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NCCN Guidelines Index Hodgkin Table of Contents Discussion NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines® ) Hodgkin Lymphoma Version 2.2013 NCCN.org Continue Version 2.2013, 05/24/13 © National Comprehensive Cancer Network, Inc. 2013, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN® . NCCN Guidelines Version 2.2013 Panel Members NCCN Guidelines Index Hodgkin Table of Contents Hodgkin Lymphoma Discussion * Richard T. Hoppe, MD/Chair § Robert Chen, MD ‡ x Monika Metzger, MD € Stanford Cancer Institute City of Hope Comprehensive Cancer Center St. Jude Children’s Research Hospital/ University of Tennessee Health Science Ranjana Hira Advani, MD † Bouthaina Dabaja, MD § Center Stanford Cancer Institute The University of Texas M. D. Anderson Cancer Center Joseph O. Moore, MD † Weiyun Z. Ai, MD ‡ Duke Cancer Institute UCSF Helen Diller Family Andres Forero, MD † ‡ Comprehensive Cancer Center University of Alabama at Birmingham David Morgan, MD †‡x Comprehensive Cancer Center Vanderbilt-Ingram Cancer Center Richard F. Ambinder, PhD, MD † The Sidney Kimmel Comprehensive Leo I. Gordon, MD ‡ Craig H. Moskowitz, MD † Þ Cancer Center at John Hopkins Robert H. Lurie Comprehensive Cancer Memorial Sloan-Kettering Cancer Center Center of Northwestern University Patricia Aoun, MD, MPH ¹ Matthew Poppe, MD § City of Hope Comprehensive Francisco J. Hernandez-Ilizaliturri, MD † Huntsman Cancer Institute Cancer Center Roswell Park Cancer Institute at the University of Utah Celeste M. Bello, MD, MSPH † Ephraim P. Hochberg, MD † Barbara Pro, MD † Þ Moffitt Cancer Center Massachusetts General Hospital Cancer Center Fox Chase Cancer Center Cecil M. Benitez, BS ¥ David G. Maloney, MD, PhD †‡ Jane N. Winter, MD ‡ Stanford Cancer Institute Fred Hutchinson Cancer Research Robert H. Lurie Comprehensive Cancer Center/Seattle Cancer Care Alliance Center of Northwestern University Philip J. Bierman, MD † ‡ x UNMC Eppley Cancer Center at David Mansur, MD § Joachim Yahalom, MD § The Nebraska Medical Center Siteman Cancer Center at Barnes- Memorial Sloan-Kettering Cancer Center Jewish Hospital and Washington Kristie A. Blum, MD ‡ University School of Medicine NCCN The Ohio State University Kristina Gregory, RN, MSN, OCN Comprehensive Cancer Center - Peter M. Mauch, MD § Hema Sundar, PhD James Cancer Hospital and Dana-Farber/Brigham and Women's Solove Research Institute Cancer Center § Radiation oncology † Medical oncology ‡ Hematology/Hematology oncology Continue x Bone marrow transplantation € Pediatric oncology ¹ Pathology Þ Internal medicine NCCN Guidelines Panel Disclosures ¥ Patient advocacy Version 2.2013, 05/24/13 © National Comprehensive Cancer Network, Inc. 2013, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN® . NCCN Guidelines Version 2.2013 Table of Contents NCCN Guidelines Index Hodgkin Table of Contents Hodgkin Lymphoma Discussion NCCN Hodgkin Lymphoma Panel Members Clinical Trials: NCCN believes that Summary of Guidelines Updates the best management for any cancer Diagnosis and Workup (HODG-1) patient is in a clinical trial. Participation in clinical trials is Primary Treatment especially encouraged. · Classical Hodgkin Lymphoma: To find clinical trials online at NCCN CS IA-IIA Favorable (HODG-2) Member Institutions, click here: CS I-II Unfavorable (Bulky disease) (HODG-4) nccn.org/clinical_trials/physician.html. CS I-II Unfavorable (Non-bulky disease) (HODG-9) NCCN Categories of Evidence and CS III-IV (HODG-11) Consensus: All recommendations are category 2A unless otherwise · Lymphocyte-Predominant Hodgkin Lymphoma: specified. CS I-IV (HODG-14) See NCCN Categories of Evidence Follow-up After Completion of Treatment and Consensus. and Monitoring For Late Effects (HODG-15) Refractory Classical Hodgkin Lymphoma (HODG-16) Suspected Relapse of Classical Hodgkin Lymphoma (HODG-17) Refractory or Relapsed Lymphocyte-Predominant Hodgkin Lymphoma (HODG-18) Unfavorable Factors (localized and advanced disease) (HODG-A) Principles of Systemic Therapy (HODG-B) Principles of Radiation Therapy (HODG-C) Deauville PET Criteria (HODG-D) Principles of Second-line Chemotherapy (HODG-E) 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. ©2013. Version 2.2013, 05/24/13 © National Comprehensive Cancer Network, Inc. 2013, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN® . NCCN Guidelines Version 2.2013 Updates NCCN Guidelines Index Hodgkin Table of Contents Hodgkin Lymphoma Discussion Summary of the changes in the 2.2013 version of the NCCN Guidelines for Hodgkin Lymphoma from the 1.2013 version include: MS-1 - The discussion section was updated to reflect the changes in the algorithm. Summary of the changes in the 1.2013 version of the NCCN Guidelines for Hodgkin Lymphoma from the 2.2012 version include: HODG-1 HODG-2 Diagnosis · Footnote “h” modified:Excludes the NCCN Unfavorable Factors for · Immunohistochemistry evaluation highly recommended for stage I-II disease: bulky mediastinal or >10 cm disease, B symptoms, Hodgkin lymphoma. ESR >50, >3 sites of disease (see Unfavorable Factors HODG-A). · Footnote “b” modified: “Typical immunophenotype for Classical · Previous footnote “m” deleted: “Patients with elevated ESR or >3 sites Hodgkin