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NCCN Flash UpdatesTM: NCCN Guidelines® and NCCN Compendium® Updated

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and the NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Non-Hodgkin’s Lymphomas. These NCCN Guidelines® are currently available as Version 1.2015.

  • Non-Hodgkin’s Lymphomas (NHL) Global changes
    • The response criteria for NHL were replaced with the recently updated Lugano Response Criteria for NHL (Cheson B, Fisher R, Barrington S, et al. Recommendations for Initial Evaluation, Staging and Response Assessment of Hodgkin and Non-Hodgkin Lymphoma – the Lugano Classification. J Clin Oncol 2014;32:3059-3067).
  • Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL)
    • First-line therapy for frail patients with significant comorbidity (CSLL-D 1 of 7)
      • Ofatumumab + chlorambucil was added as a category 2A recommendation.
      • Obinutuzumab was added as a category 2B recommendation.
      • Obinutuzumab + chlorambucil was changed from a category 2A to a category 1 recommendation. 
      • Rituximab was changed from a category 2A to a category 2B recommendation.
      • Chlorambucil was changed from a category 2A to a category 2B recommendation.
      • Pulse corticosteroids was changed from a category 2A to a category 3 recommendation.
    • For CLL without del (11q) or del (17p): (CSLL-D 1 of 7 and CSLL-D 2 of 7)
      • First-line therapy for patients ³70 years and younger patients with significant comorbidities
        • Ofatumumab + chlorambucil was added as a category 2A recommendation.
        • Obinutuzumab was added as a category 2B recommendation.
        • Obinutuzumab + chlorambucil was changed from a category 2A to a category 1 recommendation.
        • Fludarabine ± rituximab was changed from a category 2A to a category 2B recommendation.
        • Chlorambucil was changed from a category 2A to a category 2B recommendation.
        • Rituximab was changed from a category 2A to category 3 recommendation.
        • Cladribine was changed from a category 2A to category 3 recommendation.
        • Cyclophosphamide, prednisone ± rituximab was removed.
      • First-line therapy for patients <70 years without significant comorbidities
        • FCR was changed from a category 2A to a category 1 recommendation.
        • Obinutuzumab + chlorambucil was removed.
      • Relapsed/refractory therapy for patients ³70 years and younger patients with significant comorbidities
        • Obinutuzumab was added as a category 2A recommendation.
        • Ibrutinib was changed from a category 2A to a category 1 recommendation.
        • Idelalisib + rituximab was changed to idelalisib ± rituximab.
      • Relapsed/refractory therapy for patients <70 years without significant comorbidities
        • Ibrutinib was changed from a category 2A to a category 1 recommendation.
        • Idelalisib + rituximab was changed to idelalisib ± rituximab.
        • Obinutuzumab was added as a category 2A recommendation.
    • For CLL with del (17p): (CSLL-D 3 of 7)
      • First-line and relapsed/refractory therapy were put in order of preference.
      • Relapsed/refractory therapy
        • Idelalisib + rituximab was changed to idelalisib ± rituximab.
        • RCHOP was removed.
        • CFAR was removed.
    • For CLL with del (11q): (CSLL-D 4 of 7)
      • First-line therapy for patients ³70 years and younger patients with significant comorbidities
        • Obinutuzumab + chlorambucil was changed from a category 2A to a category 1 recommendation.
        • Ofatumumab + chlorambucil was added as a category 2A recommendation.
        • Rituximab was changed from a category 2A to category 3 recommendation.
    • For CLL with del (11q): (CSLL-D 5 of 7)
      • Relapsed/refractory therapy for patients ³70 years and younger patients with significant comorbidities
        • Ibrutinib was changed from a category 2A to a category 1 recommendation.
        • Idelalisib + rituximab was changed to idelalisib ± rituximab.
        • Obinutuzumab was added as a category 2A recommendation.
      • Relapsed/refractory therapy for patients <70 years without significant comorbidities
        • Ibrutinib was changed from a category 2A to a category 1 recommendation.
        • Idelalisib + rituximab was changed to idelalisib ± rituximab.
        • RCHOP was removed.
        • Obinutuzumab was added as a category 2A recommendation.
