T. Jakob1, M. Follmann2, P. Borchmann3, C. Baues4, S. Sasse3, P. J. Bröckelmann3, S. Kreissl3, D. A. Eichenauer3, B. von Tresckow3, C. Bürkle3, A. Engert3, N. Skoetz1
1 Evidence-based Oncology, Department I of Internal Medicine, University Hospital of Cologne, Germany, 2 German Guideline Program in Oncology, Berlin, Germany, 3 German Hodgkin Study Group, Department I of Internal Medicine, University Hospital of Cologne, Germany, 4 Department of Radiooncology and Cyberknife Center, University Hospital of Cologne, Germany
Introduction: Stage-adapted therapy of Hodgkin lymphoma patients allows cure in most cases, thus, effective treatment with focus on therapy-associated morbidity and mortality is of high relevance. The German guideline on diagnosis, therapy and follow-up of adult HL patients was first published in February 2013. A revision was performed to update recommendations on basis of scientific evidence and expert consensus.
Methods: A systematic literature search was conducted in CENTRAL and MEDLINE. The literature was classified, evaluated for quality criteria using the GRADEpro software and summarized in evidence tables. The close collaboration between clinical experts in multidisciplinary working groups and the German Hodgkin Study Group as well as the methodological experts from the Evidence-based Oncology ensured high quality in the guideline development process. The guideline update was funded by the German Guideline Program in Oncology (funding no 111778).
Results: The updated guideline now comprises 176 recommendations. Of these 19 have entirely new content, 77 recommendations were updated and 80 remained unchanged after being checked for validity. Most significant adjustments were made for recommendations regarding the use of positron emission tomography and computed tomography (PET/CT) at staging and for patients with advanced HL to adapt therapy after two cycles of BEACOPPesc, radiotherapy being performed with the involved-site technique, and consolidation treatment and use of novel drugs in patients with relapsed or refractory disease. The final version of the guideline was consented through experts in the field and patient representatives in a formal consensus process (consensus conferences in presence and online, and DELPHI process).
The guideline update is going to be published in June 2018. To keep it even more up to date in the future, an approach for a Living Guideline was applied for and granted. The process of yearly updates will start in autumn 2018.
Conclusion: This update of the guideline addresses current and relevant changes in diagnosis, treatment and follow-up of adult HL patients, and will help clinicians nationwide to implement these aspects into daily clinical routine.