Hodgkin Lymphoma, Version 2.2012 Featured Updates to the NCCN Guidelines

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  • 1 From Stanford Cancer Institute; UCSF Hellen Diller Family Comprehensive Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; UNMC Eppley Cancer Center at The Nebraska Medical Center; H. Lee Moffitt Cancer Center & Research Institute; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute; City of Hope Comprehensive Cancer Center; The University of Texas MD Anderson Cancer Center; Latinas Contra Cancer; University of Alabama at Birmingham Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Massachusetts General Hospital Cancer Center; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Dana-Farber/Brigham and Women’s Cancer Center; St. Jude Children’s Research Hospital/University of Tennessee Cancer Institute; Duke Cancer Institute; Vanderbilt-Ingram Cancer Center; Memorial Sloan-Kettering Cancer Center; Huntsman Cancer Institute at the University of Utah; Fox Chase Cancer Center; and National Comprehensive Cancer Network.
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The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Hodgkin Lymphoma (HL) include the clinical management of classical HL and lymphocyte-predominant HL (LPHL). Major changes have been incorporated into these guidelines since their inception. In the 2012 NCCN Guidelines for HL, PET scans are not recommended for interim restaging of patients with stage I to II favorable disease. After reevaluating the available evidence on the use of interim PET imaging, the panel recommends the use of diagnostic CT scan of involved sites for interim restaging after completion of chemotherapy for this group of patients. Maintenance rituximab for 2 years is included as an option for patients with stage IB to IIB or stage III to IV LPHL treated with rituximab alone in the first-line setting. Brentuximab vedotin is included as an option for patients with progressive disease or relapsed disease after second-line chemotherapy or high-dose therapy with autologous stem cell rescue.

  • 1

    Cheson BD. Role of functional imaging in the management of lymphoma. J Clin Oncol 2011;29:18441854.

  • 2

    Kuruvilla J, Keating A, Crump M. How I treat relapsed and refractory Hodgkin lymphoma. Blood 2011;117:42084217.

  • 3

    Younes A, Bartlett NL, Leonard JP. Brentuximab vedotin (SGN-35) for relapsed CD30-positive lymphomas. N Engl J Med 2010;363:18121821.

  • 4

    Maeda LS, Advani RH. The emerging role for rituximab in the treatment of nodular lymphocyte predominant Hodgkin lymphoma. Curr Opin Oncol 2009;21:397400.

    • Search Google Scholar
    • Export Citation
  • 5

    Hutchings M, Mikhaeel NG, Fields PA. Prognostic value of interim FDG-PET after two or three cycles of chemotherapy in Hodgkin lymphoma. Ann Oncol 2005;16:11601168.

    • Search Google Scholar
    • Export Citation
  • 6

    Sher DJ, Mauch PM, Van Den Abbeele A. Prognostic significance of mid- and post-ABVD PET imaging in Hodgkin’s lymphoma: the importance of involved-field radiotherapy. Ann Oncol 2009;20:18481853.

    • Search Google Scholar
    • Export Citation
  • 7

    Barnes JA, LaCasce AS, Zukotynski K. End-of-treatment but not interim PET scan predicts outcome in nonbulky limited-stage Hodgkin’s lymphoma. Ann Oncol 2011;22:910915.

    • Search Google Scholar
    • Export Citation
  • 8

    Straus DJ, Johnson JL, LaCasce AS. Doxorubicin, vinblastine, and gemcitabine (CALGB 50203) for stage I/II nonbulky Hodgkin lymphoma: pretreatment prognostic factors and interim PET. Blood 2011;117:53145320.

    • Search Google Scholar
    • Export Citation
  • 9

    Terasawa T, Lau J, Bardet S. Fluorine-18-fluorodeoxyglucose positron emission tomography for interim response assessment of advanced-stage Hodgkin’s lymphoma and diffuse large B-cell lymphoma: a systematic review. J Clin Oncol 2009;27:19061914.

    • Search Google Scholar
    • Export Citation
  • 10

    Gallamini A, Rigacci L, Merli F. The predictive value of positron emission tomography scanning performed after two courses of standard therapy on treatment outcome in advanced stage Hodgkin’s disease. Haematologica 2006;91:475481.

    • Search Google Scholar
    • Export Citation
  • 11

    Hutchings M, Loft A, Hansen M. FDG-PET after two cycles of chemotherapy predicts treatment failure and progression-free survival in Hodgkin lymphoma. Blood 2006;107:5259.

    • Search Google Scholar
    • Export Citation
  • 12

    Gallamini A, Hutchings M, Rigacci L. Early interim 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography is prognostically superior to international prognostic score in advanced-stage Hodgkin’s lymphoma: a report from a joint Italian-Danish study. J Clin Oncol 2007;25:37463752.

    • Search Google Scholar
    • Export Citation
  • 13

    Cerci JJ, Pracchia LF, Linardi CC. 18F-FDG PET after 2 cycles of ABVD predicts event-free survival in early and advanced Hodgkin lymphoma. J Nucl Med 2010;51:13371343.

    • Search Google Scholar
    • Export Citation
  • 14

    Advani R, Maeda L, Lavori P. Impact of positive positron emission tomography on prediction of freedom from progression after Stanford V chemotherapy in Hodgkin’s disease. J Clin Oncol 2007;25:39023907.

    • Search Google Scholar
    • Export Citation
  • 15

    Markova J, Kahraman D, Kobe C. Role of [18F]-fluoro-2-deoxy-d-glucose positron emission tomography in early and late therapy assessment of patients with advanced Hodgkin lymphoma treated with bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine and prednisone. Leuk Lymphoma 2012;53:6470.

