Guideline Updates: Leukemias and Lymphomas
As treatment approaches and prognostic indicators continue to change for various blood malignancies, recent guidelines have been updated to reflect these changes. Both the National Comprehensive Cancer Network (NCCN) and the International Workshop on chronic lymphocytic leukemia (iwCLL) have been active this year in keeping their recommendations for treatment, criteria for prognostic indicators, and suggestions for response assessments current with the latest literature.
Journal of Clinical Pathways has provided summaries of these guideline updates as they happened. Review some of these practice-changing guideline revision summaries below.
The NCCN noted changes to the primary and second-line therapy options for Hodgkin lymphoma, including new indications for ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine), BV (brentuximab vedotin), and involved site radiation therapy, among other treatments.
The iwCLL evaluated and published revisions to their original criteria for their consensus guideline for the first time in 10 years. The update highlights the clinical relevance of a few genomic alterations found in CLL (ie, del(17p), TP53, and IGHV) and provides improved assessment techniques of splenomegaly, hepatomegaly, and lymphadenopathy.
The NCCN provided various changes to the diagnosis and treatment guidelines of acute lymphoblastic leukemia. The most notable updates were for younger and older adults with Philadelphia (Ph)-positive, Ph-negative, and relapsed or refractory disease.
In February, the NCCN made a variety of revisions to their B-cell lymphoma guidelines. Updates in follicular lymphoma, marginal zone lymphoma, mantle cell lymphoma, and diffuse large B-cell lymphoma are highlighted to reflect recent United States Food and Drug Administration approvals and clinical trial findings.
The NCCN offered new recommendations for both low-risk and high-risk acute myeloid leukemia. The recommendations were centered around induction (ie, ATRA plus arsenic trioxide and gemtuzumab ozogamicin) and consolidation treatments (ie, arsenic trioxide plus ATRA and gemtuzumab ozogamicin). Additional recommendations were included for patients with high-risk disease and cardiac issues.