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NCCN Flash Update: NCCN Guidelines®, NCCN Compendium®, & NCCN Radiation Therapy Compendium™ for Hodgkin Lymphoma

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), the NCCN Drugs & Biologics Compendium (NCCN Compendium®), and NCCN Radiation Therapy Compendium™ for Hodgkin Lymphoma. These NCCN Guidelines® are currently available as Version 1.2018.

  • Classic Hodgkin Lymphoma (CHL)

    • Stage IA-IIA Favorable Disease (no bulky disease, <3 sites of disease, ESR <50, and no E-lesions):

    • Stage IA-IIA Favorable Disease (no bulky disease): After ABVD x 2 cycles (preference to treat with combined modality therapy), additional therapy for Deauville 3-4 has been revised:

      • ABVD x 2 cycles (total 4) + ISRT (30 Gy) (preferred for Deauville 3) or

        Escalated BEACOPP x 2 cycles + ISRT (30 Gy) (preferred for Deauville 4-5) (HODG-4)

      • Following this additional therapy, "Consider PET/CT" followed by "ISRT (30 Gy)" has been added. (HODG-4)

    • Stage I-II Unfavorable (Non-Bulky) (HODG-6)

      • After ABVD x 2 cycles and restaging, additional therapy for Deauville 1-2 has been revised to “AVD x 4 cycles (total 6) ± ISRT.”

      • Additional therapy for Deauville 3-4 has been revised: ABVD x 2 cycles (total 4) (preferred for Deauville 3) or Escalated BEACOPP x 2 cycles (preferred for Deauville 4)

    • Stage I-II Unfavorable (bulky mediastinal disease or >10 cm adenopathy) (HODG-7)

      • After ABVD x 2 cycles and restaging, Deauville 1-3 has been changed to Deauville 1-2 and Deauville 4 has been changed to Deauville 3-4.

      • Additional therapy for Deauville 3-4 has been revised: ABVD x 2 cycles (total 4) + ISRT (preferred for Deauville 3) or Escalated BEACOPP x 2 cycles + ISRT (30 Gy) (preferred for Deauville 4) or Escalated BEACOPP x 3 cycles

        • Following additional therapy with ABVD x 2 cycles or Escalated BEACOPP x 2 cycles, "consider PET/CT" followed by "ISRT (30 Gy)" has been added.

        • Following Escalated BEACOPP x 3 cycles, "PET/CT" followed by "Escalated BEACOPP x 1 cycle" has been added.

    • Stage III-IV Disease: Following ABVD x 2 cycles and restaging, “ABVD x 2 cycles (4 total)” has been removed from the additional therapy options for Deauville 4-5. (HODG-10)

    • Refractory Disease (HODG-15)

      • Maintenance therapy options revised

        • After HDT/ASCR for those with Deauville 1-3 prior to HDT/ASCR: "Observe or Consider Brentuximab vedotin for 1 y for patients with high risk of relapse."

        • After HDT/ASCR for those with Deauville 4 prior to HDT/ASCR: "Strongly consider Brentuximab vedotin for 1 y for patients with high risk of relapse."

        • Footnote “ww” has been added regarding brentuximab vedotin maintenance therapy: “Patients with 2 or more of the following risk factors are considered high risk: Remission duration less than 1 year, extranodal involvement, PET+ response at time of transplant, B symptoms, and/or >1 salvage/subsequent therapy regimen.”

        • The following footnote has been removed, "The value of brentuximab maintenance for a patient who previously received brentuximab vedotin is not known. It does not provide a survival benefit."

      • For those with Deauville 5, "autologous or allogeneic stem cell transplant if response to secondary therapy" has been added as an option after additional therapy.

    • Suspected Relapse (HODG-16)

      • Initial stage IA-IIA (no prior RT with failure in initial sites): The second-line therapy recommendations have been revised to clarify the recommendation for patients who received abbreviated chemotherapy (3–4 cycles) without RT, versus patients who received full-course chemotherapy.
         

  • Nodular Lymphocyte-Predominant Hodgkin Lymphoma (NLPHL)

    • For CS IIIA, IVA, "observe" has been added as a primary treatment option. (HODG-13)
       

  • Principles of Systemic Therapy

    • The second-line systemic therapy options have been revised. (HODG-E, 1 of 3)

      • Brentuximab vedotin (only for CHL) alone or in combination with the other second-line regimens

      • Gemcitabine/bendamustine/vinorelbine has been added. (Santoro A, Mazza R, Pulsoni A, et al. Bendamustine in combination with gemcitabine and vinorelbine is an effective regimen as induction chemotherapy before autologous stem-cell transplantation for relapsed or refractory Hodgkin lymphoma: final results of a multicenter phase II study. J Clin Oncol 2016;34:3293-3299.)

      • The following regimens have been moved to the list of Subsequent Systemic Therapy Options (only for CHL)

        • C-MOPP (cyclophosphamide, vincristine, procarbazine, prednisone) (category 2B)

        • MINE (etoposide, ifosfamide, mesna, mitoxantrone)

        • Mini-BEAM (carmustine, cytarabine, etoposide, melphalan)

    • Indications have been revised for the following subsequent therapy options (only for CHL) (HODG-E, 1 of 3)

      • Nivolumab (for patients previously treated with brentuximab vedotin) (for relapsed or refractory CHL following HDT/ASCR)

      • Pembrolizumab (for patients previously treated with brentuximab vedotin) (for relapsed or refractory CHL after ≥3 prior lines of therapy)

    • A new page has been added, titled “Checkpoint Inhibitors”. (HODG-E, 2 of 3)

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Compendium®, the NCCN Biomarkers Compendium®, the NCCN Chemotherapy Order Templates (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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