The National Comprehensive Cancer Network (NCCN) released its first guidelines for myeloproliferative neoplasms (MPNs), outlining diagnosis, treatment, and supportive care strategies for myelofibrosis (MF). Comprehensive recommendations for the management of essential thrombocytopenia and polycythemia vera will be included in subsequent versions of the MPN guidelines, which are projected to be released in early 2017.
"Treatment of MPNs in the United States remains heterogeneous, and it has largely been driven by review articles, individual opinion pieces, and, more recently, phase III clinical trial data," Ruben A. Mesa, MD, professor of medicine at the Mayo Clinic Cancer Center in Phoenix, Arizona, and chair of the NCCN Guidelines Panel for MPN, told ASH Clinical News.
Dr. Mesa outlined the goals for the new guidelines including helping doctors who may not have experience managing these disorders. "We are hopeful [the guidelines] will provide a service for clinicians treating MPNs, particularly those for whom managing patients with MPNs is a small part of their practice.
Next, we hope these new guidelines highlight areas that continue to require clinical investigation, and, third, that they will act as a standard of care to assist with coverage decisions by both insurance providers and government payers."
The guidelines stress the importance of using available scoring systems (the International Prognostic Scoring System or the Dynamic International Prognostic Scoring System) to make an accurate diagnosis and prognosis throughout the course of the disease.
The guidelines support ruxolitinib for symptomatic patients at each risk level (low-risk, intermediate-1, intermediate-2, or high-risk) and in all patients who have intermediate-2 or high-risk disease. The guidelines also specify that allogeneic hematopoietic cell transplantation is an option for patients with intermediate-1, intermediate-2, or high-risk disease, but the guidelines caution that "the selection of patients for allogeneic hematopoietic cell transplantation should be based on age, performance status, major comorbid conditions, psychosocial status, patient preference, and availability of caregiver."
The guidelines also highlight areas in which more evidence to guide treatment is needed. "Progressive MF to either an accelerated or overt blast phase continues to be a very difficult clinical scenario to treat and an important area of investigation and need for clinical trials," said Dr. Mesa.
Read the guidelines at nccn.org/professionals/physician_gls/pdf/mpn.pdf.
Source: National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology: Myeloproliferative Neoplasms. Version 1.2017, September 26, 2016.