Modification and Implementation of NCCN Guidelines™ on Lymphomas in the Middle East and North Africa Region

Abstract

In the Middle East and North Africa (MENA) region, cancer has many epidemiologic and clinical features that are different from those in the rest of the world. Additionally, the region has a relatively young population and large disparities in the availability of resources at diagnostic and treatment levels. A critical need exists for regional guidelines on cancer care, including those for lymphoid malignancies. A panel of lymphoma experts from MENA reviewed the 2009 version of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) on Non-Hodgkin's Lymphoma and Hodgkin Lymphoma and suggested modifications for the region that were discussed with the United States NCCN Lymphoma Panels. This article presents the consensus recommendations.

Assessing the Quality of Clinical Practice Guidelines in the Middle East and North Africa (MENA) Region: A Systematic Review

“…The description of the general characteristics of the assessed guidelines including the date and origin is illustrated in ( Table 2). Among the 61 selected CPGs, 34 guidelines were from Saudi Arabia, 12 were from multiple MENA countries, [65][66][67][68][69][70][71][72][73][74][75][76] eight were from Lebanon, [77][78][79][80][81][82][83][84] three were from Bahrain, [85][86][87] and one was from each of the following countries: Iran, 88 Egypt, 89 and Jordan. 90…”

Adaptation of NCCN Guidelines to the Middle East and North Africa Region

“…• Completing the adaptation and publication of NCCN/MENA Guidelines in 6 disease sites (non-small cell lung, breast, colon, hepatobiliary, and prostate cancers; and lymphoma) in 2010, published as a supplement to JNCCN • Raising awareness about the need for cross-border collaborative activities to answer important questions regarding cancer epidemiology and disease management, which resulted in some regional projects that came to fruition 3 • Fostering intellectual and educational interaction between regional experts and those in the United States. The regional experts learned about the function and process of NCCN as an organization with monumental experience in the field with its own culture and style, whereas the NCCN experts had the opportunity to see their guidelines through the eyes of external reviewers (the regional experts) who reviewed these guidelines with a different perspective and examined them in close detail, which sometimes resulted in NCCN adopting some of the new ideas generated from the region, such as the addition of treatment of some types of lymphomas (T-cell lymphomas) 4 Expectedly, challenges exist for such projects because of the heterogeneity in socioeconomic status and available resources among countries in the region. Therefore, it was critical to agree to keep the guidelines at the highest possible standards and avoid defaulting to the creation of "convenience" guidelines.…”

International Adaptation and Use of NCCN Guidelines

“…The modifications were then reviewed, edited, and approved by the NCCN Non-Hodgkin's Lymphomas Panel in the United States, and the regional version of the NCCN Guidelines was published in JNCCN-Journal of the National Comprehensive Cancer Network. 1 Modifications were based on several factors: available data and research results, difference in pharmacogenomics, evidence-based regional practice, and a several hundred million people, with major differences in terms of available resources, both economically and medically," declared Dr. Bazarbachi. However, Dr. Zelenetz noted that there are legitimate alternative ways to adapt guidelines to recognize the disparity in resources (such as rituximab for large cell lymphoma).…”

“…Consequently, in 2010, based on the consensus recommendations by the panel of lymphoma experts, MENA developed a new set of guidelines for the management of patients with ATLL, which were adapted into the NCCN Guidelines for Non-Hodgkin's Lymphomas in 2011. 1 "We took the lead from MENA and adapted their guideline to fill the gap that we had in the NCCN Guidelines regarding ATLL," stated Dr. Zelenetz. "Guidelines for rare diseases are almost more important than guidelines for common diseases," he added.…”