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NCCN Flash Updates: NCCN Guidelines and NCCN Templates Updated

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and the NCCN Drugs and Biologics Compendium (NCCN Compendium®) for Myeloproliferative Neoplasms. These NCCN Guidelines® are currently available as Version 2.2021.

Link directly to the Updates section of the NCCN Guidelines:
Myeloproliferative Neoplasms

  • Essential Thrombocythemia (ET-1)
    • For low-risk patients, modified second bullet: Aspirin (81-100 mg/day) for low-risk patients with vasomotor/microvascular disturbances and/or “low-risk” JAK2-positive patients.
  • Special Considerations for the Use of JAK Inhibitors (MPN-G 4 of 5)
    • Wernicke’s encephalopathy edited to Wernicke.
    • 3rd bullet, 1st sentence, modified: Fedratinib should not be started in patients with thiamine deficiency, “and if low”, should be repleted thiamine prior to treatment initiation
  • Special Considerations in the Treatment of Polycythemia Vera (PV) and Essential Thrombocythemia (ET)
     (MPN-H 2 of 3)
    • Pregnancy
      • 7th bullet; the following reference has been added after “peginterferon alfa-2a should be used:”
        • Beauverd Y, Radia D, Cargo C, et al. Pegylated interferon alpha-2a for essential thrombocythemia during pregnancy: outcome and safety. A case series. Haematologica 2016;101:e182-184.
      • 8th bullet; the following reference has been added after “who require anticoagulation and are breastfeeding”:
        • Bates SM, Rajasekhar A, Middeldorp S, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy. Blood Adv 2018;2:3317-3359.
  • The Discussion has been updated to reflect the changes to the algorithm. (MS-1)

Previous updates to the NCCN Guidelines for Myeloproliferative Neoplasms can be found in the UPDATES section of the current version.




NCCN has published updates to the NCCN Guidelines and the NCCN Compendium® for Chronic Myeloid Leukemia. These NCCN Guidelines are currently available as Version 1.2022. 

Link directly to the Updates section of the NCCN Guidelines:
Chronic Myeloid Leukemia

  • General updates: Terminologies modified to be more inclusive of sexual and gender minorities (SGM)
  • Primary Treatment (CML-2)
    • Generic wording removed for imatinib (also applies to CML-4)
    • Footnote f modified: If treatment is needed during pregnancy, it is preferable to initiate treatment with interferons (interferon alfa-2a or peginterferon alfa-2a). Interferon alfa-2a/2b and peginterferon alfa-2b have been discontinued. Peginterferon alfa-2a may be substituted for other interferon preparations. TKI therapy, particularly during the first trimester, should be avoided. See Management of CML During Pregnancy (CML-C).
    • Footnote g modified: Based on follow-up data from the BFORE, DASISION, and ENESTnd trials, second-generation TKIs (bosutinib, dasatinib, or nilotinib) are preferred for patients with an intermediate- or high-risk score. Second-generation TKIs should also be considered for specific subgroups (based on the assessment of treatment goals and benefit/risks), for example, younger patients who are interested in ultimately discontinuing treatment and especially for young women patients assigned female at birth whose goal is to achieve a deep and rapid molecular response and eventual drug discontinuation of TKI therapy for family planning purposes.
    • Footnote h added: Innovator and generic drugs approved by the regulatory authorities based on pharmacokinetic equivalence can be used interchangeably. An FDA-approved generic version is an appropriate substitute for an innovator drug (imatinib). Generic versions of other TKIs are likely to be marketed in the near future. (also applies to CML-4, CML-6)
  • Clinical Considerations (CML-3)
    • Light Green, TKI-sensitive disease
      • If treatment goal is long-term survival: >0.1%–≤1% optimal
  • Treatment Recommendations Based on BCR-ABL1 Mutation Profile (CML-5)
    • Nilotinib: G250E removed as a contraindicated mutation
  • Follow-up Therapy (CML-6)
    • Not in CCyR or in relapse changed to Less than CCyR or in relapse
    • Follow-up Therapy; PCR, Positive
      • Discuss options with transplant team: TKI ± DLI (selection of TKI is based on prior therapy depending on prior TKI, tolerance, BCR-ABL1 mutation profile, and post-HCT morbidities)
    • Footnote aa changed from a link to the Discussion to the following references: Carpenter PA, et al. Blood 2007;109:2791-2793; Olavarria E, et al. Blood 2007;110:4614-4617; DeFilipp Z, et al. Clin Lymphoma Myeloma Leuk 2016;16:466-471.
  • Treatment and Monitoring During Pregnancy (CML-C 1 of 2)
    • Bullet 4 modified:
      • If treatment is needed, it is preferable to initiate treatment with interferons. Both interferon alfa-2a or peginterferon alfa-2a have been used during pregnancy. Most of the data using interferons during pregnancy have been reported in patients with essential thrombocythemia. If introduced earlier, the use of interferon alfa-2a/2b or peginterferon alfa-2a can preserve molecular remission after discontinuation of TKI. Interferon alfa-2a/2b and peginterferon alfa-2b have been discontinued. Peginterferon alfa-2a may be substituted for other interferon preparations. Data are insufficient to establish the use of peginterferon alfa-2a (risk category C) in pregnancy and it should be used only if benefits outweigh potential risk to the fetus.
    • Reference 15 added on CML-C 2 of 2.
  • Criteria for Response and Relapse (CML-D)
    • Title modified: Criteria for Hematologic, Cytogenetic, and Molecular Response and Relapse
    • Relapse definition modified (also applies to CML-E)
      • Any sign of loss of response (defined as hematologic or cytogenetic relapse)
      • Any sign of loss of hematologic response
      • Any sign of loss of CCyR or its molecular response correlate defined as an increase in BCR-ABL1 transcript to >1%
      • 1-log increase in BCR-ABL1 transcript levels with loss of MMR should prompt bone marrow evaluation for loss of CCyR but is not itself defined as relapse (eg, hematologic or cytogenetic relapse)
    • Footnote 8 added: The loss of MMR in the presence of a CCyR does not necessarily constitute treatment failure.
       

