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New NCCN Guidelines for Primary Cutaneous B-Cell Lymphoma and Updates to NCCN Guidelines for Non-Hodgkin’s Lymphomas


NCCN presented new NCCN Clinical Practice Guidelines in Oncology™ for Primary Cutaneous B-Cell Lymphoma as well as important updates to the NCCN Guidelines for Non-Hodgkin’s Lymphomas at the NCCN 14th Annual Conference. The new NCCN Guidelines were written to distinguish Primary B-Cell Lymphomas from their nodal counterparts and provide clinicians with treatment recommendations. Andrew D. Zelenetz, MD, PhD, and Steven M. Horowitz, MD, both of Memorial Sloan-Kettering Cancer Center, presented the updates to the NCCN Guidelines.


March 14, 2009

HOLLYWOOD, FL — The addition of new NCCN Clinical Practice Guidelines in Oncology™ for Primary Cutaneous B-Cell Lymphoma was a highlight at the NCCN 14th Annual Conference on Friday, March 13. The new NCCN Guidelines are encompassed within the NCCN Guidelines for Non-Hodgkin’s Lymphomas (NHL), which also had several notable updates presented by the chair of the NCCN Guidelines Panel for NHL, Andrew D. Zelenetz, MD, PhD, of Memorial Sloan-Kettering Cancer Center.

Steven M. Horwitz, MD, of Memorial Sloan-Kettering Cancer Center, presented the new NCCN Guidelines for Cutaneous B-Cell Lymphoma pointing out the unique clinical features that distinguish Primary Cutaneous B-Cell Lymphomas from their nodal counterparts and the need for clinical practice guidelines given the commonality of B-Cell Lymphomas.

Dr. Horowitz explained that Primary Cutaneous B-Cell Lymphoma is a B-Cell Lymphoma presenting in the skin where there is no evidence of extracutaneous disease on a complete staging work-up. They may appear on the skin as a reddish rash, lump or nodule and, because they tend to develop in the dermis, or second layer of the skin, may have a slightly raised and smooth appearance.

The new NCCN Guidelines for Cutaneous B-Cell Lymphoma stress consulting a pathologist familiar with diagnosing Primary Cutaneous B-Cell Lymphoma and recommend an incisional biopsy versus a shaved one. “Many of these lymphomas can penetrate deep into the skin, therefore a shaved biopsy may literally only scratch the surface and provide inaccurate results,” Horowitz noted.

He also noted that these lymphomas are nearly always indolent or slow growing. Relapses are common regardless of the treatment; however the relapses are usually confined to the skin and rarely develop into systemic lymphoma.

In addition, the new NCCN Guidelines provide essential information to complete a work-up of a patient presenting with Primary Cutaneous B-Cell Lymphoma as well as procedures that may be useful in certain circumstances, such as PET/CT scan.

As well as the notable addition of the new NCCN Guidelines for Primary Cutaneous B-Cell Lymphoma; Andrew D. Zelenetz, MD, PhD, presented several other important updates to the overall NCCN Guidelines for NHL.

A new section diagramming the use of immunophenotyping, a technique used to study the protein expressed by cells, in the differential diagnosis of mature B-Cell and T/NK Cell Neoplasms was recently added to the NCCN NHL Guidelines.

Dr. Zelenetz noted that this immunophenotyping section will be very helpful to “sorting out difficult diagnosis dilemmas.”

Also new to the NCCN Guidelines is information regarding the potential for viral reactivation in hepatitis positive patients being treated with rituximab (Rituxan®, Genentech, Inc.). Dr. Zelenetz explained Hepatitis B can reactivate with immunosuppression.

“More than 1 million people in the United States are infected with Hepatitis B, so this is not an inconsequential issue. We’ve seen reactivation with all types of chemotherapy regimens, not just rituximab, further stressing the importance of screening for Hepatitis B before treatment begins,” Dr. Zelenetz stated.

Another notable addition to the NCCN NHL Guidelines is the addition of bendamustine (Treanda®, Cephalon, Inc.) as a treatment option to reflect the FDA’s approval of the agents in the treatment of indolent NHL and Chronic Lymphocytic Leukemia (CLL).

Extensive revisions were made to the CLL section in the new NCCN Guidelines including a new differentiator to help clinicians distinguish between CLL and Monoclonal B-Cell Lymphocytosis (MBL), recommendations for how to treat rare cases of CLL, and a new page offering information on supportive care for patients with CLL.

Lastly, Dr. Zelenetz touched upon a new section detailing hallmarks, symptoms, and treatment for Tumor Lysis Syndrome – a group of metabolic complications that can occur after the treatment of lymphoma.

About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 25 of the world's leading cancer centers, is dedicated to improving the quality and effectiveness of care provided to patients with cancer. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers. The primary goal of all NCCN initiatives is to improve the quality, effectiveness, and efficiency of oncology practice so patients can live better lives. For more information, visit NCCN.org.

The NCCN Member Institutions are:

  • Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center
  • City of Hope Comprehensive Cancer Center
  • Dana-Farber/Brigham and Women's Cancer Center
    Massachusetts General Hospital Cancer Center
  • Duke Cancer Institute
  • Fox Chase Cancer Center
  • Huntsman Cancer Institute at the University of Utah
  • Fred Hutchinson Cancer Research Center / Seattle Cancer Care Alliance
  • The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
  • Robert H. Lurie Comprehensive Cancer Center of Northwestern University
  • Mayo Clinic Cancer Center
  • Memorial Sloan Kettering Cancer Center
  • Moffitt Cancer Center
  • The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
  • Roswell Park Cancer Institute
  • Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
  • St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
  • Stanford Cancer Institute
  • University of Alabama at Birmingham Comprehensive Cancer Center
  • UC San Diego Moores Cancer Center
  • UCSF Helen Diller Family Comprehensive Cancer Center
  • University of Colorado Cancer Center
  • University of Michigan Comprehensive Cancer Center
  • The University of Texas MD Anderson Cancer Center
  • Vanderbilt-Ingram Cancer Center
  • Yale Cancer Center/Smilow Cancer Hospital