲人群中验证，但是在美国已经得到了证实，近期将在欧洲开展相关的验证试验，结果将有可能改变难治复发患者的标准治疗方案。第二个药物是依洛珠单抗（抗-SLAMF7抗体，SLAMF7为骨髓瘤细胞膜上的一个表位），ELOQUENT-2研究显示依洛珠单抗联合来那度胺和地塞米松也能提高患者的无病生存率。第三个药物是达雷木单抗（抗-CD38抗体，CD38为骨髓瘤细胞膜上的另一个重要表位），该药单用对于难治复发患者有效，其中部分缓解约为50%~60%、完全缓解约为10%~50%。除此之外，目前还有多个临床试验正在进行，将来我们会呈现更多的研究结果。因此，对于骨髓瘤来说，很多有趣的结果和新的数据正在快速进步和发展。

　　In terms of multiple myeloma， which is my expertize， we have seen presentations concerning three very active and promising drugs in the relapse and refractory setting. One is carfilzomib which was presented and published recently as the ASPIRE trial which combines carfilzomib with lenalidomide and dexamethasone compared to lenalidomide and dexamethasone alone. This results in a significantly better progression-free survival， 26 months versus 17 months in favor of the triple combination. We are now seeing other combinations with carfilzomib. It is not yet approved in Europe but has been approved in the United States. It will be approved in Europe in the near future and will probably change the standard of care in relapsed and refractory patients. The second drug is elotuzumab. This is an antibody against SLAMF7， which is an epitope on the membraneof myeloma cells. The ELOQUENT-2 study presented shows that elotuzumab， again in combination with lenalidomide and dexamethasone， also leads to better progression-free survival. The third one is daratumumab， an antibody directed against CD38. CD38 is an important epitope on the membrane of myeloma cells. This drug has single-agent activity in relapsed and refractory patients with about 50-60% PR and 10-50% CR. There are more trials ongoing and we will hear more about that in coming years. So for myeloma， things are progressing and developing with some interesting results and new data.

　　黄晓军教授：我认为EHA会议越来越国际化了，但是目前大多数的讲者还是来自欧洲。会议讨论的议题也很少有涉及替代移植、自体移植后的复发预测和治疗等方面的内容。在复发的预测和处理方面，例如在替代移植方面，美国以及亚洲已有不少研究的数据；在供者淋巴细胞输注（donor lymphocyte infusions， DLI）和疾病复发的处置方面，以及移植后监测方面我们也都已经有了一些研究，但是似乎被参考或引用的并不多。因此，这些方面的问题可能是将来EHA需要更加关注的。

　　I have attended EHA several times and my feeling is that the conference is increasingly international. My field is transplantation and the education program does not have much about alternative transplantation and relapse prediction and management after autologous transplantation. This is afield that the program maybe needs to pay more attention to. I would also add that even though it is an increasingly international conference， the speakers are almost all from Europe. Certainly in the field of relapse prediction and management， for example and alternative transplantation， I think the European experts are not really familiar with the data and input from experts， not only from Europe， but from the United States and Asia would be vital for the EHA program in the future.

　　Sonneveld教授：今年的大会有来自世界各地的将近10000名参会者。虽然讲者大多来自欧洲，但是随着时间的推移这种现象会有所改变。投稿的摘要大多来自意大利，其次是美国。中国、韩国以及土耳其的数字也不错，因此随着我们国际化程度的增加，目前的现状都会改变。

　　We have almost 10000 attendees at this conference from all over the world. This will change with time. Of the submitted abstracts， the most were from Italy， then the United States. There were very good numbers from China， Korea and Turkey. So things will change as we become more international.

　　《肿瘤瞭望》：在新型药物时代下，您认为HSCT在可移植MM治疗中的地位如何？您将选择早期还是晚期HSCT？

　　Sonneveld教授：目前，自体移植在欧洲是一线标准治疗方案的部分。很多患者要求在首次复发以后进行晚期自体移植，因为那时移植仍有效。但是，如果分析数据的话，会发现并没有太多的证据来支持这种方案。将自体移植作为一线治疗方案时，患者中位无病生存期大约45个月。而将自体移植作为复发的治疗方案时，英国研究组的结果表明无病生存期为19个月。两种方案差别还是很明显的。因此认为应将该有效的治疗方法作为一线治疗方案。目前有两项有关这个问题的临床试验正在进行，将患者随机分配为一线治疗应用自体移植和首次复发后应用自体移植组，相信在不久的将来就会有结果。

　　Right now in Europe， autologous transplantation is a standard part of first-line treatment in myeloma. Many people claim that you can delay autologous transplantation until first relapse because it is also effective at that time. But if we look at the data， there is not a lot of evidence supporting that. If you apply autologous transplantation in first-line treatment， the median progression-free survival is around 45 months. If you apply transplant at relapse， as has been demonstrated by the British group， progression-free survival is 19 months. There is quite a difference. We think that such an effective treatment should be applied as first-line. There are two ongoing trials that are looking at this question. Patients are randomized to receive autologous transplantation as part of first-line treatment or at first relapse and we will find out those results in the future.

　　黄晓军教授：虽然现在出现了很多新药用于复发难治多发性骨髓瘤，但是移植仍将是可移植的多发性骨髓瘤患者的一线治疗策略。尤其在中国，由于很多新药还没有获批上市，自体移植仍是多发性骨髓瘤的一线治疗方法。

　　So transplantation will remain first-line therapy for multiple myeloma even in the era of novel agents. But there are alternatives and more data is required for any changes to occur. In China， autologous transplantation is first-line therapy for multiple myeloma also as we don’t have much access to the new agents.

　　Sonneveld教授：骨髓瘤仍属于不能治愈的疾病，因此何不选择一种更加有效的治疗——可以将自体移植和新药联合起来用于诱导和巩固治疗部分患者，以此来提高应答率，最终治愈部分患者。

　　In addition， we cannot cure myeloma， so why not use an effective treatment. We can better use autologous transplantation plus the novel agents in combination for induction or consolidation therapy and try to improve response rates. In the process， hopefully， we can cure some patients.

　　《肿瘤瞭望》：作为中国专业的肿瘤医学媒体，我们感到很荣幸来报道像EHA年会这样的学术盛会。我们将把最新的会议动态传递到国内，也非常希望能够促进EHA与中国的学术交流和对话，看到不同领域之间碰创出火花。作为欧洲和中国血液学领域的带头人，未来是否有交流计划？

　　黄晓军教授：是的，两年前EHA和中华医学会血液学会就已经启动了一个官方的合作项目。我们需要做的是加强我们之间的合作并加入一些新的项目，如人才交流和临床试验。我们已经开始向这个方向努力了。

　　Of course. Two years ago， EHA and the Chinese Society of Hematology (CSH) commenced an official cooperation program. What we need to do is strengthen our cooperation and add new programs such as personal exchanges or clinical trials. We are already moving in the right direction.

　　Sonneveld教授：EHA的董事会讨论过与包括中国在内的多个国家开展合作研究，我相信有关合作性临床研究的具体方案将在不久后出台。中国肯定也可以为临床试验贡献大量的病例，所以这个提议对于无论是EHA还是中国都是非常有帮助的。

　　I would be very much in favor of doing that. The Board of EHA have discussed an outreach program with other countries including China and I don’t think it will be long before we do make concrete plans to proceed maybe in the area of cooperative trials. China is certainly able to contribute large numbers of patients to trials so the idea is very attractive both for EHA and for China.

编辑：张国建