News Details
New NCCN Guidelines for Primary Cutaneous B-Cell Lymphoma and Updates to NCCN Guidelines for Non-Hodgkin’s Lymphomas
NCCN presented new NCCN Clinical Practice Guidelines in Oncology™ for Primary Cutaneous B-Cell Lymphoma as well as important updates to the NCCN Guidelines for Non-Hodgkin’s Lymphomas at the NCCN 14th Annual Conference. The new NCCN Guidelines were written to distinguish Primary B-Cell Lymphomas from their nodal counterparts and provide clinicians with treatment recommendations. Andrew D. Zelenetz, MD, PhD, and Steven M. Horowitz, MD, both of Memorial Sloan-Kettering Cancer Center, presented the updates to the NCCN Guidelines.
March 14, 2009
HOLLYWOOD, FL — The addition of new NCCN Clinical Practice Guidelines in Oncology™ for Primary Cutaneous B-Cell Lymphoma was a highlight at the NCCN 14th Annual Conference on Friday, March 13. The new NCCN Guidelines are encompassed within the NCCN Guidelines for Non-Hodgkin’s Lymphomas (NHL), which also had several notable updates presented by the chair of the NCCN Guidelines Panel for NHL, Andrew D. Zelenetz, MD, PhD, of Memorial Sloan-Kettering Cancer Center.
Steven M. Horwitz, MD, of Memorial Sloan-Kettering Cancer Center, presented the new NCCN Guidelines for Cutaneous B-Cell Lymphoma pointing out the unique clinical features that distinguish Primary Cutaneous B-Cell Lymphomas from their nodal counterparts and the need for clinical practice guidelines given the commonality of B-Cell Lymphomas.
Dr. Horowitz explained that Primary Cutaneous B-Cell Lymphoma is a B-Cell Lymphoma presenting in the skin where there is no evidence of extracutaneous disease on a complete staging work-up. They may appear on the skin as a reddish rash, lump or nodule and, because they tend to develop in the dermis, or second layer of the skin, may have a slightly raised and smooth appearance.
The new NCCN Guidelines for Cutaneous B-Cell Lymphoma stress consulting a pathologist familiar with diagnosing Primary Cutaneous B-Cell Lymphoma and recommend an incisional biopsy versus a shaved one. “Many of these lymphomas can penetrate deep into the skin, therefore a shaved biopsy may literally only scratch the surface and provide inaccurate results,” Horowitz noted.
He also noted that these lymphomas are nearly always indolent or slow growing. Relapses are common regardless of the treatment; however the relapses are usually confined to the skin and rarely develop into systemic lymphoma.
In addition, the new NCCN Guidelines provide essential information to complete a work-up of a patient presenting with Primary Cutaneous B-Cell Lymphoma as well as procedures that may be useful in certain circumstances, such as PET/CT scan.
As well as the notable addition of the new NCCN Guidelines for Primary Cutaneous B-Cell Lymphoma; Andrew D. Zelenetz, MD, PhD, presented several other important updates to the overall NCCN Guidelines for NHL.
A new section diagramming the use of immunophenotyping, a technique used to study the protein expressed by cells, in the differential diagnosis of mature B-Cell and T/NK Cell Neoplasms was recently added to the NCCN NHL Guidelines.
Dr. Zelenetz noted that this immunophenotyping section will be very helpful to “sorting out difficult diagnosis dilemmas.”
Also new to the NCCN Guidelines is information regarding the potential for viral reactivation in hepatitis positive patients being treated with rituximab (Rituxan®, Genentech, Inc.). Dr. Zelenetz explained Hepatitis B can reactivate with immunosuppression.
“More than 1 million people in the United States are infected with Hepatitis B, so this is not an inconsequential issue. We’ve seen reactivation with all types of chemotherapy regimens, not just rituximab, further stressing the importance of screening for Hepatitis B before treatment begins,” Dr. Zelenetz stated.
Another notable addition to the NCCN NHL Guidelines is the addition of bendamustine (Treanda®, Cephalon, Inc.) as a treatment option to reflect the FDA’s approval of the agents in the treatment of indolent NHL and Chronic Lymphocytic Leukemia (CLL).
Extensive revisions were made to the CLL section in the new NCCN Guidelines including a new differentiator to help clinicians distinguish between CLL and Monoclonal B-Cell Lymphocytosis (MBL), recommendations for how to treat rare cases of CLL, and a new page offering information on supportive care for patients with CLL.
Lastly, Dr. Zelenetz touched upon a new section detailing hallmarks, symptoms, and treatment for Tumor Lysis Syndrome – a group of metabolic complications that can occur after the treatment of lymphoma.