NCCN Updates Treatment Guidelines for Hodgkin Lymphoma

04/18/18

The National Comprehensive Cancer Network (NCCN) has issued updates to the primary and second-line therapy options for the treatment of Hodgkin lymphoma.

ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) x 4 cycles (total 6) with involved site radiation therapy (ISRT) is now recommended for patients with stage I-II unfavorable, non-bulky classic Hodgkin lymphoma after primary treatment with ABVD x 2 cycles, along with Deauville 5 and negative biopsy.

BV (brentuximab vedotin) plus AVD (doxorubicin, vinblastine, and dacarbazine) is now included as a primary treatment option for stage III-IV classic Hodgkin lymphoma. This treatment option has been added as a category 2B recommendation, with the option of a category 2A recommendation for select patients (ie, international prognostic score ≥4, bleomycin contraindicated, or no known neuropathy). A new treatment algorithm was added with the treatment recommendations for primary therapy with BV plus AVD.

Second-line therapy options for relapsed or refractory nodular lymphocyte-predominant Hodgkin lymphoma now include a recommendation for observation or rituximab with the option of second-line systemic therapy as well as ISRT. The second-line options for relapsed or refractory disease have been reorganized to distinguish between the options for classic Hodgkin lymphoma vs nodular lymphocyte-predominant Hodgkin lymphoma.

As for checkpoint inhibitors, “Nivolumab has not been studied in pediatric patients; therefore, only pembrolizumab should be offered” has been removed from the general guidelines.

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Among the primary therapy options for nodular lymphocyte-predominant Hodgkin lymphoma removed from the Chemotherapy Order Templates include ABVD and CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone).

Among the second-line therapy options for nodular lymphocyte-predominant Hodgkin lymphoma removed from the Chemotherapy Order Templates include GVD (gemcitabine, vinorelbine, and liposomal doxorubicin) plus rituximab, GCDR (gemcitabine, carboplatin, and dexamethasone plus rituximab), mini-BEAM (carmustine, etoposide, cytarabine, and melphalan) plus rituximab, MINE (mesna, ifosfamide, mitoxantrone, and etoposide) plus rituximab, and C-MOPP – Schema I as well as C-MOPP – Schema II (cyclophosphamide, vincristine, prednisone, and procarbazine) plus rituximab.—Zachary Bessette