Weekly Guideline Update for 4/9/2025

National Cancer Comprehensive Network (NCCN)

The NCCN guidelines can be found at www.nccn.org.

Chronic Lymphocytic Leukemia/ Small Lymphocytic Lymphoma Version 3.2025

In this latest update, the NCCN has modified the discussion section to better align with algorithm changes.

Esophageal and Esophagogastric Junction Cancers Version 2.2025

The NCCN has clarified their category 1 recommendation concerning their preferred regimen of fluoropyrimidine, oxaliplatin or cisplatin, and nivolumab for PD-L1 CPS ≥1 squamous cell carcinoma.

Gastric Cancer Version 2.2025

The NCCN has updated the discussion section to better align with algorithm changes.

Myeloid/Lymphoid Neoplasms with Eosinophilia and Tyrosine Kinase Gene Fusions Version 2.2025

Like Gastric Cancer, the NCCN has also updated the discussion section of the Myeloid/Lymphoid Neoplasms guidelines.

Pediatric Aggressive Mature B-Cell Lymphomas Version 1.2025

The latest guidelines are based on histologic subtype, staging, LDH levels, and CNS and marrow involvement. New updates include the addition of a dedicated node for post-transplant lymphoproliferative disorders after solid organ transplant, and a broader integration of immunophenotyping and molecular diagnostics, including MYC IHC, Kappa/Lambda ISH, and FISH for BCL2/BCL6 in adolescent and young adult populations. The NCCN notes that pediatric high-grade B-cell lymphoma should be treated using the same regimen as pediatric BL. Dose-adjusted EPOCH-R remains the preferred frontline regimen, with updated guidance on biosimilar substitution and supportive care. Avoidance of RT is strongly preferred in pediatric primary mediastinal large B-cell lymphoma, with advanced RT techniques recommended when necessary.

US Preventive Services Task Force (USPSTF)

The USPSTF gives a “B” recommendation to provide interventions and referrals to support breastfeeding. These services can be provided both during pregnancy and after birth.

College of Neurological Surgeons (CNS)

The updated CNS guidelines now endorse laser interstitial thermal therapy (LITT) as a viable alternative to open craniotomy for adults with metastatic brain tumors exhibiting radiographic progression post-stereotactic radiosurgery (SRS). Backed by Level 1 evidence from the ongoing REMASTer trial, LITT is also recommended over medical management alone for patients with radiation necrosis.

American College of Chest Physicians (CHEST)

CHEST has released its first dedicated guideline on red blood cell transfusion in critically ill adults (excluding neurologic injury or trauma), advocating a restrictive transfusion strategy (Hb 7–8 g/dL) across most clinical contexts. This includes patients with acute GI bleeding and perioperative cardiac surgery (conditional). It does exclude those with hemorrhagic instability. The guideline also advises against restrictive thresholds in acute coronary syndrome and does not support permissive transfusion (Hb ≥8.5–10 g/dL) in septic shock.

American Academy of Ophthalmology (AAO)

Note: The following summary is based solely upon the published abstract of the AAO guidelines because the AAO places the full guideline behind a paywall.

AAO has issued its first consensus guidelines on autoimmune retinopathy (AIR). The guidelines include a structured diagnostic framework categorizing patients as probable, possible, or unlikely AIR. This classification includes six key clinical and imaging features, including outer retinal optical coherence tomography (OCT) abnormalities, full-field ERG changes, and positive anti-retinal antibodies. The guidelines emphasize distinguishing AIR from mimicking conditions through features such as the absence of significant intraocular inflammation and typical patterns on fundus autofluorescence and OCT.

European Society for Pediatric Infectious Diseases (ESPID)

ESPID has published for the diagnosis and management of complicated urinary tract infections (cUTI) in children. The guidelines define cUTI as UTIs in children at increased risk of treatment failure due to specific risk profiles, including significant urological abnormalities, multiple recurrences, severe clinical presentation, nonurological comorbidities, or neonatal status. ESPID endorses individualized approaches to diagnosis, antibiotic choice, and route of administration, emphasizing that most stable children can start with oral antibiotics. Empirical therapy should be guided by local resistance patterns and previous cultures, with early reassessment and de-escalation when appropriate. The guidelines also address when to initiate prophylaxis and advanced imaging, while discouraging universal prophylaxis due to limited benefit and potential for resistance.

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