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(NCCN Guidelines®) B-Cell Lymphomas NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) B-Cell Lymphomas Version 2.2018 — February 26, 2018 NCCN.org Continue Version 2.2018, 02/26/18 © National Comprehensive Cancer Network, Inc. 2018, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®. Printed by Anton Kabakov on 3/5/2018 6:56:57 AM. For personal use only. Not approved for distribution. Copyright © 2018 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Version 2.2018 Panel Members NCCN Guidelines Index Table of Contents B-Cell Lymphomas Discussion * Andrew D. Zelenetz, MD, PhD/Chair † Þ Beth Christian, MD † Ann S. LaCasce, MD † Memorial Sloan Kettering Cancer Center The Ohio State University Comprehensive Dana-Farber/Brigham and Women’s Cancer Center - James Cancer Hospital Cancer Center * Leo I. Gordon, MD/Co-Vice Chair ‡ ξ and Solove Research Institute Robert H. Lurie Comprehensive Cancer Amitkumar Mehta MD † ‡ Þ Center of Northwestern University Luis E. Fayad, MD ‡ Þ † University of Alabama at Birmingham The University of Texas Comprehensive Cancer Center Jeremy S. Abramson, MD † ‡ MD Anderson Cancer Center Massachusetts General Hospital Auayporn Nademanee, MD † ‡ ξ Cancer Center Martha J. Glenn, MD † ‡ Þ ξ City of Hope Comprehensive Cancer Center Huntsman Cancer Institute Ranjana H. Advani, MD † at the University of Utah Rachel Rabinovitch, MD § Stanford Cancer Institute University of Colorado Cancer Center Thomas M. Habermann, MD ‡ ξ C. Babis Andreadis, MD, MSCE ‡ † Mayo Clinic Cancer Center Nishitha Reddy, MD ‡ ξ UCSF Helen Diller Family Vanderbilt-Ingram Cancer Center Comprehensive Cancer Center Nancy Lee Harris, MD ≠ Erin Reid, MD ‡ Massachusetts General Hospital Cancer Center Nancy Bartlett, MD † UC San Diego Moores Cancer Center Siteman Cancer Center at Barnes- Francisco Hernandez-Ilizaliturri, MD † Stephen D. Smith, MD ‡ Jewish Hospital and Washington Roswell Park Cancer Institute University School of Medicine Fred Hutchinson Cancer Research Center/ Seattle Cancer Care Alliance Mark S. Kaminski, MD † Paolo Caimi, MD ‡ † University of Michigan Erin D. Snyder, MD Þ Case Comprehensive Cancer Center/ Comprehensive Cancer Center University of Alabama at Birmingham University Hospitals Seidman Cancer Comprehensive Cancer Center Center and Cleveland Clinic Taussig Christopher R. Kelsey, MD § Cancer Institute Duke Cancer Institute Lode J. Swinnen, MB, ChB ‡ ξ The Sidney Kimmel Comprehensive Julie E. Chang, MD ‡ Nadia Khan, MD † Cancer Center at Johns Hopkins University of Wisconsin Fox Chase Cancer Center Carbone Cancer Center Julie M. Vose, MD, MBA ‡ ξ Susan Krivacic, MPAff ¥ Fred & Pamela Buffett Cancer Center Julio C. Chavez, MD † Consultant Moffitt Cancer Center NCCN Continue † Medical oncology Þ Internal medicine Mary Dwyer, MS ‡ Hematology/Hematology oncology ¥ Patient advocacy Hema Sundar, PhD § Radiotherapy/Radiation oncology * Discussion Writing Committee ξ Bone marrow transplantation Member NCCN Guidelines Panel Disclosures ≠ Pathology Version 2.2018, 02/26/18 © National Comprehensive Cancer Network, Inc. 2018, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®. Printed by Anton Kabakov on 3/5/2018 6:56:57 AM. For personal use only. Not approved for distribution. Copyright © 2018 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Version 2.2018 Table of Contents NCCN Guidelines Index Table of Contents B-Cell Lymphomas Discussion NCCN B-Cell Lymphoma Panel Members Summary of the Guidelines Updates Clinical Trials: NCCN believes that the best management for any patient with • Diagnosis (DIAG-1) cancer is in a clinical trial. • Follicular Lymphoma (FOLL-1) Participation in clinical trials is especially • Marginal Zone Lymphomas (MZL-1) encouraged. Gastric MALT Lymphoma (MALT-1) To find clinical trials online at NCCN Nongastric MALT Lymphoma (NGMLT-1) Member Institutions, click here: Nodal Marginal Zone Lymphoma (NODE-1) nccn.org/clinical_trials/physician.html. Splenic Marginal Zone Lymphoma (SPLN-1) NCCN Categories of Evidence and • Mantle Cell Lymphoma (MANT-1) Consensus: All recommendations are category 2A unless otherwise indicated. • Diffuse Large B-Cell Lymphoma (BCEL-1) • High-Grade B-Cell lymphomas with Translocations of MYC and BCL2 and/or See