NCCN Updates Guidelines for Multiple B-Cell Lymphomas

05/21/18

The National Comprehensive Cancer Network (NCCN) has published updates to its clinical practice guidelines for follicular lymphoma and diffuse large B-cell lymphoma (DLBCL).

In the section for follicular lymphoma, specific changes were made to the guidelines for histologic transformation to DLBCL. For disease with minimal or no prior chemotherapy, “tisagenlecleucel (only after at least two prior chemoimmunotherapy regimens)” was added after partial response and stable/progressive disease. A footnote was revised to read, “Axicabtagene ciloleucel or tisagenlecleucel are not appropriate treatment options for patients with a complete response.”

Similar changes were made to the guidelines for multiple prior therapies. “Tisagenlecleucel (only after at least two prior chemoimmunotherapy regimens, if not previously given)” was added, and a footnote was revised to read, “Data on transplant after treatment with axicabtagene ciloleucel or tisagenlecleucel are not available.”

In the section for DLBCL, tisagenlecleucel was added as a consolidation or additional therapy in relapsed or refractory disease after partial response. In the second or higher relapse, “tisagenlecleucel (if not previously given)” was added. “Tisagenlecleucel is not FDA-approved for relapsed or refractory primary mediastinal large B-cell lymphoma” was added as a footnote to this section.  

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In high-grade B-cell lymphomas with translocations of MYC or BCL2 and/or BCL6 (Double/Triple Hit Lymphoma), tisagenlecleucel was added as an option for relapsed or refractory disease.

Information regarding tisagenlecleucel was added to the “Guidance for Treatment of Patients with Chimeric Antigen Receptor (CAR) T-Cell Therapy.”—Zachary Bessette