NCCN Clinical Practice Guidelines in Oncology …

1 Version , 08/22/14 National Comprehensive Cancer Network, Inc. 2014, All rights nccn Guidelines and this illustration may not be reproduced in any form without the express written permission of nccn . nccn Guidelines IndexNHL Table of ContentsDiscussionContinueNCCN Clinical Practice Guidelines in Oncology ( nccn Guidelines ) Non-Hodgkin , 08/22/14 National Comprehensive Cancer Network, Inc. 2014, All rights nccn Guidelines and this illustration may not be reproduced in any form without the express written permission of nccn . nccn Guidelines IndexNHL Table of ContentsDiscussionAndrew D. Zelenetz, MD, PhD/ChairMemorial Sloan Kettering Cancer CenterJeremy S. Abramson, MDMassachusetts General Hospital Cancer CenterRanjana H. Advani, MDJohn C. Byrd, MDMyron S. Czuczman, MDRoswell Park Cancer InstituteLuis E.

2 Fayad, MDThe University of TexasMD Anderson Cancer Center Leo I. Gordon, MD/Co-Vice Chair Robert H. Lurie Comprehensive CancerCenter of Northwestern UniversityWilliam G. Wierda, MD, PhD/Co-Vice Chair The University of TexasMD Anderson Cancer Center Stanford Cancer InstituteC. Babis Andreadis, MD, MSCE UCSF Helen Diller FamilyComprehensive Cancer CenterNancy Bartlett, MD Siteman Cancer Center at Barnes-Jewish Hospital and WashingtonUniversity School of Medicine The Ohio State University ComprehensiveCancer Center - James Cancer Hospitaland Solove Research Institute Richard I. Fisher, MD Fox Chase Cancer CenterRachel Rabinovitch, MD University of Colorado Cancer CenterNishitha Reddy, MD Vanderbilt-Ingram Cancer Center University of Alabama at BirminghamComprehensive Cancer Center Moffitt Cancer Center Christina Tsien, MD University of MichiganComprehensive Cancer Center xxx Erin Reid, MDUC San Diego Moores Cancer CenterLubomir Sokol, MD, PhDLode J.

3 Swinnen, MB, ChBThe Sidney Kimmel ComprehensiveCancer Center at Johns HopkinsJulie M. Vose, MD, MBAFred & Pamela Buffett Cancer Center atThe Nebraska Medical CenterJoachim Yahalom, MDMemorial Sloan Kettering Cancer CenterNadeem Zafar, MDSt. Jude Children's Research Hospital/University of Tennessee Health Science CenterAyman A. Saad, MDMartha J. Glenn, MD Huntsman Cancer Instituteat the University of Utah ancer Institute Christopher R. Kelsey, MD Duke Cancer InstituteCancer InstituteSusan Krivacic, MPAff Dana-Farber/Brigham and Women's Cancer CenterAuayporn Nademanee, MD City of Hope Comprehensive Cancer CenterPierluigi Porcu, MD The Ohio State University ComprehensiveCancer Center - James Cancer Hospitaland Solove Research InstituteOliver Press, MD, PhD Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance Nancy Lee Harris, MDMassachusetts General Hospital Cancer CenterRichard T.

4 Hoppe, MDStanford CSteven M. Horwitz, MDMemorial Sloan Kettering Cancer CenterYoun H. Kim, MDStanfordConsultantAnn S. LaCasce, MD vx* Medical Oncology Hematology/Hematology oncologyRadiation Oncology Patient advocacy Radiotherapy/Bone marrow transplantationPathology Internal medicineDermatologyx v* Writing committee memberContinueNCCN Guidelines Version Panel MembersNon-Hodgkin s LymphomasNCCN Guidelines Panel DisclosuresNCCNMary Dwyer, MSHema Sundar, PhD** nccn gratefully acknowledges Dr. Elise A. Olsen for participating in theupdate of the Primary Cutaneous B-Cell Lymphomas and MycosisFungoides/S zary Syndrome Guidelines .**Version , 08/22/14 National Comprehensive Cancer Network, Inc. 2014, All rights nccn Guidelines and this illustration may not be reproduced in any form without the express written permission of nccn .

5 nccn Guidelines IndexNHL Table of ContentsDiscussionChronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CSLL-1 Follicular Lymphoma (FOLL-1 Mantle Cell Lymphoma (MANT-1 Diffuse Large B-Cell Lymphoma (BCEL-1 Burkitt Lymphoma (BURK-1 Lymphoblastic Lymphoma (BLAST-1 AIDS-Related B-Cell Lymphomas (AIDS-1)))))))Marginal Zone Lymphomas (MZL-1)Gastric MALT Lymphoma (MALT-1 Nongastric MALT Lymphoma (NGMLT-1 Nodal Marginal Zone Lymphoma (NODE-1 Splenic Marginal Zone Lymphoma (SPLN-1 Primary Cuive Disorders (PTLD-1T-Cell Prolymphocytic Leukemia (TPLL-1 Hairy Cell Leukemia (HCL-1)))))))taneous B-Cell Lymphomas (CUTB-1 Primary Cutaneous CD30+ T-Cell LymphoproliferativeDisorders (PCTLD-1T-cell Large Granular Lymphocytic Leukemia (LGLL-1)Adult T-Cell Leukemia/Lymphoma (ATLL-1 Extranodal NK/T-Cell Lymphoma, nasal type (NKTL-1 Post-Transplant Lymphoproliferat))))Peripheral T-Cell Lymphomas (TCEL-1 Mycosis Fungoides/Sezary Syndrome (MFSS-1))The nccn Guidelines are a statement of evidence and consensus of the authors regarding their views of currently accepted approaches totreatment.

