Leukemia is one of the important diseases of hematological oncology. In this conference, extensive discussions and exchanges took place. In AML, Prof. R. Stone from the United States noted: Anthracyclines plus cytarabine as induction chemotherapy regimens for AML have not changed significantly in the last 30 years, but our knowledge of the pathophysiological changes in leukemia has increased. The daunting task of applying this knowledge for therapeutic benefit remains frustrating, due in part to the heterogeneity of AML and the lack of clear targets in a group of patients who are resistant to chemotherapy, elderly, have complex karyotypes and have received chemotherapy for other tumors. Although there are many new drugs in development, no new drugs have recently been approved for non-PML, except for gibberellin/ozomicin, and their commercial use has now been discontinued due to the lack of effectiveness found in large randomized trials adding them to chemotherapy. New drugs include the following categories: 1) tyrosine kinase inhibitors; 2) epigenetic therapies; 3) chemotherapy enhancers or pro-apoptotic factors; 4) new cytotoxic drugs; and 5) immunotherapeutic approaches. In patients with mutations in FLT3 tyrosine kinase activity, many of the individual drugs used to block FLT3 tyrosine kinase have shown significant biological activity in studies, but their clinical activity has been relatively limited. Although more promising and selective drugs in testing offer additional hope. A large randomized trial investigating chemotherapy plus the FLT3 inhibitor midostaurin is underway in AML patients aged 18-30 years with FLT3 mutations. Is such a clinical trial necessary to prove the usefulness of a new drug, or can we design clinical trials to prove biological endpoints? Professor Buchner of the German AML Collaborative Group (AMLCG) reported on the results of a multicenter study that started in 1999 and involved 56 centers to assess the role of major treatment parameters and risk factors in the management of AML. The results found a CR rate of 70.2% in patients younger than 60 years of age, compared to 53.3% in patients aged 60 years or older. The expected 7-year overall survival rate was 38% vs. 9%, and the relapse rate was 50% vs. 74%. Patient outcomes were largely determined by individual risk factors, with treatment parameters having only a mild effect. In a multifactorial analysis, genetic alterations with older age in each age group (16-60 years and 60-85 years) emerged as the strongest risk factor. It is concluded that, as preferred by AMLCG, prospective analysis of multiple determinants in unselected patients became possible by using a pre-randomization strategy. This study could serve as a model for disease research and new therapeutic approaches. In acute lymphoblastic leukemia, Professor M. Schrappe of the German ALL-BFM Study Group reported on a study of 6609 pediatric (<18 years) patients treated in five consecutive clinical trials of the ALL-BFM Study Group between 1981 and 2000. Patients were treated in 82 centers in Germany, Australia, and Switzerland. 10-year EFS improved from 65% in ALL-BFM81 to 78% in ALL-BFM95. Recurrence reduction was accompanied by the main goal of reducing acute and chronic toxicity of the treatment through risk-stratified therapy. Major advances: (1) Prophylactic cranial irradiation dose reduction to 12GY is still safe in T-ALL and high-risk ALL, and other types of patients can be treated without radiotherapy and replaced with high-dose MTX chemotherapy and intrathecal injections. (2) Delayed re-intensification therapy is as necessary for low-risk patients as for high-risk patients. (3) Maintenance therapy for less than 6 months may increase the risk of systemic recurrence. (4) Low response to prednisone therapy within the initial 7 days is a strong prognostic adverse factor. Intense induction chemotherapy may significantly improve prognosis. (5) Intensive, consolidation and re-intensive therapy are necessary for high-risk patients. In chronic lymphocytic leukemia, Professor R. Foa from Italy pointed out that chronic lymphocytic leukemia (CLL) is the most common leukemia in the Western hemisphere and rare in other regions (e.g. Japan). Because of the progressive increase in life expectancy, the incidence of CLL is also increasing. More than 70% of patients are older than 65 years old at diagnosis and have other diseases. For decades CLL has been considered a highly heterogeneous disease. The possibility of identifying biological characteristics associated with different clinical outcomes in CLL is changing our treatment strategies for CLL. An expanded approach to the study of biological characteristics allows us to make an accurate differential diagnosis between CLL and other B-cell chronic lymphoproliferative disorders, while identifying several parameters associated with different prognoses in CLL. This is important in light of the increase in the number of therapeutic agents currently indicated for CLL. We no longer rely on phenylbutyrate alone, but also on purine analogues, monoclonal antibodies, extensive use of chemo-immunotherapy, stem cell transplantation techniques, and a range of new compounds. Today, it is more realistic to consider the principles of treatment (or non-treatment) for CLL patients not only on the basis of clinical-hematological considerations, but also on the basis of biological parameters. Today, we are faced with new challenges in CLL. The challenges are as follows: 1. a prognostic stratification based on biological characteristics. 2. a different approach to young patients with poor prognostic indicators. 3. the concept of disease elimination. 