SIE-SIES-GITMO guidelines for the management of adult peripheral T- and NK-cell lymphomas, excluding mature T-cell leukaemias.
BACKGROUND
In order to promote widespread adoption of appropriate clinical practice, the Italian Society of Hematology (SIE), and the affiliate societies SIES (Italian Society of Experimental Hematology) and GITMO (Italian Group for Bone Marrow Transplantation) established to produce guidelines in the most relevant hematological areas. In this article, we report the recommendations for management of T/NK-cell lymphomas, excluding mature T-cell leukaemias.


METHODS
By using the Grades of Recommendations, Assessment, Development and Evaluation (GRADE) system, we produced evidence-based recommendations for the key clinical questions that needed to be addressed by a critical appraisal of evidence. The consensus methodology was applied to evidence-orphan issues.


RESULTS
Six courses of cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) or cyclophosphamide, doxorubicin, vincristine, etoposide and prednisone (CHOEP) chemotherapy were recommended for first-line therapy of patients with nodal, intestinal or hepatosplenic T-cell lymphomas (evidence: low; recommendation: do, weak). Except for ALK+ anaplastic large-cell lymphoma and elderly unfit patients, consolidation with high-dose chemotherapy was recommended (evidence: low; recommendation: do, weak). 50 Gy radiotherapy was the recommended first-line therapy for localized extranodal T/NK-cell lymphoma nasal type (evidence: low; recommendation: do, strong), while l-asparaginase-containing chemotherapy regimens were recommended for patients with systemic disease (evidence: very low; recommendation: do, strong).


CONCLUSIONS
In adult T/NK-cell lymphomas, GRADE methodology was applicable to a limited number of key therapeutic issues. For the remaining key issues, due to lack of appraisable evidence, recommendations was based on consensus methodology.
Division of Hematology and Bone Marrow Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milano, Milan.
P
P
Corradini
Unit of Hematology, Hospital C. Massaia, Asti.
M
M
Marchetti
Biotechnology Research Area, Center for the Study of Myelofibrosis, IRCCS Policlinico San Matteo Foundation, Pavia. Electronic address: barosig@smatteo.pv.it.
G
G
Barosi
Unit of Hematology, Ospedale Civile di Bolzano, Bolzano.
A
A
Billio
Department of Hematology and BMT Unit, Azienda Ospedaliera S. Croce e Carle, Cuneo.
A
A
Gallamini
Department of Experimental, Diagnostic and Specialty Medicine, Bologna University School of Medicine, Bologna.
S
S
Pileri
Department of Dermatology, Department of Specialised, Experimental and Diagnostic Medicine, University of Bologna, Bologna.
N
N
Pimpinelli
Department of Hematology, Spedali Civili, Brescia.
G
G
Rossi
Institute of Hematology 'Seragnoli'.
P L
PL
Zinzani
University of Bologna, Bologna, Italy.
S
S
Tura
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005047:Etoposide / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000532:radiotherapy*; D016399:Lymphoma, T-Cell / Q000188:drug therapy* / Q000532:radiotherapy*; D017410:Practice Guidelines as Topic; D011239:Prednisolone / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D014750:Vincristine / Q000627:therapeutic use
D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone; D011241:Prednisone
T/NK-cell lymphoma; clinical practice guidelines; hematopoietic stem cell transplantation