Hematologist develops innovative treatment to improve outcomes for leukemia patients, reports Zhou Wenting in Shanghai.

Hu Jiong, director of the Bone Marrow Transplantation Center of the Hematology Department, Shanghai Ruijin Hospital, checks on a patient in a hospital ward. (PHOTO PROVIDED TO CHINA DAILY)

At the beginning of his medical career three decades ago, Hu Jiong chose the roller coaster of bone marrow transplantation over the more routine merry-go-round disciplines of the medical profession.

In the early 1990s, hematology was an emerging field where a lot of improvements were needed. However, Hu says he preferred the challenge of hematology to other medical disciplines that already had set treatment plans and predictable outcomes.

That (improved survival rate) gives hope to patients and their families who originally had already lost hope. As a doctor, saving lives is always my goal. Nothing else compares with this.

Hu Jiong, director of the Bone Marrow Transplantation Center of the Hematology Department, Shanghai Ruijin Hospital

Hu, 53, is now the director of the Bone Marrow Transplantation Center of the Hematology Department, Shanghai Ruijin Hospital, and his treatment innovations have improved the outcomes for many leukemia patients.

Hematopoietic stem cell transplantation involves clearing away damaged or diseased bone marrow in a patient's body through chemotherapy and radiation therapy.

This is followed by infusing normal donor hematopoietic stem cells, and rebuilding the hematopoietic and immune system in a patient's body.

The procedure is recognized as one of the most challenging clinical treatment techniques, and requires highly skilled physicians, according to medical experts.

Hu says a patient is usually hospitalized for five to six weeks during the transplantation procedure. Doctors have to ride a roller coaster with the patient as there are many obstacles to overcome, including complications and rejection of the donor material.

"We'll be haunted by fear all the time. But I enjoy such challenges from work," says Hu, whose hospital is affiliated with Shanghai Jiao Tong University's School of Medicine.

For his patients, Hu's aim is to lessen the impact of the roller-coaster ride of treatment, by improving their outcomes, achieving a full cure, and reducing donor material rejections and recurrence of the disease.

Through constant innovations in his treatment method — intensive chemotherapy with sequential transplantation — Hu and his team have improved the long-term survival rate of patients suffering from refractory acute myeloid leukemia, or AML.Since the method was initiated in 2015, the long-term survival rate has increased from 20 percent of patients to between 50 and 60 percent.

The recurrence rate of the disease among refractory AML patients — those who do not achieve full remission after treatment — has been lowered from around 60 percent to less than 20 percent.

"That gives hope to patients and their families who originally had already lost hope. As a doctor, saving lives is always my goal. Nothing else compares with this," says Hu.

Refractory AML accounts for half of all AML cases. But these patients are often turned down by medical institutions due to the high relapse rate and risks of complications.

The increased transplantation success rate was achieved by combining established international practices with innovations introduced by Hu's team. The lower recurrence rate was a result of using new targeted medicines, which proved to have good efficacy and fewer side effects, he says.

Since the late 1990s, the international status of Hu's team has gone from follower to front-runner.

Hu poses for a photo with Didier Blaise (left), a blood and marrow transplantation expert at Institut Paoli-Calmettes in Marseille, France, after a working discussion in Shanghai last month. (PHOTO PROVIDED TO CHINA DAILY)

Spreading benefits

Multicenter prospective clinical research to confirm the treatment used at Shanghai Ruijin Hospital, is in the works.

Two centers in France have already introduced the Ruijin treatment for refractory AML patients. The centers include the Institut Paoli-Calmettes in Marseille, which began using it in 2019.

A published paper about the treatment method showed that 42 percent of patients could realize long-term survival, with the percentage expected to rise over the following years.

The centers in Shanghai and in Marseille have regular exchanges, with the two teams often visiting each other. Hu got to know Didier Blaise, leader of the blood and marrow transplantation and immune cellular therapy program at Institut Paoli-Calmettes, at an international conference in 2004.

During the COVID-19 pandemic, they held monthly online meetings to discuss difficult and complicated cases. Regular meetings have been maintained after that, with new ideas and research programs discussed.

In June, Hu was invited by the center in Marseille to join a hematology experts conference to help the center review its clinical treatment plans. A month later, Blaise was invited to Shanghai by Hu to review the Ruijin team's methods.

Sharing and reviewing knowledge and techniques helps research teams avoid getting stuck in a rut, Hu says. "Sometimes we need an onlooker from the outside to assess our programs from a different perspective, especially an international one, which may make our treatment approaches better recognized in international academic circles," he says.

Some Western experts are not solely convinced by data from study results, Hu says. A researcher needs to have sound thinking and reasoning as well as medical ethics, which include proper consideration for patients throughout the research process.

Blaise, also a senior member of the European Cooperative Group for Bone Marrow Transplantation, says Hu's team is exceptional and their dedication to refining treatments is noteworthy. Hu distinguishes himself through his ability to lead medical innovation and swiftly translate it into tangible benefits for patients, he says.

"His unwavering dedication to improving patient outcomes is palpable, driving his relentless pursuit of collaborations with diverse teams both domestically and internationally," says Blaise, who is also former chairman of the French Society of Bone Marrow Transplantation and Cell Therapy.

"This collaborative spirit extends beyond cooperation, as he adeptly orchestrates these partnerships for the collective advancement of all teams and, most importantly, the well-being of the patients they serve."

More innovation

More recently, Hu's team has been working on the optimization of transplants by using dual alkylating drugs as a front-line treatment for patients with AML. Alkylating agents are a family of anticancer drugs that interfere with a cell's DNA and inhibit cancer cell growth.

Hu was selected to give an oral presentation during the EBMT 2023 Annual Meeting in Paris in April, following the good outcomes of the alkylating drugs treatment.

"Regarding the recurrence rate, we're definitely becoming a leader. The recurrence rate for average cases is around 15 percent, and we have brought it down to 5 to 6 percent," he says, adding that it is uncommon for any transplantation center in the world to achieve single-digit results.

Around 150 patients treated at Ruijin, and another 200 patients treated in dozens of medical centers nationwide have benefited from the innovative transplantation methods of Hu's team. Among them are young patients, including minors and people in the prime of their life.

Although many medical innovators have strong personalities and fixed ideas, Hu says, "I'm open to communication and to welcoming ideas from both home and abroad. For me, that's how innovations are produced".

He is willing to send his students elsewhere and welcome outsiders to his team. Only one member of his current team of five is a former student of his.

"In my mind, it's good for them to grow and thrive when they have opportunities to work with different experts before they develop a fixed idea about their work. Work experience with different minds, and of different work methods, will stimulate them to think of new questions and see things from a variety of perspectives," he says.

Contact the writer at zhouwenting@chinadaily.com.cn