NCCN Categories of Evidence and Consensus. BCL6 (Double/Triple Hit Lymphoma) (HGBL-1) • Burkitt Lymphoma (BURK-1) NCCN Categories of Preference: • AIDS-Related B-Cell Lymphomas (AIDS-1) All recommendations are considered • Lymphoblastic Lymphoma (BLAST-1) appropriate. • Post-Transplant Lymphoproliferative Disorders (PTLD-1) See NCCN Categories of Preference • Castleman’s Disease (CD-1) • Use of Immunophenotyping/Genetic Testing in Differential Diagnosis of Classification and Staging (ST-1) Mature B-Cell and NK/T-Cell Neoplasms (NHODG-A) • Supportive Care for B-Cell Lymphomas (NHODG-B) Primary CNS Lymphoma (See NCCN Guidelines for CNS) • Lugano Response Criteria for Non-Hodgkin’s Lymphoma (NHODG-C) Waldenström’s Macroglobulinemia/Lymphoplasmacytic • Principles of Radiation Therapy (NHODG-D) Lymphoma (See NCCN Guidelines for WM/LPL) • Special Considerations for the Use of Small-Molecule Inhibitors (NHODG-E) 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. ©2018. Version 2.2018, 02/26/18 © National Comprehensive Cancer Network, Inc. 2018, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®. Printed by Anton Kabakov on 3/5/2018 6:56:57 AM. For personal use only. Not approved for distribution. Copyright © 2018 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Version 2.2018 Updates NCCN Guidelines Index Table of Contents B-Cell Lymphomas Discussion Updates in Version 2.2018 of the NCCN Guidelines for B-Cell Lymphomas from Version 2.2018 include: Mantle Cell Lymphoma MANT-A 1 of 4 • Heading was revised, "Suggested Treatment Regimens (in preference order)." MANT-A 2 of 4 • Heading was revised, "Suggested Treatment Regimens (in preference order)" and "in alphabetical order" and "in alphabetical order by category" was added to the regimen list as appropriate. Updates in Version 1.2018 of the NCCN Guidelines for B-Cell Lymphomas from Version 7.2017 include: Global changes • The common bullets related to diagnosis were removed for each subtype and FOLL-6 (continued) added to a new page, DIAG-1. For each subtype, the diagnosis section is now Footnote v was added, "If transformation is co-existing with extensive titled, "Additional Diagnostic Testing." FL, consider maintenance (see FOLL-5, Optional Extended Therapy)." • Workup, "CBC, differential, platelets" was changed to "CBC with differential." Footnote w was revised, "If proceeding to an autologous stem cell • Suggested treatment regimen references were updated throughout the rescue, consider additional cytoreductive systemic therapy ± ISRT guidelines. to induce CR prior to transplant. Axicabtagene ciloleucel is not an • Radioimmunotherapy was clarified as ibritumomab" tiuxetan" throughout the appropriate treatment option for patients with a CR." guidelines. Footnote x was added, "Repeat biopsy should be strongly considered if PET-positive prior to additional therapy. If biopsy negative, follow CR Follicular Lymphoma pathway." FOLL-2 • Workup, FOLL-7 • Histologic transformation to DLBCL after multiple lines of prior therapies, "Beta-2-microglobulin" was moved from Essential to Useful in Selected Cases and qualified with "necessary for calculation of FLIPI-2." Chemoimmunotherapy was clarified as "second-line therapy" on BCEL-C. (Also for NODE-5) FOLL-3 • Stage I, II After responsive disease, "± ISRT if not previously given" was added to Non-bulky was replaced and defined with "<7 cm" HDT/ASCR and HCT. (Also for NODE-5) Bulky was replaced and defined with ≥" 7 cm" FOLL-8 • Treatment, FOLL-4 • Stage III, IV "for patients with extensive local disease who are not candidates for excision or ISRT" was added to RCHOP. Indications for treatment ◊ 6th bullet was revised, "Steady or rapid progression." Change made "Observe" was added after "Excision (preferred)" throughout the guidelines as appropriate. • Footnote cc was revised by adding, "Localized disease (stage I,II) is more • Indication present, "Local ISRT (4–30 Gy) (palliation of locally symptomatic common than advanced-stage disease (stage III,IV)." disease)" was revised to "Palliative ISRT" and the dosing was added to • Footnote dd was revised by adding, "There are no data to support NHODG-D 3 of 4. (Also for FOLL-5, NODE-3, and NODE-4) maintenance therapy." FOLL-6 FOLL-B 1
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