4. the changing definition of remission. 5. the monitoring of small residual lesions. 6. the role of "CLL" in middle-aged and elderly people. 7. the consolidation and maintenance therapy. 8. Significance and clinical impact of monoclonal B lymphocytosis. According to Professor E. Montserrat from Spain, significant progress has been made in the treatment of patients with chronic lymphocytic leukemia (CLL) in the last decade. Due to the results of recent randomized trials, the combination of fludarabine, cyclophosphamide and melphalan (FCR) regimen is considered the treatment of choice for patients with CLL who are initially diagnosed or have received previous treatment. Importantly, there are indications that the FCR regimen may extend not only progression-free survival (PFS) but also overall survival (OS) in patients with CLL who have not received prior therapy. Given this progress, there is still much room for improvement in the treatment of CLL, and there are many questions that need to be answered. For example: 1. A high proportion of patients have comorbidities or advanced age that limit the safe use of FCR regimens; 2. Patients with 17p deletions or mutations are not effective with FCR therapy; 3. CLL remains an incurable disease. Several new monoclonal antibodies and anti-leukemic agents are ready to be applied at the optimal time for CLL treatment and hold promise for improving the efficacy of existing therapies. Among the new monoclonal antibodies, Ofatumumab and GA-101 are new CD-20 monoclonal antibodies that have shown good clinical activity. In addition, new therapeutic agents that not only attack leukemic cells but also act on the microenvironment are of interest. In this regard, ralidomide, an immunomodulatory agent, has been extensively studied in a variety of hematologic tumors, including CLL, with positive results. Several different phase II and III clinical trials investigating these agents in combination with other agents are underway. Other areas that need further investigation include the role of maintenance therapy in CLL, as well as the role of small residual lesions, a surrogate for long-term survival, as a treatment endpoint. Finally, because of the very poor prognosis for patients who fail current chemoimmunotherapy, there is an urgent need for more effective "salvage" treatment options and safer allogeneic transplantation techniques. Professor N. Kay, T. Shanafelt, USA, also commented that chronic lymphocytic leukemia is a chronic disease, but the clinical course of CLL patients is heterogeneous, and some CLL patients progress rapidly and require aggressive and sometimes repeated therapy. Recently, a more accurate heterogeneity can be obtained through the use of clinically validated risk models and new (B-cell related) prognostic indicators. Thus, clinical risk model characteristics are relatively easy to obtain, including age, Rai stage, sex, absolute lymphocyte count, β2 microglobulin and regional lymph node count. These factors have long been shown to be independently associated with patient survival. Importantly, these parameters have been validated in two independent ways to predict time to disease treatment and overall survival, even in patients with Rai stage 0. New biological prognostic factors, which truly reflect the biology of leukemic B cells, include mutational status of ZAP-70, IgVH gene, and cytogenetic abnormalities detected by fluorescence in situ hybridization (FISH). These are considered to be strong prognostic factors for treatment-free survival and overall survival, even in newly diagnosed CLL patients. These prognostic factors play an important role in the current recommendations and management of patients with CLL. Prognostic assessments can also be integrated into risk stratification systems and used to predict the efficacy of current treatment. In this discussion, we review the application of available tools for risk stratification of patients, highlighting how they can be applied in clinical practice to individualize patient counseling services, guide the frequency of follow-up, and inform our treatment choices. Lymphoma, being one of the important diseases of hematologic oncology, was also the focus of discussion at this meeting. Prof. M. Pfreundschuh from the German Study Group for Highly Staged Non-Hodgkin's Lymphoma (DSHNHL) reported on advances in the treatment of aggressive lymphoma. Their study found that 6 courses of CHOP combined with melphalan therapy achieved the best results in young patients with a good prognosis, with a 3-year EFS of 97% and 100% OS in the subgroup with a very good prognosis (no IPI risk factors, no large mass disease). Ongoing studies have evaluated whether less chemotherapy (4 courses) is non-inferior to MInT standard 6×R-CHOP-21. For the poor prognosis subgroup (IPI=1, and/or large mass disease; 3-year EFS of 75%), further improvement is needed, and ongoing studies from the French GELA and German DSHNHL groups have compared MInT standard regimens with dose intensive chemoimmunotherapy regimens were compared. In young patients with poor prognosis, the triple combination of high-dose chemotherapy, stem cell support strategy ("Mega-CHOEP") combined with melphalan was inferior to 8 courses of CHOEP-melphalan therapy, with the latter regimen achieving the best results reported to date in this subgroup of DLBCL ( Schmitz, et al.,ASH 2090#406). In older patients, the best outcome reported to date was the 6 courses of CHOP-14 plus 8 courses of melphalan used in the RICOVER-60 study (Pfreundschuh et al, Lancet Oncology,2008). However, whether R-CHOP-14 will become the world standard of care for elderly patients will depend