 

NCCN has published updates to the NCCN Chemotherapy Order Templates (NCCN Templates®) for Chronic Myeloid Leukemia to reflect the currently published NCCN Guidelines for Chronic Myeloid Leukemia v1.2022.

  • Changes to the Indications section have been updated on the following templates:
    • CML1: Dasatinib
    • CML2: Imatinib
    • CML4: Nilotinib
    • CML8: Bosutinib
    • CML9: Omacetaxine
    • CML10: PONATinib
  • References have been updated on the following templates:
    • CML1: Dasatinib
    • CML2:  Imatinib
    • CML4: Nilotinib
    • CML8: Bosutinib
    • CML10: PONATinib

 

NCCN has published updates to the NCCN Templates® for Multiple Myeloma to reflect the currently published NCCN Guidelines for Multiple Myeloma v1.2022.

  • The following NEW NCCN Templates have been published:
    • MUM105: Carfilzomib/Lenalidomide/Dexamethasone + Daratumumab
    • MUM106: Bortezomib/Lenalidomide/Dexamethasone - Maintenance
    • MUM107: Bortezomib/Lenalidomide/Dexamethasone (VRD-lite)
  • Changes to the Indication section have been made on the following templates:
    • MUM2: Lenalidomide Maintenance
    • MUM16: Bortezomib/Lenalidomide/Dexamethasone
    • MUM33: DT-PACE
      (Dexamethasone/Thalidomide/CISplatin/DOXOrubicin/Cyclophosphamide/Etoposide)
    • MUM34: DCEP (Dexamethasone/Cyclophosphamide/Etoposide/CISplatin)
    • MUM46: Bortezomib/Cyclophosphamide/Dexamethasone
    • MUM48: VTD-PACE
       (Bortezomib/Thalidomide/Dexamethasone/CISplatin/DOXOrubicin/Cyclophosphamide/Etoposide)
    • MUM57: Bortezomib - Maintenance
    • MUM59: Carfilzomib/Lenalidomide/Dexamethasone
    • MUM65: Lenalidomide/Dexamethasone + Elotuzumab
    • MUM67: Ixazomib/Lenalidomide/Dexamethasone
    • MUM68: Bortezomib/Panobinostat/Dexamethasone
    • MUM85: Bortezomib/Lenalidomide - Maintenance
    • MUM89: Ixazomib - Maintenance
    • MUM95: Bortezomib/Cyclophosphamide/Dexamethasone + Daratumumab
    • MUM102: Carfilzomib/Cyclophosphamide/Dexamethasone
    • MUM103: Melphalan flufenamide/Dexamethasone
  • Emetic Risk has been updated on the following templates:
    • MUM45: Cyclophosphamide/Lenalidomide/Dexamethasone - Previously Treated
    • MUM46: Bortezomib/Cyclophosphamide/Dexamethasone
    • MUM58: Bortezomib/Cyclophosphamide/Dexamethasone - Previously Treated
    • MUM72: Cyclophosphamide/Pomalidomide/Dexamethasone
    • MUM75: Cyclophosphamide/Lenalidomide/Dexamethasone
    • MUM78: Carfilzomib/Cyclophosphamide/Dexamethasone - Previously Treated
    • MUM86: Carfilzomib/Cyclophosphamide/Thalidomide/Dexamethasone
    • MUM90: Cyclophosphamide/Ixazomib/Dexamethasone
    • MUM95: Bortezomib/Cyclophosphamide/Dexamethasone + Daratumumab
    • MUM102: Carfilzomib/Cyclophosphamide/Dexamethasone
  • Changes to the Chemotherapy Regimen section have been made on the following templates:
    • MUM15: Bortezomib/DOXOrubicin/Dexamethasone
    • MUM16: Bortezomib/Lenalidomide/Dexamethasone
    • MUM18: Bortezomib/Liposomal DOXOrubicin/Dexamethasone
    • MUM33: DT-PACE
      (Dexamethasone/Thalidomide/CISplatin/DOXOrubicin/Cyclophosphamide/Etoposide)
    • MUM34: DCEP (Dexamethasone/Cyclophosphamide/Etoposide/CISplatin)
    • MUM45: Cyclophosphamide/Lenalidomide/Dexamethasone - Previously Treated
    • MUM46: Bortezomib/Cyclophosphamide/Dexamethasone
    • MUM48: VTD-PACE

