{"entity":{"id":"dlbcl","kind":"cancer","name":"Diffuse large B-cell lymphoma","aka":[],"tldr":"Diffuse large B-cell lymphoma (DLBCL) is an aggressive but curable lymphoma. CAR-T cures about 40% of relapsed patients, and off-the-shelf bispecifics are now approved.","summary":"Diffuse large B-cell lymphoma is the most common aggressive lymphoma, about 30% of all non-Hodgkin lymphoma, with a median age around 65. It is curable: R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, prednisone) cures roughly 60% of patients, more with low IPI and fewer with high-risk features (IPI 3-5, double-hit MYC/BCL2 rearrangement, activated B-cell origin, TP53 loss). Staging uses PET-CT and the Lugano classification; biology is read from cell of origin and FISH for MYC, BCL2 and BCL6, with genetic classifiers (LymphGen) and ctDNA emerging.\n\nFrontline therapy stood still for twenty years until POLARIX (2022) showed that replacing vincristine with the CD79b ADC polatuzumab vedotin improves progression-free survival (5-year 64.9% vs 59.1%), and frontMIND (Lancet 2026) showed tafasitamab plus lenalidomide added to R-CHOP improves PFS in IPI 3-5 disease (HR 0.75); epcoritamab plus R-CHOP (EPCORE DLBCL-2) and golcadomide plus R-CHOP (GOLSEEK-1) follow. For the 30-40% who relapse, the sequence has been rebuilt around T-cell redirection: CD19 CAR-T (axi-cel, liso-cel) beats salvage chemotherapy and transplant for relapse within a year (ZUMA-7 with an overall survival benefit; TRANSFORM), while transplant remains for later chemosensitive relapse. Off-the-shelf CD20×CD3 bispecifics (glofitamab, epcoritamab, mosunetuzumab, odronextamab) give complete remissions in about 40% of heavily pretreated patients, and chemotherapy-free doublets such as mosunetuzumab-polatuzumab (SUNMO) beat salvage chemotherapy. CD19 ADC (loncastuximab), tafasitamab-lenalidomide, and the ROR1 ADC zilovertamab vedotin fill later lines.\n\nThe open questions are regulatory as much as scientific. EPCORE DLBCL-1 (2026) improved PFS but not overall survival against chemotherapy; STARGLO's survival benefit was rejected by the FDA because the trial was mostly enrolled in Asia. Nobody has compared bispecifics with CAR-T head to head. ctDNA (PhasED-seq) predicts cure better than PET and is the obvious tool for response-adapted frontline therapy. Primary refractory disease, CNS relapse, older and frail patients, and access to CAR-T outside major centres remain the hard problems.","asOf":"2026-09-07","wikipedia":"https://en.wikipedia.org/wiki/Diffuse_large_B-cell_lymphoma","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Diffuse_large_B-cell_lymphoma"},{"label":"Lymphoma Action: helpline services","url":"https://lymphoma-action.org.uk/information-and-support/support-you/helpline-services"},{"label":"Lymphoma Action: questions to ask your medical team about lymphoma","url":"https://lymphoma-action.org.uk/information-and-support/tests-scans-and-lymphoma-staging/questions-ask-your-medical-team-about-lymphoma"},{"label":"Lymphoma Action: follow-up after lymphoma treatment","url":"https://lymphoma-action.org.uk/information-and-support/living-and-beyond-lymphoma/follow-after-lymphoma-treatment"},{"label":"Lymphoma Action: infections, risk and prevention","url":"https://lymphoma-action.org.uk/information-and-support/side-effects-lymphoma-and-treatment/infections-risk-and-prevention"},{"label":"Lymphoma Action: neutropenia (low neutrophils)","url":"https://lymphoma-action.org.uk/information-and-support/side-effects-lymphoma-and-treatment/neutropenia-low-neutrophils"},{"label":"Lymphoma Action: cancer-related fatigue","url":"https://lymphoma-action.org.uk/information-and-support/side-effects-lymphoma-and-treatment/cancer-related-fatigue"},{"label":"Lymphoma