Blood cancers

Haematologists publish Australia’s first classical Hodgkin lymphoma guidelines

Australia’s first classical Hodgkin lymphoma guidelines have been drafted, giving clinicians concise, localised and up-to-date information on staging and treating newly-diagnosed patients, a Queensland-based haematologist says.

The Australasian Lymphoma Alliance-backed practice statement features recommendations on diagnostic testing and risk-stratification, PET-adapted therapy and late effects surveillance, based on the latest available evidence, according to Gold Coast University Hospital haematologist Associate Professor Tara Cochrane, who helped develop the guidelines.

When asked about key recommendations, Associate Professor Cochrane highlighted their diagnostic table, suggesting that it is often unnecessary to take a bone marrow biopsy as part of the work-up if a PET-CT is conducted to stage the patient.

For most patients, a bone marrow biopsy is actually not necessary, which is important, particularly for young patients who can avoid an invasive procedure,” Associate Professor Cochrane told the limbic.

She further emphasised the importance of accommodating patients’ values and priorities, noting that this is now possible with the range of PET-adapted approaches available.

Ideally, treatment decisions should be made with patients and a multidisciplinary team, including haematology, radiation oncology, nuclear medicine, radiology and pathology specialists, the guidelines suggested.

Previously, Australian haematologists relied on the ESMO and National Comprehensive Cancer Network (NCCN) guidelines for treatment recommendations, which are excellent but ageing, long and/or not always applicable to the Australian context, Associate Professor Cochrane said.

Since the ESMO guidelines came out three years ago, there’s been a number of studies assessing PET-adapted therapy in newly diagnosed Hodgkin lymphoma, Associate Professor Cochrane said.

Because of the time they were published, they haven’t really incorporated that latest data into them, she noted.

The NCCN guidelines did get an update in April this year, however, with international variation in medication availability, they are not necessarily applicable in the Australian environment, she said.

They NCCN guidelines are also extremely long and actually quite cumbersome to navigate, and so our concise document is hopefully easy to digest — containing all the pertinent points relating to management of frontline classical Hodgkin lymphoma”.

The “Assessment and Management of Newly Diagnosed Classical Hodgkin Lymphoma: A Consensus Practice Statement from the Australasian Lymphoma Alliance” was drafted by 13 haematologists and radiation oncologists in Australia, all of whom have special interest in lymphoma, Associate Professor Cochrane said.

They were reviewed by the broader membership of the Australasian Lymphoma Alliance, prior to their submission to the Internal Medicine Journal.

Associate Professor Cochrane hopes these guidelines will become Australian haematologists’ primary reference when treating newly-diagnosed patients with classical Hodgkin lymphoma.

The guidelines are available in the Internal Medicine Journal.

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