  • Follicular Lymphoma
    • All of the suggested treatment regimens are now listed in order of preference. (FOLL-B 1 of 3)
    • First-line therapy (FOLL-B 1 of 3)
      • Lenalidomide + rituximab was added as a category 3 recommendation.
    • First-line Therapy for Elderly or Infirm (FOLL-B 1 of 3)
      • Radioimmunotherapy was changed from a category 2A to a category 2B recommendation.
    • First-line Consolidation or Extended Dosing (optional) (FOLL-B 1 of 3)
      • Radioimmunotherapy (after induction with chemotherapy or chemoimmunotherapy) was changed from a category 1 to a category 2A recommendation.
    • Second-line and Subsequent Therapy (FOLL-B 2 of 3)
      • FCMR (fludarabine, cyclophosphamide, mitoxantrone, rituximab) (category 1) was removed.
  • Diffuse Large B-Cell Lymphoma (DLBCL)
    • The National Comprehensive Cancer Network-International Prognostic Index (NCCN-IPI) was added as a resource. (BCEL-A)
    • Second-line and Subsequent Therapy (non-candidates for high-dose therapy) (BCEL-C 2 of 4)
      • Brentuximab vedotin for CD30+ disease was added as a category 2B recommendation.
  • AIDS-Related B-cell Lymphomas
    • Hepatitis C testing was added as an essential workup. (AIDS-2)
    • A new page titled, “Supportive care for AIDS-related B-cell lymphomas” was added. (AIDS-A)
  • Primary Cutaneous B-Cell Lymphomas
    • Initial therapy (CUTB-2)
      • Solitary/regional, the first treatment option was revised, “Local RT (preferred) and/or Excision.”
      • Generalized disease, “Palliative chemotherapy such as chlorambucil ± rituximab or CVP ± rituximab” was revised to “Other systemic therapy.”
    • The response to therapy section was extensively revised due to combining it with the relapsed disease algorithm. (CUTB-2)
  • Peripheral T-Cell Lymphomas
    • First-line therapy: (TCEL-B 1 of 3)
      • For histologies other than ALCL, ALK+
        • The regimens were put into “preferred regimen (in alphabetical order)” and “alternative regimens (in alphabetical order)” categories.
        • CHOP followed by ICE (ifosfamide, carboplatin, etoposide) was removed.
    • Second-line and subsequent therapy: (TCEL-B 1 of 3)
      • For both intention to proceed to high-dose therapy and non-candidate for high-dose therapy, bendamustine was added.
      • Intention to proceed to high-dose therapy
        • Brentuximab vedotin for systemic CD30+ PTCL was changed from a category 2B to a category 2A recommendation.
        • MINE regimen was removed.
      • Non-candidate for high-dose therapy
        • Bortezomib was changed from a category 2A to a category 2B recommendation.
  • Mycosis Fungoides/Sezary Syndrome
    • Skin-directed Therapies: (MFSS-A)
      • Carmustine was removed from topical chemotherapy.
    • Systemic Therapies, Category B (MFSS-A)
      • First-line regimens are now listed in alphabetical order.
      • Brentuximab vedotin was added as an option for first-line therapy. 
      • Low-dose pralatrexate was moved from second-line to first-line therapy.
    • Systemic Therapies, Category C (MFSS-A)
      • The regimens are now listed in alphabetical order.
      • Brentuximab vedotin was added.
  • Primary Cutaneous CD30+ T-Cell Lymphoproliferative Disorders
    • Cutaneous ALCL primary treatment (PCTLD-4)
      • Brentuximab vedotin was added as an option for both “Primary cutaneous ALCL, multifocal lesions” and “Cutaneous ALCL with regional node (excludes systemic ALCL).”
    • Lymphomatoid papulosis (PCTLD-5)
      • Extensive lesions or symptomatic: “Brentuximab vedotin or Clinical trial” were added as treatment options for relapsed/refractory disease after primary treatment.
  • Hairy Cell Leukemia
    • Vemurafenib was added as a treatment option for relapsed/refractory disease non-responsive to or progressing on purine analog therapy. (HCL-2)
  • Staging
    • The Lugano Modification of Ann Arbor Staging System was added to the guidelines. (ST-3)

For the complete updated versions of the NCCN Guidelines, the NCCN Compendium®, and the NCCN Chemotherapy Order Templates (NCCN Templates®), please visit NCCN.org.

To access the NCCN Biomarkers Compendium®, please visit NCCN.org/biomarkers.

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

Free NCCN Guidelines apps iPhone, iPad, and Android devices are now available! Visit NCCN.org/apps

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