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NCCN Flash Updates: NCCN Chemotherapy Order Templates (NCCN Templates®) for Hodgkin Lymphoma

NCCN has published updates to the NCCN Chemotherapy Order Templates (NCCN Templates®) for Hodgkin Lymphoma to reflect the currently published NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Hodgkin Lymphoma v1.2020.

  • The following NEW NCCN Templates® have been published:
    • HDL7: AVD (DOXOrubicin/VinBLAStine/Dacarbazine)
    • HDL23: CVP (Cyclophosphamide/VinCRIStine/PredniSONE) + RiTUXimab
    • HDL49: RiTUXimab
    • HDL51: Gemcitabine/Bendamustine/VinORELBine
    • HDL52: Brentuximab vedotin + Bendamustine
    • HDL53: Brentuximab vedotin + Nivolumab
    • HDL54: Nivolumab
    • HDL55: Pembrolizumab
    • HDL56: ABVD (DOXOrubicin/Bleomycin/VinBLAStine/Dacarbazine) – Older Adults
    • HDL57: AVD (DOXOrubicin/VinBLAStine/Dacarbazine) – Older Adults
    • HDL58: CHOP (Cyclophosphamide/DOXOrubicin/VinCRIStine/PredniSONE) – Older Adults
    • HDL59: PVAG (PredniSONE/VinBLAStine/DOXOrubicin/Gemcitabine) – Older Adults
    • HDL60: VEPEMB (VinBLAStine/Cyclophosphamide/PredniSONE/
      Procarbazine/Etoposide/MitoXANTRONE/Bleomycin) – Older Adults
    • HDL61: Brentuximab vedotin + Dacarbazine – Older Adults
    • HDL62: Bendamustine/CARBOplatin/Etoposide
    • HDL63: GEMOX (Gemcitabine/OXALIplatin)
    • HDL64: Brentuximab vedotin followed by AVD (DOXOrubicin/VinBLAStine/Dacarbazine) – Older Adults
  • Changes to the Chemotherapy Regimen, Indication, and References sections have been made to the following templates:
    • HDL1: ABVD (DOXOrubicin/Bleomycin/VinBLAStine/Dacarbazine) – Stage I-II Favorable
    • HDL2: ABVD (DOXOrubicin/Bleomycin/VinBLAStine/Dacarbazine) – Stage I-II Unfavorable
    • HDL3: ABVD (DOXOrubicin/Bleomycin/VinBLAStine/Dacarbazine) – Stage III-IV
    • HDL4: Stanford V (Mechlorethamine/DOXOrubicin/Etoposide/VinCRIStine/VinBLAStine/
      Bleomycin/PredniSONE) – Stage I-II Favorable
    • HDL5: Stanford V
      (Mechlorethamine/DOXOrubicin/Etoposide/VinCRIStine/VinBLAStine/
      Bleomycin/PredniSONE) – Stage I-II Unfavorable
    • HDL6: Escalated-dose BEACOPP
      (Bleomycin/Etoposide/DOXOrubicin/Cyclophosphamide/VinCRIStine/
      PredniSONE/Procarbazine) – Stage III-IV
    • HDL17: ABVD (DOXOrubicin/Bleomycin/VinBLAStine/Dacarbazine) + RiTUXimab
    • HDL31: Brentuximab vedotin
    • HDL32: Bendamustine
    • HDL46: Escalated-dose BEACOPP
      (Bleomycin/Etoposide/DOXOrubicin/Cyclophosphamide/VinCRIStine/
      PredniSONE/Procarbazine) – Stage I-II
  • Changes to the Chemotherapy Regimen section have been made to the following templates:
    • HDL11: Mini-BEAM (Carmustine/Etoposide/Cytarabine/Melphalan)
    • HDL14: GVD (Gemcitabine/VinORELBine/Liposomal DOXOrubicin)
    • HDL50: AVD (DOXOrubicin/VinBLAStine/Dacarbazine) + Brentuximab vedotin – Stage III-IV
  • Changes to the Indication section have been made to the following templates:
    • HDL8: ICE (Ifosfamide/CARBOplatin/Etoposide)
    • HDL9: DHAP (Dexamethasone/Cytarabine/CISplatin)
    • HDL10: ESHAP (Etoposide/MethylPREDNISolone/Cytarabine/CISplatin)
    • HDL11: Mini-BEAM (Carmustine/Etoposide/Cytarabine/Melphalan)
    • HDL12: MINE (Mesna/Ifosfamide/MitoXANTRONE/Etoposide)
    • HDL14: GVD (Gemcitabine/VinORELBine/Liposomal DOXOrubicin)
    • HDL15: IGEV (Ifosfamide/Gemcitabine/VinORELBine/PredniSONE)
    • HDL19: CHOP (Cyclophosphamide/DOXOrubicin/VinCRIStine/PredniSONE) + RiTUXimab
    • HDL25: C-MOPP – Schema I (Cyclophosphamide/VinCRIStine/PredniSONE/Procarbazine)
    • HDL26: C-MOPP – Schema II (Cyclophosphamide/VinCRIStine/PredniSONE/Procarbazine)
    • HDL29: GCD (Gemcitabine/CARBOplatin/Dexamethasone)
    • HDL34: ICE (Ifosfamide/CARBOplatin/Etoposide) + RiTUXimab
    • HDL35: DHAP (Dexamethasone/Cytarabine/CISplatin) + RiTUXimab
    • HDL36: ESHAP (Etoposide/MethylPREDNISolone/Cytarabine/CISplatin) + RiTUXimab
    • HDL41: IGEV (Ifosfamide/Gemcitabine/VinORELBine/PredniSONE) + RiTUXimab
    • HDL47: Everolimus
    • HDL48: Lenalidomide
    • HDL50: AVD (DOXOrubicin/VinBLAStine/Dacarbazine) + Brentuximab vedotin – Stage III-IV
  • Changes to the References section have been made to the following templates:
    • HDL8: ICE (Ifosfamide/CARBOplatin/Etoposide)
    • HDL10: ESHAP (Etoposide/MethylPREDNISolone/Cytarabine/CISplatin)
