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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^®), the NCCN Drugs and Biologics Compendium (NCCN Compendium^®), and the NCCN Radiation Therapy Compendium™ for Hodgkin Lymphoma and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™). These NCCN Guidelines^® are currently available as Version 1.2022. 

Link directly to the Updates section of the NCCN Guidelines:
Hodgkins Lymphoma

• Clinical staging/risk classification of classic Hodgkin lymphoma (CHL) (HODG-2)
  • Column added to table for "ESR >50 or # Sites >3".
  • Column added to table for "Type".
• Stage I/II Unfavorable CHL (B symptoms or bulky mediastinal disease or >10 cm adenopathy) (HODG-4)
  • Box added with "Special considerations for Deauville 4–5 after ABVD x 2 cycles". (Also on HODG-5)
  • Deauville 4–5 after ABVD x 2 cycles
    • After therapy with Escalated BEACOPP x 2 cycles, if Deauville 1–3, added "(adapted from RATHL)" to the chemotherapy alone option of escalated BEACOPP x 2 cycles.
• Stage III/IV CHL (HODG-5)
  • Primary treatment:
    • Option modified: Brentuximab vedotin + AVD (category 2B) (category 2A in select patients; eg, no known neuropathy, IPS ≥4v or bleomycin contraindicated) (Use with caution in patients aged >60 y; contraindicated in those with neuropathy) (Also on HODG-6)
    • Brentuximab vedotin + AVD has been moved from "Useful in certain circumstances" to "Other recommended regimen".
  • After primary treatment with ABVD x 2 cycles, then Deauville 4–5 at restaging, and treatment with escalated BEACOPP x 3 cycles:
    • Option modified for those with Deauville 1–3 after restaging: Escalated BEACOPP x 1 cycle ± ISRT (Also on HODG-7)
• Primary treatment of Nodular Lymphocyte-Predominant Hodgkin Lymphoma (NLPHL) (HODG-8)
  • Footnote ff modified: Generally, a brief course of chemotherapy (3–4 2–4 months) would be given with radiation therapy.
• Follow-up After Completion of Treatment Up to 5 Years (HODG-9)
  • Bullet modified: Consider neck/chest/abdomen/pelvis CT scan with contrast no more often than every 6 mo for the first 2 y following completion of therapy, or as clinically indicated after 2 y, especially in NLPHL where late relapse may occur.
• Refractory CHL (HODG-11)
  • Deauville 4, additional therapy
    • Arrow added from RT to "If response, consider transplant (autologous or allogeneic)".
    • Arrow added from subsequent systemic therapy ± RT to "if response, consider transplant (autologous or allogeneic)".
• NLPHL Refractory or suspected relapse (HODG-13)
  • After "Biopsy negative," option added: Observe with short-interval follow-up (see HODG-9).
• Principles of Systemic Therapy Relapsed or Refractory Disease (HODG-C, 3 of 5)
  • Table headings modified:
    • Second-Line and Subsequent Therapy
    • Third-Line and Subsequent Therapy
• Second-line and subsequent therapy for relapsed/refractory CHL
  • Option added: GVD + pembrolizumab
• Third-line and subsequent therapy for relapsed/refractory CHL
  • Option modified: GCD (gemcitabine, carboplatin cisplatin, dexamethasone)

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®), the NCCN Drugs and Biologics Compendium (NCCN Compendium) for Myelodysplastic Syndromes. These NCCN Guidelines^® are currently available as Version 2.2022.

Link directly to the Updates section of the NCCN Guidelines:
Myelodysplastic Syndromes

• Management of Lower-Risk Disease (IPSS-R Very-Low-, Low-, Intermediate-Risk Disease [MDS-3])
  • Footnote “u” was modified to include eltrombopag. “Patients generally ≤60 y and with ≤5% marrow blasts, or those with hypocellular marrows, PNH clone positivity, or STAT-3 mutant cytotoxic T-cell clones. IST includes equine ATG ± cyclosporin A ± eltrombopag. Additionally, for severe thrombocytopenia, eltrombopag alone could be considered.”
• Management of Higher-Risk Disease (IPSS-R, Intermediate, High, Very-High-Risk Disease [MDS-6])
  • Footnote “nn” was modified: “Some emerging data have shown efficacy of novel agents, including venetoclax in combination with hypomethylating agents or targeted IDH1/2 inhibitors for cytoreduction for patients with high-risk MDS (DiNardo C, et al. N Engl J Med 2018;378:2386-2398) who have HMA-refractory disease. When used as cytoreduction for MDS in combination with HMA, venetoclax has been effectively given in monthly courses of 14 days (Garcia JS, et al. ASH Annual Meeting 2020:Abstract 656). should not extend beyond 14 days. Repeat of marrow evaluation after 1–2 cycles is important imperative to clarify ensure recovery of hematopoiesis and potential requirement for further therapy. Clinical trials are preferred. (See Discussion).”

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®), for Adolescent and Young Adult (AYA) Oncology. These NCCN Guidelines^® are currently available as Version 2.2022. 

Link directly to the Updates section of the NCCN Guidelines:
Adolescent and Young Adult

• Discussion (MS-1)
  • The Discussion section was updated for all 2022 changes. 

NCCN has published updates to the NCCN Chemotherapy Order Templates (NCCN Templates^®) for Thyroid Carcinoma to reflect the currently published NCCN Guidelines for Thyroid Carcinoma v3.2021.

• Changes to the Indication section have been made on the following NCCN Templates^®:
  • HUR7: Cabozantinib
  • PAP7: Cabozantinib
  • FOLC7: Cabozantinib
• References have been updated on the following templates:
  • HUR7: Cabozantinib
  • PAP7: Cabozantinib
  • FOLC7: Cabozantinib
• Changes to the Chemotherapy Regimen section have been made on the following templates:
  • HUR7: Cabozantinib
  • PAP7: Cabozantinib
  • FOLC7: Cabozantinib
• 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:
  • Cabozantinib

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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NCCN Flash Updates™ is a subscription service from NCCN that provides timely notification of updated and new information appearing in the NCCN Guidelines, the NCCN Compendium^®, and other NCCN Content.

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