Diagnosis, treatment and management of lymphoma patients in post epidemic period
A novel coronavirus pneumonia outbreak broke out on the eve of the Spring Festival. With the efforts of a series of policies and medical staff, the epidemic situation was controlled. Patients with lymphoma usually have low immunity and are at high risk of this outbreak. In this special period, in order to promote academic exchanges in the field of lymphoma and provide standardized diagnosis and treatment programs for patients, the project of long-distance exchange of lymphoma experts was carried out, and many experts were connected remotely to solve the difficult problems of diagnosis and treatment of lymphoma patients. Yimaitong invited professors Li Jianyong and Xu Wei from the First Affiliated Hospital of Nanjing Medical University, Hu Yongjun from Huai'an hospital and Lu Xuzhang from Changzhou Second People's hospital to interview and share the experience of standardized diagnosis and treatment of lymphoma patients in the post epidemic period.
Professor Li Jianyong
Chief physician: class a special Professor, doctoral supervisor, post doctoral cooperative Supervisor
Director of Hematology Department of the First Affiliated Hospital of Nanjing Medical University (Jiangsu Provincial People's Hospital); director of Pukou chronic gonorrhea Center
Standing member of the 11th Committee of Hematology branch of Chinese Medical Association
Chairman of the 4th committee and honorary chairman of the 5th Committee of Hematology and oncology of China Anti Cancer Association
Head of China chronic lymphocytic leukemia Working Group
Vice chairman of CSCO China lymphoma Alliance
Vice chairman of integrated hematology Committee of Chinese Medical Doctor Association
Deputy head of Lymphoma Group, oncology branch, Chinese Medical Association
The seventh chairman of Hematology branch of Jiangsu Medical Association
President designate of Hematology branch of Jiangsu Doctor Association
Chairman of Hematology branch of Jiangsu geriatric Association
Vice chairman of hematopoietic stem cell association and Cell Therapy Committee of China Medical Education Association
Member of the Standing Committee of the blood immunity branch of the Chinese society of Immunology
Chairman of Hematology branch of Nanjing Medical Association
Professor Xu Wei, deputy director of Hematology Department and doctoral supervisor of the First Affiliated Hospital of Nanjing Medical University (Jiangsu People's Hospital)
Vice chairman of Hematology Committee of China Anti Cancer Association, leader of Lymphoma Group, vice chairman of lymphoma Committee of China geriatric health care association Member of lymphoma professional committee member of Experimental Hematology Professional Committee of Chinese society of pathophysiology member and Secretary of integrated hematology Professional Committee of integrated medical doctor branch of Chinese Medical Doctor Association vice chairman of Hematology Society of Jiangsu Medical Association member of chairman of lymphoma Professional Committee of Jiangsu Research Hospital Association member of chairman of Jiangsu anti lymphoma Alliance Vice chairman of Hematology Committee of the association, vice chairman of the Standing Committee of lymphoma Committee of Jiangsu cancer society, Nanjing Hematology Society
Professor Hu Yongjun
Chief physician of Huai'an hospital
Academic and technical leading talents of "533 talent project" in Huai'an City
Vice chairman of Hematology branch of Huai'an Medical Association
"Ten hundred thousand" talent training plan of Huai'an City
Presided over two projects of Huai'an science and Technology Bureau
Participate in two research projects of major diseases in Jiangsu Province
Jiangsu health and Family Planning Commission and Huai'an health and Family Planning Commission won a new technology award
Associate Professor Lu Xuzhang
Director of 6 ward, Department of Hematology, Yanghu hospital, Changzhou Second People's Hospital
Director of Hematology Research Office
Deputy chief physician
Master Guide
Doctor of Medicine
Post-doctoral
1. At present, the anti epidemic work in our country has made some achievements, but we can't relax our vigilance. As a high-risk group of infection, the treatment of lymphoma patients is still facing major challenges. During the post epidemic period, how should lymphoma patients do well in protection and self-management?
Professor Li Jianyong: at present, the epidemic situation in China has been effectively controlled in general, but there are still some asymptomatic infected people, which is a problem that our doctors and patients should pay attention to. Therefore, patients should pay attention to protection, such as wearing masks when going out, washing hands frequently, indoor ventilation, maintaining a safe social distance, etc. Because of the poor immunity of lymphoma patients themselves, the use of some drugs will also inhibit the immune function, more likely to infect the virus. So, I think the most important thing is to avoid infection, because once infected, it is relatively difficult to deal with. At present, lymphoma patients can not relax, we should pay great attention to prevention.
