03/06/2017

NCCN has published updates to the NCCN Guidelines®, NCCN Compendium® and NCCN Imaging AUC™ for Hodgkin Lymphoma.

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 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.