Hodgkin Lymphoma Version 1.2017, NCCN Clinical Practice Guidelines in Oncology

Abstract

OverviewHodgkin lymphoma (HL) is an uncommon malignancy involving lymph nodes and the lymphatic system. Most patients are diagnosed between 15 and 30 years of age, followed by another peak in adults aged ≥55 years. In 2017, an estimated 8,260 people will be diagnosed with HL in the United States and 1,070 will die of the disease. AbstractThis portion of the NCCN Guidelines for Hodgkin lymphoma (HL) focuses on the management of classical HL. Current management of classical HL involves initial treatment with chemotherapy or combined modality therapy followed by restaging with PET/CT to assess treatment response using the Deauville criteria (5-point scale). The introduction of less toxic and more effective regimens has significantly advanced HL cure rates. However, long-term follow-up after completion of treatment is essential to determine potential long-term effects. Please NoteThe NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines These guidelines are also available on the Internet. For the latest update, visit NCCN.org.

Spontaneous Regression of Hodgkin Lymphoma: Case Report and Review of the Literature

“…The current standard of care for newly diagnosed HL includes chemotherapy, with or without radiotherapy [5, 6]. The true incidence of spontaneous regression of HL is difficult to estimate; however, it is believed to be a rare occurrence, with only several previous reports in the literature (Table 1).…”

Positron Emission Tomography Scanning in the Management of Hodgkin Lymphoma Patients: A Single-Institution Experience

“…As far as the role of PET-CT in surveillance is concerned, it has been recognized in the NCCN guidelines as unnecessary [13]. Likewise, recent research is providing a growing body of evidence of the limitations in PET-CT usage in follow-up.…”

“…However, the official recommendations concerning the use of PET-CT in initial HL staging are slightly inconsistent. The National Comprehensive Cancer Network (NCCN) defines PET-CT as an integral part of this procedure [13], whereas in the European Society for Medical Oncology (ESMO) guidelines PET-CT is considered only an additional tool that may be included in the staging process [16].…”

“…However, a more and more appreciable role of PET-CT is being emphasized [13]. In its current recommendations of diagnostic and therapeutic proceedings in malignant tumors, the Polish Society for Medical Oncology encourages the use of PET-CT scanning at different points in HL management, particularly supporting it in the assessment of final post-therapy outcome [14].…”

Interim FDG-PET in lymphoma, a questionable practice in hematology

“…The 2014 Lugano criteria [5,6] and 2016 refinement of the Lugano criteria [7] not only promote performing FDG-PET scans after treatment, but also during treatment, also known as interim FDG-PET. These examinations are also promoted by other guidelines such as the guidelines of the European Society of Oncology (ESMO) [8,9] and the National Comprehensive Cancer Network (NCCN) [10,11], and the value of these examinations are hyped at conference meetings [12][13][14]. Consequently, interim FDG-PET scanning is adopted worldwide at numerous institutions, and thousands of lymphoma patients undergo an interim FDG-PET evaluation every year.…”