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NCCN Flash Update: NCCN Guidelines®, NCCN Compendium®, & NCCN Imaging AUC™ Updated

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), the NCCN Drugs & Biologics Compendium (NCCN Compendium®), and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™) for Hodgkin Lymphoma. These NCCN Guidelines® are currently available as Version 1.2017.

  • Workup for Hodgkin Lymphoma (HODG-1)
    • The following evaluation options have been added and are considered useful in selected cases:
      • Hepatitis C testing
      • MRI or PET/MRI with contrast (skull base to mid-thigh)
         
  • Classical Hodgkin Lymphoma (CHL) Stage IA-IIA (no bulky disease) (HODG-4)
    • The following option has been revised for patients with Deauville 1-2 following ABVD x 2 cycles (preference to treat with combined modality therapy): “ABVD x 1 2 cycle (total 3) + ISRT (30 Gy)”
       
  • CHL Stage I-II Unfavorable (Non-bulky) (HODG-6)
    • Primary treatment with ABVD has been changed from 4 cycles to 2 cycles before restaging. (Also on HODG-7)
    • The treatment options have been revised for Deauville 1-2 after 2 cycles of ABVD. Options now include:
      • ABVD x 2 cycles (total 4) + ISRT, or
      • AVD x 4 cycles (total 6) +/- ISRT
    • The following option has been added for Deauville 3-4 after 2 cycles of ABVD: “Escalated BEACOPP x 2 cycles”.
    • For Deauville 5 and biopsy negative after 2 cycles of ABVD, the option of “ABVD x 4 cycles + ISRT” has been changed to “AVD x 4 cycles + ISRT”.
       
  • CHL Stage I-II Unfavorable (Bulky mediastinal disease or >10 cm adenopathy) (HODG-7)
    • The treatment options have been revised for Deauville 1-3 after 2 cycles of ABVD. Options now include:
      • ABVD x 2 cycles (total 4) + ISRT, or
      • AVD x 4 cycles (total 6) +/- ISRT
    • The following option has been added for Deauville 4 after 2 cycles of ABVD: “Escalated BEACOPP x 2 cycles + ISRT (30 Gy)”.
       
  • CHL Stage III-V (HODG-10)
    • Primary treatment with ABVD has been made the preferred option.
    • For Deauville 1-3 after 2 cycles of ABVD, the option of “ABVD x 4 cycles (total 6)” has been removed.
    • For Deauville 4-5 after 2 cycles of ABVD, the recommendations have been clarified for those treated with escalated BEACOPP versus ABVD.
      • If treated with ABVD, the following option has been added for Deauville 1-3, and Deauville 4-5 if negative biopsy: “ABVD x 2 cycles (total 6) ± ISRT to initially bulky or PET+ sites.”
         
  • CHL Refractory Disease (HODG-15)
    • The following maintenance therapy options have been revised:
      • For Deauville 1-3 after high-dose therapy and autologous stem cell rescue: “Consider brentuximab vedotin for 1 y if primary refractory or extranodal disease or relapse <12 months following primary therapy.”
      • For Deauville 4 after high-dose therapy and autologous stem cell rescue, the recommendation has been changed to “Strongly consider brentuximab vedotin for 1 y.”
         
  • Nodular Lymphocyte- Predominant Hodgkin Lymphoma (NLPHL) (HODG-13)
    • ISRT has been made the preferred primary treatment option for stage IA or contiguous stage IIA NLPHL.
    • For CS IB-IIB or I-IIA (bulky) disease, "± rituximab" has been changed to "+ rituximab." (Also for CS III-IVA, III-IVB).
       
  • Principles of Systemic Therapy (HODG-B, 1 of 2)
    • The second bullet has been revised to clarify that routine use of growth factors is not recommended with ABVD.
       
  • Principles of Systemic Therapy for Relapsed or Refractory Disease (HODG-E)
    • It has been clarified that the additional therapy options of nivolumab and pembrolizumab are recommended for patients previously treated with brentuximab vedotin.
    • The following pembrolizumab reference has been added: Armand P, Shipp MA, Ribrag V, et al. Programmed Death-1 blockade with pembrolizumab in patients with classical Hodgkin Lymphoma after brentuximab vedotin failure. J Clin Oncol 2016; 34(31):3733-3739.
       
  • Management of CHL in Older Adults (Age >60) (HODG-F)
    • Nivolumab has been added as a palliative therapy option for patients previously treated with brentuximab vedotin.
       
  • The Discussion section has been updated to reflect the changes in the algorithm. (MS-1)

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®), and the NCCN Imaging AUC™, please visit NCCN.org.

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

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

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