Updated NCCN Guidelines for HL, FL and MCL

The National Comprehensive Cancer Network (NCCN) has updated its guidelines for several lymphoma subtypes in light of the new 2016 WHO classifications for Mature B-Cell, T-Cell, and NK-Cell conditions, and due to the latest drug approvals and clinical data. Below are some of the key changes in the updated NCCN Guidelines for Hodgkin Lymphoma, and other B-cell Lymphomas. The current version for both of these guidelines are Version 3.2016 for Hodgkin Lymphoma and Version 1.2017 for B-cell Lymphomas. Please see the individual guidelines for full details.

Hodgkin Lymphoma:

• Nivolumab is not indicated as a treatment option in relapsed or progressing classical HL after Autologous Hematopoietic Stem Cell Rescue (ASCR) with High Dose Therapy (HDT) and maintenance therapy with brentuximab vedotin

Follicular Lymphoma:

• Diagnosis Cyclin D1 (IHC) has been moved to ‘Useful under certain conditions’ from ‘Essential’
• Stage I and II have been separated into:
  • Stage I (non-bulky), contiguous stage II (non-bulky) and the initial therapy is Involved Site Radiation Therapy (ISRT)
  • Stage I (bulky), contiguous stage II (bulky) or non-contiguous stage II.
• First-line
  • Addition of rituximab for consideration in patients with low tumor burden
  • Lenalidomide and rituximab is now a category 2B recommendation, rather than category 3
• Second-line
  • Idelalisib added in patients refractory to both alkylator and rituximab
  • Added bendamustine + obinutuzumab to category 2A

MCL

• Less aggressive therapy
  • Lenalidomide + rituximab treatment of MCL added to category 2A
• Second-Line therapy
  • Venetoclax added to category 2A
  • Rituximab, bendamustine, and bortezomib added to category 2B
  • FCMR combination therapy was removed in MCL
  • FMR combination therapy was removed in MCL