Action: lymphoma, work and you","url":"https://lymphoma-action.org.uk/information-and-support/living-and-beyond-lymphoma/day-day-living/lymphoma-work-and-you"},{"label":"Maggie's: support and information","url":"https://www.maggies.org/support-and-information/"},{"label":"Lymphoma Action: diffuse large B-cell lymphoma","url":"https://lymphoma-action.org.uk/information-and-support/types-lymphoma/non-hodgkin-lymphoma/diffuse-large-b-cell-lymphoma"},{"label":"Lymphoma Action: CAR-T cell therapy","url":"https://lymphoma-action.org.uk/information-and-support/lymphoma-treatment/car-t-cell-therapy"},{"label":"Lymphoma Action: autologous (your own) stem cell transplant","url":"https://lymphoma-action.org.uk/information-and-support/lymphoma-treatment/stem-cell-transplants/self-autologous-stem-cell"},{"label":"Lymphoma Action: when lymphoma comes back, or does not respond","url":"https://lymphoma-action.org.uk/information-and-support/living-and-beyond-lymphoma/lymphoma-comes-back-relapses-or-doesnt-respond"},{"label":"Lymphoma Action: CT and PET/CT scans","url":"https://lymphoma-action.org.uk/information-and-support/tests-scans-and-lymphoma-staging/ct-and-petct-scan"},{"label":"Thompson et al., utility of routine post-therapy surveillance imaging in diffuse large B-cell lymphoma, Journal of Clinical Oncology 2014","url":"https://doi.org/10.1200/JCO.2014.55.7561"},{"label":"NHS: non-Hodgkin lymphoma, treatment","url":"https://www.nhs.uk/conditions/non-hodgkin-lymphoma/treatment/"},{"label":"Macmillan: non-Hodgkin lymphoma","url":"https://www.macmillan.org.uk/cancer-information-and-support/lymphoma/non-hodgkin-lymphoma"}],"tags":["heme","spike"],"related":["car-t-before-transplant-lbcl","bispecific-plus-adc-lymphoma","lymphoma-research-foundation","follicular-lymphoma","primary-mediastinal-b-cell-lymphoma","burkitt-lymphoma","mantle-cell-lymphoma","primary-cns-lymphoma","peripheral-t-cell-lymphoma","double-hit-rearrangement","myc-bcl2-double-expressor","bcl2-rearrangement","myd88-l265p","cd79b-itam-mutation","ezh2-y646-mutation","ig-tcr-clonality","lymphoma-roadmap","lymphoma-ev-genetic-subtype-directed-first-line","lymphoma-ev-ctdna-instead-of-the-interim-scan","lymphoma-ev-manufacturing-time-as-a-trial-endpoint"],"cancers":[],"sections":[],"technologies":["car-t","t-cell-engager","adc","monoclonal-antibody","ctdna-lymphoma-monitoring","autologous-stem-cell-transplant","protac-degrader","fdg-pet","bispecific-antibody","allogeneic-hsct","pet-ct","imrt-igrt","g-csf-growth-factors","palliative-radiotherapy","palliative-care","fertility-preservation","psycho-oncology","peer-support-groups","survivorship-care-plan","financial-navigation","cbt-fatigue-distress","exercise-during-chemotherapy","multidisciplinary-tumour-board","oncology-nutrition","prehabilitation","histopathology-ihc","cytogenetics-fish","cgp","clonality-testing"],"targets":["cd19","cd20","cd3","ror1","bcl2","ezh2","cd47","cd79b","cd22","myd88","card11","bcl6","myc-gene","crebbp","ep300","kmt2d","tp53","cdkn2a","b2m","btk"],"drugs":["clonoseq","carmustine","prednisone","palifermin","rasburicase","polatuzumab-vedotin","tafasitamab","lenalidomide","glofitamab","epcoritamab","mosunetuzumab","zynlonta","selinexor","zilovertamab-vedotin","tocilizumab","human-normal-immunoglobulin","obinutuzumab","gemcitabine","oxaliplatin","melphalan","thiotepa"],"companies":["marker-therapeutics","ranok-therapeutics-hangzhou","roche-genentech","genmab","abbvie","gilead","bms","incyte","regeneron","adc-therapeutics","merck","novartis","foresight-diagnostics"],"institutions":["mskcc","md-anderson","dana-farber","mayo-clinic","gustave-roussy","the-christie"],"pathways":["apoptosis-bcl2","germinal