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NCCN Flash Update: NCCN Guidelines®, NCCN Compendium®, & NCCN Templates® Updated

NCCN has published updates to the NCCN Guidelines®, NCCN Chemotherapy Order Templates (NCCN Templates®), and NCCN Drugs & Biologics Compendium (NCCN Compendium®) for B-Cell Lymphomas. These NCCN Guidelines are currently available as Version 1.2017.

  • General
    • The algorithms related to B-cell lymphomas were formerly published under the NCCN Guidelines for Non-Hodgkin’s Lymphomas and will now be published under the NCCN Guidelines for B-Cell Lymphomas.
    • The 2016 WHO classification of the Mature B-Cell, T-Cell, and NK-Cell Neoplasms was added.
    • For imaging, the target anatomy and the use of contrast was added to CT and whole-body was added to PET/CT as appropriate throughout the guidelines.
  • Follicular Lymphoma
    • Recommendations for the treatment of “Pediatric-type Follicular Lymphoma” in adults have been added. (FOLL-7)
    • First-line Therapy (FOLL-B 1 of 3)
      • For rituximab, "consider for low tumor burden" was added.
      • “Lenalidomide + rituximab” was changed from a category 3 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 2A to a category 2B recommendation.
    • Second-line and Subsequent Therapy (FOLL-B 1 of 3)
      • “Bendamustine + obinutuzumab” was added with a category 2A recommendation.
      • For idelalisib, the qualifier "refractory to both alkylator and rituximab" was added.
    • Second-line Consolidation or Extended Dosing (FOLL-B 1 of 3)
      • “Obinutuzumab maintenance for rituximab refractory disease (1 g every 8 wks for total of 12 doses)" was changed from a category 2B to a category 2A recommendation.
  • Mantle Cell Lymphoma (MCL)
    • Stage II bulky, III, IV (MANT-4) 
      •  A new treatment pathway for indolent MCL was added in place of the previous recommendation of “observation.”
    • First-line Therapy (MANT-A 1 of 3)
      • "Lenalidomide + rituximab" was added as an option for less aggressive therapy.
    • Second-line therapy (MANT-A 1 of 3)
      • “Bendamustine, bortezomib, and rituximab” was added with a category 2B recommendation.
      • “Venetoclax” was added with a category 2A recommendation.
      • “FC (fludarabine, cyclophosphamide) ± rituximab” was changed from a category 2A to a category 3 recommendation.
      • “PCR (pentostatin, cyclophosphamide, rituximab)” was changed from a category 2A to a category 3 recommendation.
      • “PEPC (prednisone, etoposide, procarbazine, cyclophosphamide) ± rituximab” was changed from a category 2A to a category 3 recommendation.
      • “FCMR (fludarabine, cyclophosphamide, mitoxantrone, rituximab)” and “FMR (fludarabine, mitoxantrone, rituximab)” were removed
    • The following NCCN Templates® have been deleted to reflect the changes in the NCCN Guidelines for B-Cell Lymphomas:
      • MCL10: FCMR (Fludarabine/Cyclophosphamide/MitoXANTRONE + Rituximab)
      • MCL12: FMR (Fludarabine/MitoXANTRONE + Rituximab)
  • Diffuse Large B-Cell Lymphoma (DLBCL)
    • Second-line and Subsequent Therapy (BCEL-C 2 of 4)
      • For non-candidates for high-dose therapy, “Gemcitabine, vinorelbine ± rituximab” was added as an option with a category 3 recommendation.
  • Post-Transplant Lymphoproliferative Disorders (PTLD)
    • Suggested treatment regimens (PTLD-A)
      • For sequential chemoimmunotherapy with rituximab, options after restaging with PET/CT scan were added as follows:
        • Rituximab 375 mg/m2 weekly x 4 weeks
          • Restage with PET/CT scan
            • If PET/CT scan negative, rituximab 375 mg/m2 every 3 weeks x 4 cycles
            • If PET/CT scan positive, CHOP-21 every 3 weeks x 4 cycles

 

NCCN has published updates to the NCCN Guidelines and NCCN Compendium® for T-Cell Lymphomas. These NCCN Guidelines® are currently available as Version 1.2017.