on the results of the recently completed randomized comparison of R-CHOP-14 with R-CHOP-21 by GELA (France) and NCRI (UK), respectively. In conclusion, although CHOP-like chemotherapy in combination with melphalan represents the accepted primary treatment regimen for patients with DLBCL, the optimal number of courses, as well as the optimal dose and dose density, remains to be determined. Further strategies to improve outcomes will be discussed, for example, increasing the dose density and/or the total dose of melova. Professor C. Gisselbrecht, France, noted that salvage chemotherapy followed by high-dose chemotherapy and autologous stem cell transplantation (ASCT) is the standard regimen for the treatment of chemotherapy-sensitive relapsed diffuse large B-cell lymphoma. The addition of rituximab to salvage chemotherapy improves response rates and disease-free survival. Results from the CORAL clinical trial showed that R-ICE was not shown to be more effective than R-DHAP than the other regimen. Among the 396 patients initially randomized, the overall response rate was 63%, with a complete remission rate of 38%. response rates did not differ between R-ICE and R-DHAP, at 63.5% and 62.8%, respectively. There was no significant difference in 3-year EFS and OS between R-ICE and R-DHAP, (26% and 35%, p=0.6) and (47% and 51%, p=0.5), respectively. 3-year EFS was significantly influenced by the following factors: previous rituximab treatment, early relapse (<12m), re IPI score of 2-3. Remaining combination chemotherapy with new agents or new monoclonal antibodies should be evaluated in patients who are not suitable for transplantation. Clinical trials containing new regimens of radioimmunotherapy and/or post-transplantation line immunotherapy are ongoing. DLBCL is a heterogeneous group of diseases and the prognostic impact of GCB and ABC classification in relapsed/refractory DLBCL has not been analyzed. the results of the Bio-CORAL study may help to develop new treatment options. Prof. A. Freedman, USA, further noted that the role of stem cell transplantation for follicular lymphoma is still controversial. Autologous transplantation at CR1/PR1 is generally not recommended for patients with follicular lymphoma. Four randomized clinical trials demonstrated that autologous transplantation improved PFS and EFS in FL patients, but none improved OS. for relapsed FL patients, the CUP clinical trial confirmed that autologous transplantation significantly improved OS relative to wait-and-see. long-term follow-up results in relapsed FL patients who received autologous stem cell transplantation were encouraging, with a 10-year PFS of 30%-50% and a PFS curve at 10 years leveling off. The use of monoclonal antibodies, new drugs, and immunoradiotherapy drugs has influenced the extent of stem cell transplantation use in patients with relapsed FL. Another option is allogeneic stem cell transplantation including conventional intensity or reduced pretreatment intensity. Both of these approaches have greater therapeutic toxicity than conventional chemotherapy and autologous transplantation. The 2-year treatment-related mortality rate for reduced pretreatment intensity allogeneic transplantation (RIC) is 15-25%. Nonetheless, the treatment efficacy of RIC is impressive with a PFS of 45%-80% at 3-5 years of PFS. Stem cell transplantation is a suitable treatment for chemotherapy-sensitive disease. Allogeneic stem cell transplantation has better long-term efficacy compared to autologous stem cell transplantation, but also significantly higher mortality. Therefore, he is suitable for patients with higher risk stratification and fewer disease complications. The role of stem cell transplantation remains unclear considering the heterogeneity of the disease and the advances in new treatments. In the discussion of MDS, special attention was given to MDS in children and adolescents. Professor C.M. Niemeyer of the European Working Group of MDS in Childhood (EWOG-MDS) reported in particular that myelodysplastic syndrome (MDS) in children is a heterogeneous disorder of bone marrow cells. Regardless of the setting in which the disorder occurs, childhood MDS is thought to have pre-existing genetic alterations. Childhood MDS can be divided into two major categories: 1) normal nucleotype refractory hematocrit 2) and other types of MDS. the former is found in 50% of MDS cases. The histological differences between normokaryemic refractory hematocrit and hyperplastic dysplasia are described in detail in the recent WTO classification. In contrast to other types of MDS, normokaryemic refractory hematocrit MDS rarely has chromosomal abnormalities and rarely progresses to MDS with an increased proportion of primitive cells; it mainly presents with bone marrow hematocrit. Although some patients are initially effective on immunosuppressive therapy, the rate of hematopoietic stem cell transplantation after treatment failure exceeds 50%. Recently reduced intensity or demyelinating stem cell transplantation has been limited by the donor, but treatment results in a 5-year survival rate of more than 90%. Refractory hemocytopenic MDS with increased primitive cells and abnormal karyotype usually progresses to RAEB, RAEB-T or myelodysplasia-associated AML (AML-MDR). Progressive MDS, treated with AML chemotherapy regimens, does not have an HSCT survival rate of less than 30%. The outcome of HSCT treatment in all-compatible or unrelated donors is about 60% EFS at 5 years. Toxicity and relapse are the main reasons for treatment failure. Future studies should confirm whether optimization of pre-transplant treatment strategies can improve survival after transplantation.