-centre-reaction","bcr-signalling","inflammation-nfkb","myc","epigenetic-reprogramming"],"terms":["ipi-score","cell-of-origin","double-hit-lymphoma","lugano-classification","mrd","crs","icans","lymphoma-tx-regimen-alphabet","lymphoma-tx-cns-prophylaxis","lymphoma-tx-maintenance","lymphoma-tx-car-t-pathway","lymphoma-tx-bispecific-step-up","lymphoma-tx-transplant-role","lymphoma-tx-radiotherapy","lymphoma-tx-tumour-lysis","lymphoma-tx-hepatitis-b-reactivation","lymphoma-tx-pjp-and-infection-prophylaxis","lymphoma-tx-immunoglobulin-replacement","lymphoma-tx-crs-icans","lymphoma-tx-fertility-preservation","lymphoma-tx-uk-versus-us","lymphoma-tx-uk-access","lymphoma-tx-failed-and-negative","cancer-related-fatigue","late-effects","febrile-neutropenia","neutropenia","financial-toxicity","central-venous-access","hypogammaglobulinaemia","performance-status","quality-of-life","lymphoma-decision-transplant-or-car-t","lymphoma-decision-fertility-timing","lymphoma-decision-trial","lymphoma-decision-local-or-car-t-centre","lymphoma-living-fatigue","lymphoma-living-infection-years-after","lymphoma-living-vaccinations","lymphoma-living-scanxiety-and-surveillance","lymphoma-living-returning-to-work","tumor-lysis-syndrome","deauville","lymphoma-bio-cell-of-origin-in-practice","lymphoma-bio-lymphgen","lymphoma-bio-germinal-centre","lymphoma-bio-antigen-escape","lymphoma-bio-lineage-antigen-cost"],"trials":["nct07011056","nct07570823","nct06929624","nct07409428","nct07188558","nct07215585","nct06792253","nct04442022","nct04529772","nct04094311","nct06717347","nct07226752","nct04384484","nct05429268","nct06508658","nct01804686","nct06091865","nct04404283","l-mind","zuma-1","polarix","frontmind","zuma-7","transform","belinda","starglo","sunmo","epcore-dlbcl-1","epcore-dlbcl-2","lotis-2","waveline-003","golseek-1","flyer","calgb-50303","goya","remarc","polargo","juliet","transcend-nhl-001","polar-bear","arched"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["blood-cancer-discovery","blood-cancer-journal","clinical-lymphoma-myeloma-and-leukemia","current-hematologic-malignancy-reports","haematologica","hematological-oncology","leukemia-and-lymphoma"],"dependsOn":[],"notes":["Living with diffuse large B-cell lymphoma, the decisions and the people who make them: This is orientation from public patient pages, guidelines and the trials themselves, not advice for your case: your own team's instructions and the 24-hour number they gave you come first, and no figure here is a prediction about you. The decision records, the question sets, the first 60 days checklist and the red cards on this page were written from the NHS, Lymphoma Action, Macmillan and Cancer Research UK patient pages, from NICE NG52, NG47, CG151 and NG234, from the NHS Breast Screening Programme protocols and the Green Book, and from the trial reports named beside each figure, all read on 1 October 2026.","On the second-line decision. The figures in the decision record come from the trials' own publications: ZUMA-7 randomised 359 people and reported 24-month event-free survival of 41 per cent against 16 per cent, and four-year overall survival of 54.6 against 46.0 per cent at a median follow-up of 47.2 months; BELINDA randomised 322 people to a different cell product and found median event-free survival of 3.0 months in both arms. They describe those trial populations, not any one person, and the people in them were selected for early relapse."],"group":"haematologic","burden":"~150,000 new cases a year worldwide; ~25,000 in the US; median age 65; about 60% cured with first-line therapy.","subtypes":["Germinal-centre B-cell-like (GCB) vs activated B-cell-like (ABC / non-GCB)","High-grade B-cell lymphoma with MYC