NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Acute Lymphoblastic Leukemia and Survivorship

• FLASCO
• October 5, 2016
• Clinical Practice Updates, News

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) for Acute Lymphoblastic Leukemia. These NCCN Guidelines^® are currently available as Version 2.2016. 

• The Discussion section has been updated to reflect the changes in the algorithm. (MS-1)

*For your reference, the previous update (Version 1.2016) to the NCCN Guidelines for Acute Lymphoblastic Leukemia, published on April 6, 2016, is available at the following link: https://www.nccn.org/professionals/physician_gls/pdf/all.pdf

NCCN has published updates to the NCCN Guidelines for Survivorship. These NCCN Guidelines are currently available as Version 2.2016. 

• A new algorithm providing recommendations for the treatment of “Menopause-Related Symptoms” (SMP-1) was added to the “Late Effects/Long-Term Psychosocial and Physical Problems” section.
• The algorithms were updated for the following sections: Anthracycline-Induced Cardiac Toxicity and Healthy Lifestyles: Physical Activity, Nutrition, Supplements
• The Discussion text has been updated to reflect the changes in the algorithm. (MS-1)
• Survivorship Assessment (Patient Version) (SURV-A 1 of 2)
  • “Menopause” was added to the list of “Survivorship Concerns” with the following questions:
    • Have you been bothered by hot flashes/night sweats? Yes/No
    • Have you been bothered by other menopause-related symptoms (ex, vaginal dryness, incontinence)? Yes/No
  • Anthracycline-Induced Cardiac Toxicity
    • Principles of Anthracycline-Induced Cardiac Toxicity (SCARDIO-1)
      • Second bullet revised: “…Data suggest that signs of cardiac dysfunction can be seen prior to the development of If detected…”
      • Fourth bullet revised: “Having a history of anthracycline exposure plus additional cardiovascular risk factors increases the risk of developing cardiomyopathy and heart failure…”
    • Initial Clinical Assessment for Patients Who Have Received Previous Anthracycline Therapy (SCARDIO-2)
      • Recommendations under the bullet “Evaluate for presence of heart failure risk factors” were revised:
        • “High cumulative anthracycline dose (ie, cumulative doxorubicin dose at or higher than 300 mg/m2 or equivalent)”
        • “Low-normal LVEF (50%–54%) at baseline”
        • Bullet removed: “Review other cardiovascular risk factors.”
      • Second column; second bullet revised: “Consider two-dimensional echocardiogram (ECHO) with Doppler flow study for survivors with one or more risk factors within 1 year after completion of anthracycline therapy.”
      • Footnote d revised: ” Patients with symptoms of heart failure should receive undergo an echocardiogram.” The deleted information in footnote d was included in the “Evaluate for presence of heart failure risk factors” section noted above.
    • Healthy Lifestyles: Physical Activity, Nutrition, Supplements
      • General Principles of Healthy Lifestyles (HL-1)
        • Recommendations under “For a healthy lifestyle, all survivors should be encouraged to:” were revised as follows:
          • “Weigh oneself at least weekly to monitor weight gain/loss.”
          • “Engage in general physical activity daily (eg, taking the stairs, parking in the back of parking lot).”
          • “Avoid prolonged sedentary behavior (eg, sitting for long periods).”
          • “Avoid tanning beds” was added under “Practice sun safety.”
        • Fourth bullet revised: “Routine use of dietary supplements is not recommended for the purposes of cancer control. Nutrients should be obtained from food sources rather than relying on dietary supplements.“
      • Physical Activity
        • The headers “Low risk,” “Moderate Risk,” and “High Risk” were removed for the three separate pathways. (SPA-3)
        • In the first pathway, “High baseline level of physical activity” removed. (SPA-3)
        • Footnote d revised: “Lymphedema is not a contraindication for physical activity. Moderate activity is safe for most survivors. Lymphedema patients…” (SPA-3)
        • Considerations for Specific Populations (SPA-A)
          • Recommendations under Peripheral Neuropathy were revised:
            • “Stability, balance, and gait should be assessed before engaging in exercise; consider balance training as indicated.”
            • New sub-bullet added: “Resistance training recommendations:” with “Consider resistance training machines” added.
          • Recommendations under “Poor Bone Health” were revised:
            • “Survivors with osteoporosis should have fracture risk and/or bone density assessed before initiation of exercise program as clinically indicated”
            • New bullet added: “Consider balance assessment and training as indicated for patients at risk for falls.”
          • Strategies to Increase Physical Activity (SPA-B)
            • New bullets added: “Consider use of pedometer or wearable fitness tracker to monitor activity goals (eg, obtain 10,000 steps per day)” and “Encourage social support (exercise buddy, group).”
          • Nutrition and Weight Management
            • General Principles of Nutrition (SNWM-1)
              • Footnote c revised to include approximate USDA food plate volumes.
            • General Principles of Weight Management (SNWM-2)
              • Text reorganized and sub-bullets under “Principles of Weight Loss” revised:
                • “Limit foods that are high in calories, particularly those that provide relatively few nutrients such as sugar sweetened beverages and food with high amounts of fats and sugars (ie, many desserts, fried foods, fast foods).”
                • “Substitute high-calorie foods with low-calorie, nutrient-dense foods…”
                • New bullets added: “Monitor weight daily” and “Track diet, calories, and physical activity routines.“

*For your reference, the previous update (Version 1.2016) to the NCCN Guidelines for Survivorship, published on March 30, 2016, is available at the following link: https://www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf

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

To access the NCCN Biomarkers Compendium^®, please visit NCCN.org/biomarkers.

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

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

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