2. Affected by the epidemic situation, the treatment of many lymphoma patients was delayed. So, which patients do you think can be appropriately delayed? What symptoms must patients come to the hospital in time?
Professor Li Jianyong: lymphoma can be divided into inert lymphoma, invasive lymphoma and highly invasive lymphoma. Highly invasive lymphoma develops very fast, and this kind of patients should be treated as near as possible. For invasive lymphoma, such as diffuse large B-cell lymphoma, peripheral T-cell lymphoma and so on, it should be considered according to the patient's condition. If well controlled, a delay of a week or more may not have a significant impact. If you can't go to the hospital, you can consider using oral drugs. For example, nadamine can be used for mantle cell lymphoma, xidabamide can be used for peripheral T-lymphoma, or combined with oral chemotherapy. However, if the disease is not well controlled, fever and lymph nodes increase in a short period of time, we need to go to the hospital. Inert lymphoma is generally stable, and patients can delay treatment for several months. Of course, if the patient's lymph nodes increase rapidly during the period of taking medicine, then drug resistance may occur. At this time, the patient should go to the hospital for treatment. If the patient is not in a special situation, try to stay at home.
3. There are many types of lymphoma. What is the significance of accurate classification and standardized treatment of lymphoma?
Professor Xu Wei: there are more than 100 types of lymphoma. The pathogenesis, clinical manifestations and prognosis of each type of lymphoma are different. In addition, due to different pathogenesis, we choose different treatment options. Therefore, the accurate classification of lymphoma is of great significance. Some of the lymphomas, such as the most common diffuse large B-cell lymphoma, can be cured in about 60% - 70% of patients, but if there is no standardized treatment, the chance of cure will be lost, so standardized treatment is also very important.
4. During the epidemic, many experts including you solved the difficult problem of lymphoma diagnosis and treatment through remote connection. Would you please talk about the value of this method for lymphoma diagnosis and treatment in the post epidemic period?
Professor Xu Wei: online remote medical treatment has certain advantages, especially for patients from other places or with inconvenient transportation, which can avoid the risk of infection caused by public transportation. But there are also some inconveniences, such as the medical history provided by online patients is just the tip of the iceberg, whose clinical manifestations we can not accurately grasp, nor can we carry out physical examination or laboratory examination, which may lead to missed diagnosis or misdiagnosis, which is also the lack of online medical treatment, so I think during the post epidemic period, we should return to the original medical treatment mode.
5. How to prevent and control the epidemic in Huai'an hospital and what measures have been taken by the hematology department during the epidemic. With the end of the epidemic, patients will speed up their return to treatment. Would you like to talk about your hospital's suggestions for improving patients' return and treatment in the post epidemic period?
Prof. Hu Yongjun: novel coronavirus pneumonia has been highly valued by our government and has taken strong measures. Our hospital set up a group headed by the president according to the government's deployment and requirements. The organization is strong and effective. Every day we have a regular meeting to report the epidemic situation. Monitor the medical staff and isolation personnel with fever or respiratory symptoms, and report any situation at any time. In addition, we strengthened the management of outpatients, especially the fever outpatients, which were managed separately from the general outpatients. At the same time, we increased the hospital protection and strengthened the measures related to disinfection and isolation.
Novel coronavirus pneumonia novel coronavirus pneumonia was adopted in the Department of Hematology during the epidemic period. First, before the admission, routine chest CT and nucleic acid test of new crown pneumonia were used to exclude new crown pneumonia. Second, strengthen the management of the caregivers. All the caregivers, like the inpatients, should monitor their body temperature every day and wear masks at the same time. Third, strengthen the management of disinfection in wards and wards every day, and disinfect the air in floors and rooms.
At present, the patients have gradually returned to the normal track and reached the hospital condition before the outbreak. Basically, all patients can be admitted to hospital and receive effective treatment. However, our epidemic prevention and control has not been relaxed. At present, no suspected or confirmed cases have been found among inpatients and caregivers.