NCCN临床实践指南_原发性皮肤淋巴瘤(2019.V1)英文版

1、Continue NCCN org Version 1 2019 11 21 18 2018 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Clinical Practice Guidelines in Oncology NCCN Guidelines Version 1 2019 November 21 2018 Continue Primary Cutaneous Lymphomas NCCN Mary Dwyer MS Hema Sundar PhD Continue NCCN Guidelines Panel Disclosures Medical oncology Hematology Hematology oncology Radiotherapy R

2、adiation oncology Bone marrow transplantation Pathology Internal medicine Dermatology Plastic surgery Patient advocacy Discussion Writing Committee Member Bradley M Haverkos MD MPH MS University of Colorado Cancer Center Richard T Hoppe MD Stanford Cancer Institute Eric Jacobsen MD Dana Farber Brigham and Women s Cancer Center Deepa Jagadeesh MD MPH Case Comprehensive Cancer Center University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute Youn H Kim MD Stanford Can

3、cer Institute Matthew A Lunning DO Fred T N M and the appropriate guidelines page for each stage Two new footnotes were added Footnote q Folliculotropism is a histologic feature that can occur irrespective of stage Histologic evidence of folliculotropic MF is associated with higher risk of disease progression In selected cases or inadequate response consider primary treatment for stage IIB tumor stage disease Footnote r Large cell transformation LCT is a histologic feature that can occur irrespe

4、ctive of clinical stage LCT often but not always corresponds to a more aggressive growth rate requiring systemic therapies MFSS 5 Dutch Criteria for Lymph Nodes was added MFSS 6 through MFSS 12 The algorithm pages were all extensively revised Large cell transformed LCT treatment was added MFSS A 1 of 6 Skin directed therapies Topical carmustine was added as a category 2B Phototherapy was revised PUVA UVA 1 for thicker plaques MFSS A 2 of 6 Systemic therapies For SYST CAT A and SYST CAT B the Cat

5、egories of Preference was applied SYST CAT A Methotrexate dose was changed from 100 mg weekly to 50 mg weekly SYST CAT B other therapies were moved to Useful under certain circumstances Relapsed refractory disease requiring systemic therapy The new list also applies to LCT The previous Category C SYST CAT C were moved to Preferred regimens for LCT Footnotes g i j l m n and p were added MFSS A 3 of 6 Combination therapies were put in alphabetical order Erythrodermic disease Sezary syndrome treatm

6、ent options were added NCCN Guidelines Version 1 2019 Primary Cutaneous Lymphomas Version 1 2019 11 21 18 2018 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Guidelines Index Table of Contents Discussion Printed by Maria Chen on 11 21 2018 9 22 48 PM For personal use only Not approved for distribution Copyright 2018 National Comprehensive Cancer Network Inc

7、All Rights Reserved UPDATES Updates in Version 1 2019 of the NCCN Guidelines for Primary Cutaneous Lymphomas from Version 2 2018 include Principles of Radiation Therapy LYMP A The principles for all three algorithms were combined into one page of Principles and updated as appropriate Supportive Care LYMP C A new section for anti infective prophylaxis was added PCTLD 2 Cutaneous ALCL Workup Essential 7th bullet was revised Bone marrow aspiration and biopsy optional for solitary C ALCL or C ALCL w

8、ithout extracutaneous involvement on imaging 6th bullet a sub bullet was added Biopsy of enlarged lymph nodes or suspected extracutaneous sites if biopsy of skin is not diagnostic Rebiopsy if consult material is nondiagnostic LyP Workup Useful in selected cases 3rd bullet was revised C A P CT with contrast or integrated whole body PET CT not done for typical LyP PCTLD 3 Primary cutaneous ALCL multifocal lesions Primary treatment Brentuximab vedotin was changed from a category 1 to a category 2A

9、recommendation For Other recommended regimens skin directed therapies see MFSS A was added Methotrexate dose was changed from 100 mg weekly to 50 mg weekly Relapsed refractory disease For both primary cutaneous ALCL multifocal lesions and cutaneous ALCL with regional node the 4th bullet was changed from Treat with mycosis fungoides Category C Systemic Therapies SYST CAT C See MFSS A to Treat with Large Cell Transformation Therapies see MFSS A PCTLD 4 Limited lesions asymptomatic primary treatmen

10、t phototherapy was removed MFSS B Supportive Care for MFSS Pruritus Assessment 3rd bullet was revised from Other potential causes for pruritus should be ruled out to For severe or persistent pruritus despite therapeutic response other potential causes for pruritus should be investigated Pruritus Treatment The following bullets were added Co management with a dermatologist with expertise is skin care and CTCL Optimized skin directed and systemic therapy for MF SS Mild unscented soaps for bathing

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