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(NCCN Guidelines®) Hodgkin Lymphoma NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Hodgkin Lymphoma Version 1.2019 — April 9, 2019 NCCN.org NCCN Guidelines for Patients® available at www.nccn.org/patients Continue Version 1.2019, 04/09/19 © 2019 National Comprehensive Cancer Network® (NCCN®), All rights reserved. NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN. Printed by Lili Dai on 4/23/2019 12:24:48 PM. For personal use only. Not approved for distribution. Copyright © 2019 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Index NCCN Guidelines Version 1.2019 Table of Contents Hodgkin Lymphoma Discussion *Richard T. Hoppe, MD/Chair § Leo I. Gordon, MD ‡ David G. Maloney, MD, PhD † ‡ Stanford Cancer Institute Robert H. Lurie Comprehensive Cancer Fred Hutchinson Cancer Research Center of Northwestern University Center/Seattle Cancer Care Alliance *Ranjana H. Advani, MD/Vice Chair † Stanford Cancer Institute Francisco J. Hernandez-Ilizaliturri, MD † Matthew McKinney, MD ‡ Roswell Park Comprehensive Duke Cancer Institute Weiyun Z. Ai, MD, PhD ‡ † Cancer Center UCSF Helen Diller Family Monika Metzger, MD € ‡ Comprehensive Cancer Center Ephraim P. Hochberg, MD † St. Jude Children’s Research Hospital/ Massachusetts General Hospital The University of Tennessee Richard F. Ambinder, MD, PhD † Cancer Center Health Science Center The Sidney Kimmel Comprehensive Cancer Center at John Hopkins Jiayi Huang, MD § David Morgan, MD † ‡ x Siteman Cancer Center at Barnes- Vanderbilt-Ingram Cancer Center Philippe Armand, MD, PhD ‡ Jewish Hospital and Washington Dana-Farber/Brigham and Women’s University School of Medicine Carolyn Mulroney, MD † ‡ x Cancer Center UC San Diego Moores Cancer Center Patrick B. Johnston, MD, PhD † Þ Celeste M. Bello, MD, MSPH † Mayo Clinic Cancer Center Rachel Rabinovitch, MD § Moffitt Cancer Center University of Colorado Cancer Center Mark S. Kaminski, MD † Cecil M. Benitez, PhD ¥ University of Michigan Stuart Seropian, MD † Þ Stanford Cancer Institute Rogel Cancer Center Yale Cancer Center/ Smilow Cancer Hospital Philip J. Bierman, MD † ‡ x Vaishalee P. Kenkre, MD ‡ Fred & Pamela Buffett Cancer Center University of Wisconsin Randa Tao, MD § Carbone Cancer Center Huntsman Cancer Institute Kirsten M. Boughan, MD ‡ x at the University of Utah Case Comprehensive Cancer Center/ Nadia Khan, MD † University Hospitals Seidman Cancer Fox Chase Cancer Center Jane N. Winter, MD ‡ † Center and Cleveland Clinic Taussig Robert H. Lurie Comprehensive Cancer Cancer Institute Ryan C. Lynch, MD † ‡ Center of Northwestern University Fred Hutchinson Cancer Research Robert Chen, MD ‡ x Center/Seattle Cancer Care Alliance Joachim Yahalom, MD § City of Hope Memorial Sloan Kettering Cancer Center National Medical Center Kami Maddocks, MD ‡ The Ohio State University Comprehensive NCCN Bouthaina Dabaja, MD § Cancer Center- James Cancer Hospital Jennifer Burns The University of Texas and Solove Research Institute Ndiya Ogba, PhD MD Anderson Cancer Center x Bone marrow ≠ Pathology transplantation € Pediatric oncology Continue ‡ Hematology/ ¥ Patient advocacy NCCN Guidelines Panel Disclosures Hematology oncology § Radiation oncology Þ Internal medicine * Discussion writing † Medical oncology committee member Version 1.2019, 04/09/19 © 2019 National Comprehensive Cancer Network® (NCCN®), All rights reserved. NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN. Printed by Lili Dai on 4/23/2019 12:24:48 PM. For personal use only. Not approved for distribution. Copyright © 2019 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Index NCCN Guidelines Version 1.2019 Table of Contents Hodgkin Lymphoma Discussion NCCN Hodgkin Lymphoma Panel Members NCCN believes that the Summary of Guidelines Updates Clinical Trials: best management for any patient with cancer is in a clinical trial. Diagnosis and Workup (HODG-1) Participation in clinical trials is Clinical Staging for Classic Hodgkin Lymphoma (HODG-2) especially encouraged. Primary Treatment of Classic Hodgkin Lymphoma (CHL): To find clinical trials online at NCCN • CS I-II (Non-bulky) (HODG-3, HODG-4, HODG-5, HODG-6) Member Institutions, click here: • CS I-II Unfavorable (Bulky mediastinal disease or >10 cm adenopathy) (HODG-7) nccn.org/clinical_trials/clinicians.aspx. • CS III-IV (HODG-9) NCCN Categories of Evidence and Primary Treatment of Nodular Lymphocyte-Predominant Hodgkin Lymphoma (NLPHL): Consensus: All recommendations are • CS IA-IV (HODG-12) category 2A unless otherwise indicated. See NCCN Categories of Evidence Follow-up After Completion of Treatment and