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NCCN Flash Updates: NCCN Guidelines Updated for Pediatric Hodgkin Lymphoma

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®), the NCCN Drugs & Biologics Compendium (NCCN Compendium^®), the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™) for Pediatric Hodgkin Lymphoma. These NCCN Guidelines^® are currently available as Version 1.2024.

Link directly to the Updates section of the NCCN Guidelines: Pediatric Hodgkin Lymphoma

Global Changes

• References updated throughout the Guideline

PHL-1

• Essential, bullet 10 modified: Fertility/fertility preservation Counseling on infertility risk (see NCCN Guidelines for AYA Oncology) (Also for PHL-E 3 of 4)

PHL-2

• Footnote i added: Risk stratification and staging criteria differ for adult trials/regimens. See NCCN Guidelines for Hodgkin Lymphoma (Adult).

PHL-3

• Footnote removed from EuroNet-PHL-C1: Study is complete and data are emerging.
• Footnote q added: Omission of ISRT should be more strongly considered for patients who meet the GPOH-2002 response criteria (Mauz-Korholz C, et al. J Clin Oncol 2010;28:3680-3686).

PHL-4

• Useful in certain circumstances, new regimen added: Nivolumab-AVD (category 2B) (S1826)

PHL-5

• Other recommended regimens, new regimen aded: Nivolumab-AVD (category 2B) (S1826)
• Useful in certain circumstances
  • Regimen removed: ABVE-PC x 2 cycles
    (AHOD1331)
  • Regimen removed: ABVD

PHL-7

• Footnote y modified: Data are limited on the use of rituximab for early-stage NLPHL. (Also for PHL-E 2 of 4)
• Footnote aa modified: Advanced-stage NLPHL is rare in pediatric patients. Confirm pathologic diagnosis prior to treatment. See Principles of Pathology (PHL-B).

PHL-8

• Disease surveillance/follow-up after completion of treatment
  • Imaging, bullet 1 modified: Consider end-of-therapy ECHO.

PHL-9

• Footnote ff modified: Recommendations for those who may avoid ASCR: initial stage other than IIIB or IVB, no prior exposure to RT, duration of CR1 >1 year, and absence of extranodal disease or B symptoms at relapse. Harker-Murray PD, et al. J Clin Oncol 2023;41(Suppl):7515-Abstract 7515.

PHL-A (1 of 3)

• Protocol Rationale column removed for all regimens. (Also for PHL-A 2 of 3)
• OEPA/OEPA-COPDAC (EuroNet-PHL-C1), Criteria for RT
  • Bullet 1 modified: < CR on imaging after 2 cycles of OEPA (applies to patients with low-risk [LR] disease on GPOH 2002)
  • Bullet 3 modified: Patients with LR/IR/HR disease on C1 (emerging data) received RT only if FDG-PET positive (Deauville 3–5) or not in at least partial response (PR) after 2 cycles of OEPA
    • Sub-bullet added: Consider boost for residual mass >100 mL or <75% volume reduction and minimum volume >5 mL at early response assessment.
• ABVE-PC, high-risk (AHOD1331) category removed.
• Footnotes
  • Footnote a modified: Stage IVA was included in the intermediate-risk group in the trial, although is not recommended for standard care. (Also for PHL-A 2 of 3)
  • Footnote removed: Study is complete and data are emerging. (Also for PHL-A 2 of 3)

PHL-A (2 of 3)

• Bv-AVE-PC
  • Criteria for RT, bullet 4 modified: Consider treating without a boost for lesions that were LMA that was Deauville 3 after 2 cycles and continues to be Deauville 3 after 5 cycles.

PHL-B (1 of 5)

• Histologic classification
  • Bullet 1 modified: Diagnosis should be established according to guidelines in the 2017 WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues 2022 World Health Organization (WHO) Classification of Haematolymphoid Tumours, 5th edition or the 2022 International Consensus Classification (ICC) of Mature Lymphoid Neoplasms.
• NLPHL
  • Bullet 2 modified: Variant histologic patterns in NLPHL should be documented in the pathology report, where possible, as T-cell-rich and/or diffuse patterns C–F may be associated with higher risk of disease progression and relapse and shorter time to relapse.
• Footnotes
  • Footnote a revised: The different morphologic variants of CHL have different clinicopathologic associations and differential diagnoses. Refer to the 2017 2022 WHO Classification or ICC 2022 for more details.
  • Footnote b added: Per WHO 2022, NLPHL remains under the family of HL, while ICC 2022 replaces the term NLPHL with nodular lymphocyte-predominant B-cell lymphoma (NLPBL). Both classifications recognize the clinical and biologic similarities of NLPHL to an indolent B-cell lymphoma and NLPBL is an acceptable term per WHO 2022 (Alaggio R, et al. Leukemia 2022;36:1720-1748; Campo E, et al. Blood 2022;140:1229-1253).

PHL-C (1 of 3)

• Footnote c added: Measures to reduce brown fat activation, such as warming or pharmacologic suppression, may be considered to minimize false-positive findings.

PHL-D (1 of 2)

• Bullet 1 modified: These are only guiding principles of initial staging adapted from criteria of various protocols. This table is not intended to replace protocol-specific staging. Refer to applicable study protocol for complete staging details.
• Lung
  • Protocols, bullet 1 modified: E-lesions: Extralymphatic structures (lung lesions) contiguous with nodal masses are considered to be E-lesions.
• Bone
  • Protocols, bullet 3 modified: Extralymphatic structures (bone lesions) contiguous with nodal masses are considered to be E-lesions.

PHL-E (1 of 4)

• AVPC, note modified: Cyclophosphamide and doxorubicin dosing in AHOD0431 differs from AHOD03P1.
• ABVE-PC, high-risk (AHOD1331) category removed.

PHL-E (3 of 4)

• Footnote g modified: Emerging dData are showing utility as a re-induction option; consider for subsequent therapy if not previously used.

PHL-F (2 of 4)

• Footnote a added: In HLHR13, post-chemotherapy volumes were irradiated.

MS-1

• The discussion section has been updated to reflect the changes in the algorithm.

 

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Drugs & Biologics Compendium (NCCN Compendium^®), the NCCN Biomarkers Compendium^®, the NCCN Chemotherapy Order Templates (NCCN Templates^®), the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), please visit NCCN.org.

To view the NCCN Guidelines for Patients^®, please visit NCCN.org/patientguidelines.

Free NCCN Guidelines apps for iPhone, iPad, and Android devices are now available! Visit NCCN.org/apps.

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