    • HDL19: CHOP (Cyclophosphamide/DOXOrubicin/VinCRIStine/PredniSONE) + RiTUXimab
    • HDL34: ICE (Ifosfamide/CARBOplatin/Etoposide) + RiTUXimab
    • HDL35: DHAP (Dexamethasone/Cytarabine/CISplatin) + RiTUXimab
    • HDL36: ESHAP (Etoposide/MethylPREDNISolone/Cytarabine/CISplatin) + RiTUXimab
  • Febrile Neutropenia risk has been updated on the following templates:
    • HDL15: IGEV (Ifosfamide/Gemcitabine/VinORELBine/PredniSONE)
    • HDL29: GCD (Gemcitabine/CARBOplatin/Dexamethasone)
    • HDL41: IGEV (Ifosfamide/Gemcitabine/VinORELBine/PredniSONE) + RiTUXimab
  • The following myeloid growth factor notes for templates with a febrile neutropenia risk of “high” have been revised in the Supportive Care section:
    • Filgrastim (or clinically appropriate G-CSF agent) 5 mcg/kg subcutaneously daily, recommended to start the day following or up to 3 – 4 days after completion of chemotherapy and to continue until post-nadir ANC recovery to normal or near-normal levels by laboratory standards. Dose is rounded to the nearest vial size by institution-defined weight limits. Same-day administration is not recommended.
      OR
      Pegfilgrastim (or clinically appropriate biosimilar) 6 mg subcutaneously once, recommended to be given the day following or up to 3 – 4 days after completion of chemotherapy. There are insufficient data to support use of pegfilgrastim for cytotoxic chemotherapy regimens administered less frequently than every 2 weeks. Same-day administration is not recommended.
    • For more information on prophylaxis of febrile neutropenia and a list of appropriate agents, refer to the Myeloid Growth Factors algorithms in the NCCN Guidelines for Hematopoietic Growth Factors and Appendix C to the NCCN Templates.
    • Affected templates:
      • HDL6: Escalated-dose BEACOPP (Bleomycin/Etoposide/DOXOrubicin/Cyclophosphamide/VinCRIStine/
        PredniSONE/Procarbazine) – Stage III-IV
      • HDL8: ICE (Ifosfamide/CARBOplatin/Etoposide)
      • HDL9: DHAP (Dexamethasone/Cytarabine/CISplatin)
      • HDL10: ESHAP (Etoposide/MethylPREDNISolone/Cytarabine/CISplatin)
      • HDL11: Mini-BEAM (Carmustine/Etoposide/Cytarabine/Melphalan)
      • HDL12: MINE (Mesna/Ifosfamide/MitoXANTRONE/Etoposide)
      • HDL15: IGEV (Ifosfamide/Gemcitabine/VinORELBine/PredniSONE)
      • HDL29: GCD (Gemcitabine/CARBOplatin/Dexamethasone)
      • HDL34: ICE (Ifosfamide/CARBOplatin/Etoposide) + RiTUXimab
      • HDL35: DHAP (Dexamethasone/Cytarabine/CISplatin) + RiTUXimab
      • HDL36: ESHAP (Etoposide/MethylPREDNISolone/Cytarabine/CISplatin) + RiTUXimab
      • HDL41: IGEV (Ifosfamide/Gemcitabine/VinORELBine/PredniSONE) + RiTUXimab
      • HDL46: Escalated-dose BEACOPP (Bleomycin/Etoposide/DOXOrubicin/Cyclophosphamide/VinCRIStine/
        PredniSONE/Procarbazine) – Stage I-II
      • HDL50: AVD (DOXOrubicin/VinBLAStine/Dacarbazine) + Brentuximab vedotin – Stage III-IV
  • The following myeloid growth factor note for templates with a febrile neutropenia risk of “intermediate” has been revised in the Supportive Care section:
    • CSFs may be considered for primary prophylaxis based on the febrile neutropenia (FN) risk of the chemotherapy regimen. For more information on prophylaxis of FN and a list of appropriate agents, refer to the Myeloid Growth Factors algorithms in the NCCN Guidelines for Hematopoietic Growth Factors and Appendix C to the NCCN Templates.
    • Affected templates:
      • HDL19: CHOP (Cyclophosphamide/DOXOrubicin/VinCRIStine/PredniSONE) + RiTUXimab
  • Drug information notes for the following medications have been updated in the Supportive Care, Monitoring and Hold Parameters, and/or Safety Parameters and Special Instructions sections:
    • Bendamustine
    • Bleomycin
    • Brentuximab vedotin
    • CARBOplatin
    • Carmustine
    • CISplatin
    • Cyclophosphamide
    • Cytarabine
    • Dacarbazine
    • DOXOrubicin
    • Etoposide
    • Everolimus
    • Gemcitabine
    • Ifosfamide
    • Lenalidomide
    • Liposomal DOXOrubicin
    • Mechlorethamine
    • Mesna
    • Procarbazine
    • Rituximab
    • VinBLAStine
    • VinCRIStine
    • VinORELBine

 

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 Chemotherapy Order Templates (NCCN Templates®), the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), please visit NCCN.org.

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