      (Bortezomib/Thalidomide/Dexamethasone/CISplatin/DOXOrubicin/Cyclophosphamide/Etoposide)MUM51: Bendamustine/Lenalidomide/Dexamethasone
    • MUM58: Bortezomib/Cyclophosphamide/Dexamethasone - Previously Treated
    • MUM59: Carfilzomib/Lenalidomide/Dexamethasone
    • MUM60: Carfilzomib/Lenalidomide/Dexamethasone - Previously Treated
    • MUM69: Carfilzomib/Panobinostat
    • MUM71: Carfilzomib/Pomalidomide/Dexamethasone
    • MUM72: Cyclophosphamide/Pomalidomide/Dexamethasone
    • MUM75: Cyclophosphamide/Lenalidomide/Dexamethasone
    • MUM78: Carfilzomib/Cyclophosphamide/Dexamethasone - Previously Treated
    • MUM84: Pomalidomide/Dexamethasone + Elotuzumab
    • MUM86: Carfilzomib/Cyclophosphamide/Thalidomide/Dexamethasone
    • MUM90: Cyclophosphamide/Ixazomib/Dexamethasone
    • MUM95: Bortezomib/Cyclophosphamide/Dexamethasone + Daratumumab
    • MUM97: Bortezomib/Lenalidomide/Dexamethasone + Daratumumab
    • MUM101: Pomalidomide/Selinexor/Dexamethasone
    • MUM102: Carfilzomib/Cyclophosphamide/Dexamethasone
    • MUM103: Melphalan flufenamide/Dexamethasone
    • MUM104: Isatuximab-irfc/Carfilzomib/Dexamethasone
  • Drug information notes for the following agents have been updated in the Supportive Care, Monitoring and Hold Parameters, and/or Safety Parameters and Special Instructions sections:
    • Bendamustine
    • Carfilzomib
    • Cyclophosphamide
    • Daratumumab
    • Daratumumab and hyaluronidase-fihj
    • Dexamethasone
    • Elotuzumab
    • Isatuximab-irfc
    • Ixazomib
    • Lenalidomide
    • Melphalan
    • Pomalidomide
    • Selinexor
    • Thalidomide




NCCN has published updates to the NCCN Templates for Multiple Myeloma to reflect the currently published NCCN Guidelines for Multiple Myeloma v1.2022.

  • The Title has been updated on the following template:
    • MUM32: High-Dose or Fractionated Cyclophosphamide
  • References have been updated on the following template:
    • MUM32: High-Dose or Fractionated Cyclophosphamide
  • Emetic Risk has been updated on the following template:
    • MUM32: High-Dose or Fractionated Cyclophosphamide
  • Changes to the Chemotherapy Regimen section have been made on the following template:
    • MUM32: High-Dose or Fractionated Cyclophosphamide
  • Drug information notes for the following agents have been updated in the Supportive Care, Monitoring and Hold Parameters, and/or Safety Parameters and Special Instructions sections:
    • Cyclophosphamide

 

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.

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

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

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