Monitoring for Late Effects (HODG-13) and Consensus. Refractory CHL (HODG-15) Suspected Relapse of CHL (HODG-16) NCCN Categories of Preference: Refractory or Suspected Relapse of NLPHL (HODG-17) All recommendations are considered appropriate. Unfavorable Risk Factors for Stage I–II CHL (HODG-A) See NCCN Categories of Preference. Principles of Systemic Therapy (HODG-B) Principles of Radiation Therapy (HODG-C) PET 5-Point Scale (Deauville Criteria) (HODG-D) Management of CHL in Older Adults (HODG-E) NCCN Guidelines for Patients® are available at www.nccn.org/patients. Staging (ST-1) The NCCN Guidelines® are a statement of evidence and consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult the NCCN Guidelines is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient’s care or treatment. The National Comprehensive Cancer Network® (NCCN®) makes no representations or warranties of any kind regarding their content, use or application and disclaims any responsibility for their application or use in any way. The NCCN Guidelines are copyrighted by National Comprehensive Cancer Network®. All rights reserved. The NCCN Guidelines and the illustrations herein may not be reproduced in any form without the express written permission of NCCN. ©2019. Version 1.2019, 04/09/19 © 2019 National Comprehensive Cancer Network® (NCCN®), All rights reserved. NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN. Printed by Lili Dai on 4/23/2019 12:24:48 PM. For personal use only. Not approved for distribution. Copyright © 2019 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Index NCCN Guidelines Version 1.2019 Table of Contents Hodgkin Lymphoma Discussion Updates in Version 1.2019 of the NCCN Guidelines for Hodgkin Lymphoma from Version 3.2018 include: HODG-1 HODG-4 • Under essential workup, seventh bullet revised: PET/CT scan (skull base to • Algorithms on this page include options for stage I,II mid-thigh or vertex to feet in selected cases) favorable/unfavorable, non-bulky CHL (preference to • Footnote "d", line added: PET/CT should be obtained in accordance with treat with chemotherapy alone) American College of Radiology (ACR) practice guidelines. • For Deauville 1-3, modified indications for the option of • Footnote i has been removed from this page, but it remains on HODG-12: AVD x 4 cycles, to include: initial stage IIB or ≥3 sites or NLPHL has a different natural history and response to therapy than CHL... ESR >50 HODG-2 • Following ABVD x 2 cycles and restaging: • Table updated based on guideline revisions. For deauville 3, additional ABVD x 2 cycles (total 4) has been changed to a category 2B recommendation. HODG-3 Additional therapy recommendations for deauville 4-5 • Pathway for "Preference to treat with combined modality therapy" has been have been moved to HODG-5. moved onto this page (previously on HODG-4). Algorithms on this page • Footnote "aa" added: CALGB study 50604: Straus DJ, include options for any patients with stage IA, IIA favorable, non-bulky CHL, et al. Blood 2018;132:1013-1021. including those meeting GHSG HD10 study criteria (≤2 sites of disease, ESR <50 and no E-lesions). HODG-5 • Following GHSG HD10 criteria pathway, following ABVD x 2 and restaging: • Stanford V algorithm has been removed. Deauville 4: • Algorithms added for Deauville 4-5 following primary ◊ Removed biopsy option and "consider" from ABVD x 2 cycles. therapy with ABVD x 2 cycles and interim restaging. ◊ Added "ISRT (30 Gy)" after 2 additional cycles of ABVD (total 4) and • Following additional therapy for deauville 4, after interim imaging. restaging if deauville 1-3, or deauville 4-5 with negative Deauville 5 and biopsy negative, loop added to follow Deauville 4 pathway biopsy: ◊ for treatment, ABVD x 2 cycles (total 4). Options added: ABVD x 2 cycles (total 6) ± ISRT ◊ • For any IA/IIA favorable, non-bulky disease, following primary therapy Option revised: Escalated BEACOPP x 2 cycles ± with ABVD x 2 cycles and restaging with imaging, additional therapy ISRT recommendations for deauville 4-5 have been moved to HODG-5. • For deauville 5 after primary therapy: • Footnote "m" added: Other recommended primary therapy regimens include: If biopsy negative, option revised: Escalated Stanford V x 8 weeks + 30 Gy ISRT. (Advani RH, et al. Ann Oncol BEACOPP x 2 cycles ± ISRT 2013;24:1044-1048) Following additional therapy with escalated • Footnote "p"; updated reference: Andre MPE, et al. J Clin Oncol BEACOPP, after restaging if deauville 1-3, or deauville 2017;35:1786-1794. 4-5 if biopsy negative, the following option has been • Footnote
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