Contributions
Abstract: EP779
Type: E-Poster Presentation
Session title: Hodgkin lymphoma - Clinical
Background
The German guideline for diagnosis, treatment and follow-up of adult patients with Hodgkin Lymphoma is an evidence-based guideline that is updated according to the living guideline principle. The guideline was first published in February 2013, and updated in June 2018. The second update (presented here) was published in October 2020; a third update will follow in 2021.
Aims
To keep recommendations on diagnosis, treatment and follow-up up-to-date and in line with new clinical research evidence.
Methods
The guideline was developed and updated jointly by a number of different national clinical and methodological experts. In March 2019, the systematic literature search was updated and conducted in MEDLINE, Embase und CENTRAL. After independent screening by methodological experts, the newly identified evidence was presented to the clinical working groups of the guideline. Subsequently, data was extracted from all studies that contributed to the clinical research questions of the guideline, and evaluated according to GRADE principles. Based on these results, new recommendations were derived and existing recommendations updated. All unmodified, updated and new recommendations were revised, discussed and voted on in a formal consensus process by a clinical expert panel from the participating professional societies. The guideline was funded by the German Cancer Aid (funding number 113332).
Results
The updated guideline entails 168 recommendations in total; thereof 29 updated and 13 new recommendations. The new recommendations concern patients in the intermediate stages, pregnant patients and rehabilitation measures. In patients with intermediate risk, a PET/CT-guided radiotherapy approach can be applied, if treated with two cycles of BEACOPPescalated followed by two cycles of ABVD (“2+2”). Thus, after chemotherapy with “2+2”, an interim PET/CT scan shall be performed. Only those patients with a positive (Deauville-Score ≥4) interim PET/CT scan-result shall receive consolidation radiotherapy. For pregnant patients who are diagnosed in their first trimester of pregnancy, start of chemotherapy should be delayed until the beginning of the second trimester, if justifiable. For pregnant patients who are diagnosed in their second or third trimester, chemotherapy can be administered. Whether or not awaiting delivery is an option, shall be decided individually. If chemotherapy is administered, it should be stopped at the latest between the 35th and 37th week of pregnancy, or two weeks before delivery. Radiotherapy should be avoided during pregnancy. Patients who receive chemotherapy during pregnancy, can receive consolidation radiotherapy after delivery, but there should not be more than 12 weeks between completion of chemotherapy and start of radiation therapy. Prematurity, particularly before the 32nd week of pregnancy, should be avoided. Furthermore, pregnant patients shall undergo close obstetric monitoring, in addition to standard examinations. After therapy, all patients shall be offered medical rehabilitation to enable social reintegration and participation in work life.
Conclusion
Living guideline in the sense of a regular, standardized process in a defined time frame provides current recommendations for the treatment of different patient groups, which should be translated into daily clinical practice. As far as possible, guideline implementation will be monitored by recommendation-based quality indicators measured by cancer registries or certification systems.
Keyword(s): Hodgkin's lymphoma, Treatment
Abstract: EP779
Type: E-Poster Presentation
Session title: Hodgkin lymphoma - Clinical
Background
The German guideline for diagnosis, treatment and follow-up of adult patients with Hodgkin Lymphoma is an evidence-based guideline that is updated according to the living guideline principle. The guideline was first published in February 2013, and updated in June 2018. The second update (presented here) was published in October 2020; a third update will follow in 2021.
Aims
To keep recommendations on diagnosis, treatment and follow-up up-to-date and in line with new clinical research evidence.
Methods
The guideline was developed and updated jointly by a number of different national clinical and methodological experts. In March 2019, the systematic literature search was updated and conducted in MEDLINE, Embase und CENTRAL. After independent screening by methodological experts, the newly identified evidence was presented to the clinical working groups of the guideline. Subsequently, data was extracted from all studies that contributed to the clinical research questions of the guideline, and evaluated according to GRADE principles. Based on these results, new recommendations were derived and existing recommendations updated. All unmodified, updated and new recommendations were revised, discussed and voted on in a formal consensus process by a clinical expert panel from the participating professional societies. The guideline was funded by the German Cancer Aid (funding number 113332).
Results
The updated guideline entails 168 recommendations in total; thereof 29 updated and 13 new recommendations. The new recommendations concern patients in the intermediate stages, pregnant patients and rehabilitation measures. In patients with intermediate risk, a PET/CT-guided radiotherapy approach can be applied, if treated with two cycles of BEACOPPescalated followed by two cycles of ABVD (“2+2”). Thus, after chemotherapy with “2+2”, an interim PET/CT scan shall be performed. Only those patients with a positive (Deauville-Score ≥4) interim PET/CT scan-result shall receive consolidation radiotherapy. For pregnant patients who are diagnosed in their first trimester of pregnancy, start of chemotherapy should be delayed until the beginning of the second trimester, if justifiable. For pregnant patients who are diagnosed in their second or third trimester, chemotherapy can be administered. Whether or not awaiting delivery is an option, shall be decided individually. If chemotherapy is administered, it should be stopped at the latest between the 35th and 37th week of pregnancy, or two weeks before delivery. Radiotherapy should be avoided during pregnancy. Patients who receive chemotherapy during pregnancy, can receive consolidation radiotherapy after delivery, but there should not be more than 12 weeks between completion of chemotherapy and start of radiation therapy. Prematurity, particularly before the 32nd week of pregnancy, should be avoided. Furthermore, pregnant patients shall undergo close obstetric monitoring, in addition to standard examinations. After therapy, all patients shall be offered medical rehabilitation to enable social reintegration and participation in work life.
Conclusion
Living guideline in the sense of a regular, standardized process in a defined time frame provides current recommendations for the treatment of different patient groups, which should be translated into daily clinical practice. As far as possible, guideline implementation will be monitored by recommendation-based quality indicators measured by cancer registries or certification systems.
Keyword(s): Hodgkin's lymphoma, Treatment