NCCN has published updates to the NCCN Guidelines® and NCCN Compendium® for Chronic Lymphocytic Leukemia (CLL)/Small Lymphocytic Lymphoma (SLL).

·         The NCCN Guidelines for CLL/SLL (previously included as part of NCCN Guidelines for Non-Hodgkin’s Lymphomas) have been published as separate NCCN Guidelines.

·         General

o    Ann Arbor staging was clarified as “Lugano Modification of Ann Arbor Staging System.”

·         Workup (CSLL-2)

o    Under essential workup, the 8th bullet was revised, “Pregnancy testing in women of child-bearing age (if chemotherapy or RT planned).”

o    Under useful under certain circumstances, the 9th bullet was revised, “PET/CT scan is not useful in CLL but can assist in directing nodal biopsy if Richter’s transformation is suspected.”

·         For SLL/Localized (Lugano Stage I), a dose was added to locoregional RT, “24–30 Gy.”  (CSLL-3)

·         For CLL/SLL without del(17p)/TP53 mutation, the age criteria were revised. (CSLL-5, CSLL-D 1 of 5, CSLL-D 2 of 5)

o    Age ≥65 y and younger patients with significant comorbidities

o    Age ≥65 ywithout significant comorbidities

·         Supportive Care (CSLL-C)

o    The supportive care section for patients with CLL/SLL was revised and combined with appropriate information from the “Supportive Care for NHL” section in the NCCN Guidelines for Non-Hodgkin’s Lymphomas.

·         Suggested treatment regimens

o    First-line therapy for CLL/SLL without del(17p)/TP53 mutation (CSLL-D 1 of 5)

§  For frail patients with significant comorbidity (not able to tolerate purine analogs)

·         Rituximab was changed from a category 2B to a category 3 recommendation

·         Chlorambucil was changed from a category 2B to a category 3 recommendation.

·         Pulse corticosteroids was removed.

§  For age ≥65 y and younger patients with significant comorbidities

·         Chlorambucil was changed from a category 2B to a category 3 recommendation.

·         Fludarabine ± rituximab was removed.

§  For age <65 y without significant comorbidities

·         Ibrutinib was added with a category 2A recommendation.

o    Relapsed/refractory therapy for CLL/SLL without del(17p)/TP53 mutation (CSLL-D 2 of 5)

§  For both frail patients with significant comorbidity or age ≥65 y and younger patients with significant comorbidities

·         Venetoclax was added with a category 2A designation.

·         Ibrutinib, bendamustine, rituximab was added with a category 3 designation.

·         Idelalisib, bendamustine, rituximab was added with a category 3 designation.

§  For age <65 y without significant comorbidities

·         Venetoclax was added with a category 2A designation.

·         FC + ofatumumab was added with a category 2A designation.

·         Ibrutinib, bendamustine, rituximab was added with a category 2B designation.

·         Idelalisib, bendamustine, rituximab was added with a category 2B designation.

·         Fludarabine + alemtuzumab was removed.

o    First-line therapy for CLL/SLL with del(17p)/TP53 mutation (CSLL-D 3 of 5)

§  Obinutuzumab + chlorambucil was changed from a category 2A to a category 3 recommendation.

§  FCR (Fludarabine, cyclophosphamide, rituximab) and FR (fludarabine, rituximab) were removed.

o    First-line therapy for CLL/SLL with del(17p)/TP53 mutation (CSLL-D 3 of 5)

§  Idelalisib + rituximab was changed from a category 1 to a category 2A recommendation

·         Special Considerations for the Use of Small-Molecule Inhibitors (Ibrutinib and Idelalisib) (CSLL-F 1 of 2)

o    For ibrutinib, the 6th bullet was added, “In CLL, at time of disease progression on ibrutinib, transition to next therapy as soon as possible upon stopping ibrutinib since progression may accelerate when ibrutinib is stopped. Treatment-free interval should be as short as possible.”

o    For ibrutinib, the 6th bullet was added, “In CLL, at time of disease progression on ibrutinib, transition to next therapy as soon as possible upon stopping ibrutinib since progression may accelerate when ibrutinib is stopped. Treatment-free interval should be as short as possible.”

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the 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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