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NCCN Flash Update: NCCN Resources Updated for Occult Primary & Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL)

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), and NCCN Radiation Therapy Compendium™ for Occult Primary (Cancer of Unknown Primary [CUP]). These NCCN Guidelines® are currently available as Version 1.2018.

  • Suspected Metastatic Malignancy (OCC-1)
    • Symptom-directed endoscopy was changed to Clinically-directed endoscopy, as indicated.
    • Core needle biopsy (preferred) and/or FNA with cell block of most accessible site.
       
  • Pathologic Diagnosis (OCC-2)
    • Localized has been added to adenocarcinoma or carcinoma not otherwise specified throughout the guidelines.
       
  • Localized adenocarcinoma / Supraclavicular Nodes (OCC-3)
    • Men and women: Endoscopy, if clinically indicated is new to the page.
       
  • Tumor-Specific Markers and their Staining Pattern (OCC-A)
    • The Immunohistochemistry Markers section of the guidelines has been extensively modified.
       
  • Principles of Radiation Therapy (OCC-C)
    • Palliative Therapy, modified as follows:
      • Regimen: A number of hypofractionation regimens could be considered, but typically 8 Gy in 1 fraction, 20 Gy in 4–5 fractions, or 30 Gy in 10 fractions are most frequently used.

 

 

 

NCCN has published updates to the NCCN Chemotherapy Order Templates (NCCN Templates®) for Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL) to reflect the currently published NCCN Guidelines for CLL/SLL, Version 2.2018.

 

  • Indications for the following NCCN Templates have been updated:
    • CLL14 – FR (Fludarabine + RiTUXimab)
    • CLL24 – CHOP (Cyclophosphamide/DOXOrubicin/VinCRIStine/PredniSONE) + RiTUXimab
    • CLL28 – OFAR (OXALIplatin/Fludarabine/Cytarabine + RiTUXimab)

 

  • Prednisone dosing and references for the following NCCN Template have been updated:
    • CLL24 – CHOP (Cyclophosphamide/DOXOrubicin/VinCRIStine/PredniSONE) + RiTUXimab

 

  • New note for mucocutaneous reactions secondary to RiTUXimab has been added to the Monitoring and Hold Parameters section for the following NCCN Templates:
    • CLL14 – FR (Fludarabine + RiTUXimab)
    • CLL24 – CHOP (Cyclophosphamide/DOXOrubicin/VinCRIStine/PredniSONE) + RiTUXimab
    • CLL28 – OFAR (OXALIplatin/Fludarabine/Cytarabine + RiTUXimab)

 

  • Administration instructions for RiTUXimab have been updated on the following NCCN Template:
    • CLL14 – FR (Fludarabine + RiTUXimab)

 

  • New note for liver monitoring for cytarabine has been added to the Monitoring and Hold Parameters section for the following NCCN Template:
    • CLL28 – OFAR (OXALIplatin/Fludarabine/Cytarabine + RiTUXimab)


For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Drugs & Biologics Compendium (NCCN Compendium®), the NCCN Biomarkers Compendium®, the NCCN Templates®, the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), please visit NCCN.org.

To view the NCCN Guidelines for Patients®, please visit NCCN.org/patients.

Free NCCN Guidelines apps for iPhone, iPad, and Android smartphones & tablets are now available! Visit NCCN.org/apps

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