6 Any clinician seeking to apply or consult the nccn Guidelines is expected to use independent medical judgment in the context ofindividual Clinical circumstances to determine any patient s care or treatment. The National Comprehensive Cancer Network ( nccn ) makes norepresentations or warranties of any kind regarding their content, use or application and disclaims any responsibility for their application or use inany way. The nccn Guidelines are copyrighted by National Comprehensive Cancer Network . All rights reserved. The nccn Guidelines and theillustrations herein may not be reproduced in any form without the express written permission of nccn . 2014. Clinical Trials:Categories of Evidence andConsensus: nccn believes thatthe best management for any cancerpatient is in a Clinical in Clinical trials isespecially find Clinical trials online at NCCNM ember Institutions,All recommendationsare category 2A unless of Evidenceand ConsensusNCCN Guidelines Version Table of ContentsNon-Hodgkin s LymphomasNCCN Non-Hodgkin s Lymphoma Panel MembersSummary of the Guidelines UpdatesUse of Immunophenotyping/Genetic Testingin Differential Diagnosis of Mature B-Celland NK/T-Cell Neoplasms (NHODG-ASupportive Care for NHL (NHODG-BResponse Criteria for Non-Hodgkin sLymphoma (NHODG-CPrinciples of Radiation Therapy (NHODG-D))))Special Considerations for the Use of B-CellReceptor Inhibitors (Ibrutinib and Idelalisib)(NHODG-E)

7 Primary CNS Lymphoma (See nccn Guidelines for CNSW aldenstr m s Macroglobulinemia/Lymphoplasmacytic Lymphoma(See nccn Guidelines for WM/LPL))Classification and Staging (ST-1)Version , 08/22/14 National Comprehensive Cancer Network, Inc. 2014, All rights nccn Guidelines and this illustration may not be reproduced in any form without the express written permission of nccn . nccn Guidelines IndexNHL Table of ContentsDiscussionNCCN Guidelines Version UpdatesNon-Hodgkin s LymphomasUPDATESU pdates to the version of the nccn Guidelines for Non-Hodgkin's Lymphomas from the version include:Continued on next pageMS-1 The Discussion sections for Follicular Lymphoma and Mantle Cell Lymphoma have been updated. Tositumomab/iodine I-131 tositumomab and the corresponding references have been removed from the Guidelines due to the discontinuation of lymphomaFOLL-BUpdates to the version of the nccn Guidelines for Non-Hodgkin's Lymphomas from the version include:Peripheral T-Cell LymphomasTCEL-B 1 of 2 Second-line therapy:For both candidate and non-candidate for transplant, Belinostat (category 2B) was added.

8 >Updates to the version of the nccn Guidelines for Non-Hodgkin's Lymphomas from the version include: Footnote h was added, Indicated for patients for whom rituximabmonotherapy would be considered appropriate due to the presence ofother co-morbidities (reduced renal function as measured bycreatinine clearance <60 mL/min, or NCI CTCAE Grade 3 neutropeniaor Grade 3 thrombocytopenia resulting from myelotoxic effects ofprior therapy with cytotoxic agents.). andCLL without del (11q) or del (17p) and CLL with del (11q):Relapsed/refractory therapy, Short response for age 70 y Idelalisib + rituximab was therapy, short response for age <70 y or olderpatients without significant >7>7 Idelalisib + rituximab was 2 of 7 CSLL 5 of 7 FOLL-B 1 of 3 Second-line and Subsequent Dosing Idelalisib was added.

9 >Follicular LymphomaCSLL-D 3 of 7 CLL with del (17p):First-line therapy Ibrutinib was therapy Idelalisib + rituximab was added.>7>7 New page titled, See Special Considerations for Use of B-Cell ReceptorInhibitors (Ibrutinib and Idelalisib) (NHODG-E) was added. A footnotewas added to the appropriate pages with a link to this Lymphocytic Leukemia/Small Lymphocytic LymphomaVersion , 08/22/14 National Comprehensive Cancer Network, Inc. 2014, All rights nccn Guidelines and this illustration may not be reproduced in any form without the express written permission of nccn . nccn Guidelines IndexNHL Table of ContentsDiscussionNCCN Guidelines Version UpdatesNon-Hodgkin s LymphomasUPDATESU pdates to the version of the nccn Guidelines for Non-Hodgkin's Lymphomas from the version include:Continued on next pageGlobal changesNew guidelinesChronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma Suggested treatment regimen references were updated throughout theguidelines.

10 IFRT was changed to ISRT throughout the Cutaneous CD30+ T-Cell Lymphoproliferative Disordersguidelines were Large Granular Lymphocyte LeukemiaFrail patient, significant comorbidity: Obinutuzumab + chlorambucil was without del (11q) or del (17p): Alemtuzumab was :Footnote was removed: (Also for CSLL-D 4 of 8)Footnote was removed: Lenalidomide can be given as continuous orintermittent dosing for patients with CLL. Growth factors and/or doseadjustment may be needed to address cytopenias, without necessitatingholding CLL without del (11q) or del (17p):Relapsed/refractory therapy, Short response for age 70 y Ibrutinib was g is new to the page: Guidelines were added. Chlorambucil rituximab was changed to Rituximab + chlorambucil and chlorambucil was added as a therapy, Age 70 y or younger patients with comorbidities Obinutuzumab + chlorambucil was added.