  • General
    • The algorithms related to T-cell lymphomas were formerly published under the NCCN Guidelines for Non-Hodgkin’s Lymphomas and will now be published under the NCCN Guidelines for T-Cell Lymphomas.
    • The 2016 WHO classification of the Mature B-Cell, T-Cell, and NK-Cell Neoplasms was added.
    • For imaging, the target anatomy and the use of contrast was added to CT and whole-body was added to PET/CT as appropriate throughout the guidelines.
  • New Algorithm
    • A treatment algorithm for "Breast Implant-Associated ALCL" was added. (BIAA-1)
  • Peripheral T-Cell Lymphomas (PTCL)
    • Subtypes, "Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL)" was added with footnote f, "MEITL has only recently been separated as its own entity and optimal treatment has not been defined." (TCEL-1)
    • Second-line and Subsequent therapy (TCEL-B)
      • "Brentuximab vedotin for CD30+ AITL" was added for both with intention and no intention to transplant.
  • Mycosis Fungoides/Sezary Syndrome
    • Stage IV (MFSS-9)
      • Sezary syndrome
        • Alemtuzumab and Clinical trial were added as options for relapsed or persistent disease.
      • Non Sezary or visceral disease
        • Clinical trial was added as an option for relapsed or persistent disease.
    • Supportive Care for MF/SS (MFSS-B)
      • Statement was added, "Collaboration with dermatologist for supportive care is essential."
      • For infections prophylaxis
        • The 3rd sub-bullet was revised by adding, “Diluted bleach baths or soaks (if limited area): Either 2 teaspoons of bleach in 1 gallon of water OR 1 quarter of a cup (NOT 1 cup) of bleach in a bathtub of water.”
  • Primary Cutaneous CD30+ T-Cell Lymphoproliferative Disorders
    • Interferon alpha was added as a primary treatment option for primary cutaneous ALCL (multifocal lesions) with a category 3 recommendation. (PCTLD-4)
  • Adult T-Cell Leukemia/Lymphoma
    • For Second-line Therapy (with intention to proceed to HDT/ASCR) or Subsequent Therapy to HDT/ASCR, suggested treatment regimens were added. (ATLL-B)
      • Hyperlinks to these regimens were added to ATLL-3.
  • Extranodal NK/T-Cell Lymphoma, nasal type
    • "NK/T-Cell Lymphoma Prognostic Index" was replaced with the "Prognostic Index of Natural Killer Lymphoma (PINK)" and "Prognostic Index of Natural Killer Lymphoma with Epstein-Barr Virus DNA (PINK-E)." (NKTL-A)
      • The index was also updated in the workup section on NKTL-1.
  • Principles of Radiation Therapy (LYMP-C 3 of 4)
    • NK-T cell lymphoma
      • The dose for RT as primary treatment was modified, 50–65 50–55 Gy.
      • The dose for RT in combined modality therapy was modified, 45–60 45–50.4 Gy.

 

NCCN has published updates to the NCCN Guidelines and NCCN Compendium for Hairy Cell Leukemia. These NCCN Guidelines are currently available as Version 1.2017.

  • The algorithm for Hairy Cell Leukemia was formerly published under the NCCN Guidelines for Non-Hodgkin’s Lymphomas and will now be published under the NCCN Guidelines for Hairy Cell Leukemia.

 

NCCN has published updates to the NCCN Guidelines and NCCN Compendium for Primary Cutaneous B-Cell Lymphomas. These NCCN Guidelines are currently available as Version 1.2017.

  • General
    • The algorithm for Primary Cutaneous B-Cell Lymphomas was formerly published under the NCCN Guidelines for Non-Hodgkin’s Lymphomas and will now be published under the NCCN Guidelines for Primary Cutaneous B-Cell Lymphomas.
    • The algorithm for Primary Cutaneous Diffuse Large B-cell Lymphoma, Leg type was moved to the NCCN Guidelines for B-Cell Lymphomas - Diffuse Large B-cell Lymphoma section.
  • Initial therapy (CUTB-2)
    • For local RT, the dose of "24–30 Gy" was added.
    • Footnote f was revised: "Additional imaging studies during the course of treatment are not needed. PET/CT (strongly preferred) or C/A/P CT with contrast at the end of treatment to assess response. It can be repeated if there is clinical suspicion of progressive disease.”

 

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Compendium, the NCCN Chemotherapy Order Templates (NCCN Templates®), and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), 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.com/patients.

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


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