    • Search Google Scholar
    • Export Citation
  • 16

    Bonadonna G, Bonfante V, Viniani S. ABVD plus subtotal nodal versus involved-field radiotherapy in early-stage Hodgkin’s disease: long-term results. J Clin Oncol 2004;22:28352841.

    • Search Google Scholar
    • Export Citation
  • 17

    Engert A, Plutschow A, Eich HT. Reduced treatment intensity in patients with early-stage Hodgkin’s lymphoma. N Engl J Med 2010;363:640652.

    • Search Google Scholar
    • Export Citation
  • 18

    Advani RH, Hoppe RT, Maeda LS. Stage I-IIA non-bulky Hodgkin’s lymphoma. Is further distinction based on prognostic factors useful? The Stanford experience. Int J Radiat Oncol Biol Phys 2011;81:13741379.

    • Search Google Scholar
    • Export Citation
  • 19

    Meyer RM, Gospodarowicz MK, Connors JM. Randomized comparison of ABVD chemotherapy with a strategy that includes radiation therapy in patients with limited-stage Hodgkin’s lymphoma: National Cancer Institute of Canada Clinical Trials Group and the Eastern Cooperative Oncology Group. J Clin Oncol 2005;23:46344642.

    • Search Google Scholar
    • Export Citation
  • 20

    Meyer RM, Gospodarowicz MK, Connors JM. ABVD alone versus radiation-based therapy in limited-stage Hodgkin’s lymphoma. N Engl J Med 2012;366:399408.

    • Search Google Scholar
    • Export Citation
  • 21

    Ekstrand BC, Lucas JB, Horwitz SM. Rituximab in lymphocyte-predominant Hodgkin disease: results of a phase 2 trial. Blood 2003;101:42854289.

    • Search Google Scholar
    • Export Citation
  • 22

    Schulz H, Rehwald U, Morschhauser F. Rituximab in relapsed lymphocyte-predominant Hodgkin lymphoma: long-term results of a phase 2 trial by the German Hodgkin Lymphoma Study Group (GHSG). Blood 2008;111:109111.

    • Search Google Scholar
    • Export Citation
  • 23

    Azim HA Jr, Pruneri G, Cocorocchio E. Rituximab in lymphocyte-predominant Hodgkin disease. Oncology 2009;76:2629.

  • 24

    Jackson C, Sirohi B, Cunningham D. Lymphocyte-predominant Hodgkin lymphoma—clinical features and treatment outcomes from a 30-year experience. Ann Oncol 2010;21:20612068.

    • Search Google Scholar
    • Export Citation
  • 25

    Fanale MA, Lai CM, McLaughlin P. Outcomes of nodular lymphocyte predominant Hodgkin’s lymphoma (NLPHL) patients treated with R-CHOP [abstract]. Blood 2010;116:Abstract 2812.

    • Search Google Scholar
    • Export Citation
  • 26

    Eichenauer DA, Fuchs M, Pluetschow A. Phase 2 study of rituximab in newly diagnosed stage IA nodular lymphocyte-predominant Hodgkin lymphoma: a report from the German Hodgkin Study Group. Blood 2011;118:43634365.

    • Search Google Scholar
    • Export Citation
  • 27

    Horning SJ, Bartlett NL, Breslin S. Results of a prospective phase II trial of limited and extended rituximab treatment in nodular lymphocyte predominant Hodgkin’s disease (NLPHD) [abstract]. Blood 2007;110:Abstract 644.

    • Search Google Scholar
    • Export Citation
  • 28

    Advani RH, Horning SJ, Hoppe RT. Frontline therapy of nodular lymphocyte predominant Hodgkin lymphoma with rituximab: the Stanford University experience [abstract]. Blood 2011;118:Abstract 2686.

    • Search Google Scholar
    • Export Citation
  • 29

    Linch DC, Winfield D, Goldstone AH. Dose intensification with autologous bone-marrow transplantation in relapsed and resistant Hodgkin’s disease: results of a BNLI randomised trial. Lancet 1993;341:10511054.

    • Search Google Scholar
    • Export Citation
  • 30

    Schmitz N, Pfistner B, Sextro M. Aggressive conventional chemotherapy compared with high-dose chemotherapy with autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkin’s disease: a randomised trial. Lancet 2002;359:20652071.

    • Search Google Scholar
    • Export Citation
  • 31

    Moskowitz AJ, Perales MA, Kewalramani T. Outcomes for patients who fail high dose chemoradiotherapy and autologous stem cell rescue for relapsed and primary refractory Hodgkin lymphoma. Br J Haematol 2009;146:158163.

    • Search Google Scholar
    • Export Citation
  • 32

    Moskowitz CH, Kewalramani T, Nimer SD. Effectiveness of high dose chemoradiotherapy and autologous stem cell transplantation for patients with biopsy-proven primary refractory Hodgkin’s disease. Br J Haematol 2004;124:645652.

    • Search Google Scholar
    • Export Citation
  • 33

    Sirohi B, Cunningham D, Powles R. Long-term outcome of autologous stem-cell transplantation in relapsed or refractory Hodgkin’s lymphoma. Ann Oncol 2008;19:13121319.

    • Search Google Scholar
    • Export Citation
  • 34

    Chen RW, Gopal AK, Smith SE. Results from a pivotal phase II study of brentuximab vedotin (SGN-35) in patients with relapsed or refractory Hodgkin lymphoma (HL) [abstract]. J Clin Oncol 2011;29(Suppl):Abstract 8031.

    • Search Google Scholar
    • Export Citation
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