The National Comprehensive Cancer Network (NCCN) has issued updates on their guidelines for Hodgkin lymphoma (HL), which focus on the management of classical HL (CHL) and nodular lymphocyte-predominant HL (NHPHL) using existing treatments and the need for long-term follow-up after treatment completion. The new guidelines also provide recommendations on how to best manage patients in clinical trials.
Hodgkin lymphoma CT scan. (Source: Creative Commons)
The NCCN updated guidelines are separated into four parts: staging and prognosis, principles of radiation therapy, treatment guidelines, and follow-up after completion of treatment. For staging and prognosis, the authors provide flow charts on a patient’s diagnosis, workup, and clinical presentation. Excisional lymph node biopsy, rather than core needle biopsy or find-needle aspiration biopsy, is recommended for these patients, as well as PET/CT scans, pregnancy tests for women of childbearing age to preserve fertility, and counseling on fertility, smoking cessation, and psychosocial needs.
The use of PET and CT imaging were also encouraged in the new guidelines for initial staging and response assessment for patients with HL who have completed treatment. According to the guidelines, PET scans revealed positive results when used to stage and restage patients with lymphoma. The authors stated, however, that the value of PET scans remain unclear so it is important to consider a patient’s Deauville score before proceeding with treatment.
Radiation therapy (RT) is also recommended for patients with HL as it may offer “significantly and clinically relevant advantages,” especially in the case of sparing important organs such as the heart, lungs, kidneys, spinal cord and more, the authors stated. RT may also decrease the risk for late, normal tissue damage and achieve local tumor control.
The authors conclude that although HL is now curable in most patients due to the use of more effective and less toxic treatment options, patients are likely to experience treatment-related side effects later on in life. For example, late relapse or transformation to large cell lymphoma may occur in patients with NLPHL, according to the guidelines.
The authors advise oncologists to perform long-term follow-ups, especially during the first five years after treatment and then every year afterwards.
“Counseling about issues of survivorship and careful monitoring for late treatment-related side effects should be an integral part of follow-up,” they said in the guidelines.
Lastly, the authors highly encourage patients to participate in clinical trials.