lymphoma: CD15+, CD30+,PAX-5+ (weak) ; CD3-, CD20 - of disease may be managed with Stanford V per this algorithm.” · (majority), CD45-, CD79a-. Typical immunophenotype for Footnote “o” added with link to Deauville PET criteria. · Footnote “r” modified: Biopsy to confirm no change in histology. Lymphocyte-predominant Hodgkin lymphoma: CD20+, CD45+, Clinical circumstances may warrant additional treatment even in face CD79a+, BCL6+, PAX-5+; CD3-, CD15-, CD30-. An expanded panel of negative biopsy. (also applies to HODG-3 through HODG-13, HODG- of markers may be required especially if equivocal diagnosis. See 16) NHL Guidelines. · Footnote “s” added: “Deauville 3 should have short interval follow-up Workup including PET-CT.” (also applies to HODG-3, HODG-10, HODG-13 · HIV test moved from “Essential” to “Useful in selected cases” and HODG-16 through HODG-18) “encouraged” added. · HODG-3 Neck CT: “if neck RT contemplated” added. · Restaging modified: Restage after chemotherapy with PET-CT CT · “Fertility preservation” added to “Useful in selected cases” with through regions of initial disease footnote “e”: “Fertility preservation options include: · Deauville criteria added to determine further treatment options. Semen cryopreservation, if chemotherapy or pelvic RT · Footnote “o” added with link to Deauville PET criteria. contemplated. IVF or ovarian tissue or oocyte cryopreservation. · Pathway for stable disease removed. Oophoropexy in pre-menopausal women if pelvic RT is HODG-4 contemplated.” · Primary treatment: ABVD changed from 4 cycles to “2-4 cycles” and HODG-2 listed as a category 1 recommendation. Primary treatment · Primary treatment: BEACOPP x 2 + ABVD x 2 + RT added as a · Combined modality therapy (ABVD x 2-4 cycles + involved-site RT treatment option. (ISRT) (category 1) or Stanford V x 8 weeks) + involved field RT · Deauville criteria added to determine further treatment options. [IFRT]) (category 1) · Footnote “o” added with link to Deauville PET criteria. · ABVD alone changed from a category 2B recommendation to a · Deauville 1-3 after restaging: ABVD changed from 2 cycles to “2-4 category 2A recommendation. cycles” and IFRT removed as a treatment option. · Restaging modified: Restage after chemotherapy with PET-CT CT · Deauville 4 after restaging: ABVD changed from 2 cycles to “2-4 through regions of initial disease. · Deauville criteria added to determine further treatment options. cycles.” · Deauville 1-3: recommendation after ISRT changed to “Observe.” · Deauville 4: Restaging after 4-6 cycles of ABVD moved to · Deauville 4: Biopsy added as an option. page HODG-5. Version 2.2013, 05/24/13 © National Comprehensive Cancer Network, Inc. 2013, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN® . UPDATES NCCN Guidelines Version 2.2013 Updates NCCN Guidelines Index Hodgkin Table of Contents Hodgkin Lymphoma Discussion Summary of the changes in the 1.2013 version of the NCCN Guidelines for Hodgkin Lymphoma from the 2.2012 version include: HODG-5 HODG-11 · Deauville criteria added to determine further treatment options. · Previous footnote “y” deleted: “If stable disease after 2 cycles of · Footnote “o” added with link to Deauville PET criteria. ABVD, consider a total of
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  • ABVD Versus Modified Stanford V Versus MOPPEBVCAD With

    ABVD Versus Modified Stanford V Versus MOPPEBVCAD With

    ABVD versus modified stanford V versus MOPPEBVCAD with optional and limited radiotherapy in intermediate- and advanced-stage Hodgkin's lymphoma: final results of a multicenter randomized trial by the Intergruppo Italiano Linfomi. Gobbi PG, Levis A, Chisesi T, Broglia C, Vitolo U, Stelitano C, Pavone V , Cavanna L, Santini G , Merli F , Liberati M ,Baldini L , Deliliers GL, Angelucci E, Bordonaro R , Federico M ;Intergruppo Italiano Linfomi . PURPOSE: In this multicenter, prospective, randomized clinical trial on advanced Hodgkin's lymphoma (HL), the efficacy and toxicity of two chemotherapy regimens, doxorubicin, vinblastine, mechlorethamine, vincristine, bleomycin, etoposide, and prednisone (Stanford V) and mechlorethamine, vincristine, procarbazine, prednisone, epidoxirubicin, bleomycin, vinblastine, lomustine, doxorubicin, and vindesine (MOPPEBVCAD), were compared with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) as standard therapy to select which regimen would best support a reduced radiotherapy program, which was limited to < or = two sites of either previous bulky or partially remitting disease (a modification of the original Stanford program). PATIENTS AND METHODS: Three hundred fifty-five patients with stage IIB, III, or IV HL were randomly assigned. Three hundred thirty-four patients were assessable for the study and received six cycles of ABVD (n = 122), three cycles of Stanford V (n = 107), or six cycles of MOPPEBVCAD (n = 106); radiotherapy was administered to 76, 71, and 50 patients in these three arms, respectively. RESULTS: The complete response rates for ABVD, Stanford V, and MOPPEBVCAD were 89%, 76% and 94%, respectively; 5-year failure-free survival (FFS) and progression-free survival rates were 78%, 54%, 81% and 85%, 73%, and 94%, respectively (P < .01 for comparison of Stanford V with the other two regimens).