and BCL2 rearrangements (double hit)","LymphGen genetic subtypes: MCD, BN2, N1, EZB, ST2, A53","Primary mediastinal B-cell lymphoma (distinct; PD-1 responsive)","Primary CNS lymphoma (distinct; methotrexate-based)","Transformed indolent lymphoma (Richter, transformed follicular)","EBV-positive DLBCL of the elderly","Primary refractory vs early relapse (<12 months) vs late relapse"],"biomarkers":["Cell of origin (GCB/ABC)","Double-hit (MYC/BCL2)","CD19/CD20","ctDNA MRD","IPI / NCCN-IPI","Cell of origin (Hans IHC, Lymph2Cx)","MYC, BCL2, BCL6 FISH","TP53 mutation","CD19 and CD20 expression (loss after CAR-T or bispecific)","Interim and end-of-treatment PET (Deauville)","ctDNA (PhasED-seq, clonoSEQ)","LDH","CNS-IPI for CNS prophylaxis decisions"],"standardOfCare":[{"setting":"Limited stage (I-II, non-bulky)","approach":"R-CHOP × 4 with PET-guided omission of radiation (FLYER, S1001): 4 cycles if interim PET negative; involved-site radiotherapy if PET positive.","refs":["doxorubicin","fdg-pet","imrt-igrt","lugano-classification"],"guideline":{"nccn":"Category 1 (R-CHOP × 4 PET-adapted for stage I-II)","version":"NCCN B-Cell Lymphomas 2026","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1480"}},{"setting":"Advanced stage, IPI 0-1","approach":"R-CHOP × 6 (or Pola-R-CHP); consider 4 cycles plus 2 rituximab in young low-risk patients (FLYER).","refs":["doxorubicin","polatuzumab-vedotin","ipi-score"],"guideline":{"nccn":"Category 1","version":"NCCN 2026"}},{"setting":"Advanced stage, IPI 2-5","approach":"Pola-R-CHP × 6 (POLARIX) or R-CHOP × 6; tafasitamab + lenalidomide + R-CHOP (frontMIND) pending approval for IPI 3-5; DA-EPOCH-R for double-hit lymphoma; CNS prophylaxis for high CNS-IPI (contested).","refs":["polarix","polatuzumab-vedotin","frontmind","tafasitamab","double-hit-lymphoma"],"guideline":{"nccn":"Pola-R-CHP category 1 for IPI 2-5","version":"NCCN 2026"}},{"setting":"Frail or elderly","approach":"R-mini-CHOP; epcoritamab-based regimens in trials for the elderly (EPCORE NHL-2 cohorts); tafasitamab-lenalidomide where transplant is never an option.","refs":["epcoritamab","tafasitamab","lenalidomide"]},{"setting":"Primary refractory or relapse within 12 months","approach":"CD19 CAR-T (axi-cel or liso-cel) preferred over salvage chemotherapy and transplant (ZUMA-7, TRANSFORM); bridging therapy while manufacturing; bispecific ± chemotherapy if CAR-T unavailable.","refs":["axicabtagene-ciloleucel","zuma-7","transform","car-t"],"guideline":{"nccn":"Category 1 (axi-cel, liso-cel)","version":"NCCN 2026"}},{"setting":"Late relapse (>12 months), transplant-eligible","approach":"Salvage chemotherapy (R-ICE, R-DHAP, R-GemOx) → high-dose therapy and autologous transplant if chemosensitive; CAR-T if not.","refs":["autologous-stem-cell-transplant","car-t"]},{"setting":"Relapse, transplant-ineligible","approach":"CD20×CD3 bispecific (glofitamab, epcoritamab) or mosunetuzumab-polatuzumab (SUNMO); pola-BR; tafasitamab-lenalidomide; loncastuximab tesirine.","refs":["glofitamab","epcoritamab","mosunetuzumab","polatuzumab-vedotin","tafasitamab","zynlonta","sunmo"]},{"setting":"Third line and beyond","approach":"CAR-T if not yet given; bispecific after CAR-T (active in CD19-negative relapse if CD20 retained); loncastuximab; zilovertamab vedotin (trial); allogeneic transplant in selected fit patients; clinical trials.","refs":["axicabtagene-ciloleucel","glofitamab","epcoritamab","zynlonta","zilovertamab-vedotin","waveline-003"]},{"setting":"Before the first dose: the tests that change the plan","approach":"An excision or core biopsy reported to the current WHO classification, with immunohistochemistry for CD20, CD10, BCL6, MUM1, BCL2, MYC, Ki-67 and, where MYC is expressed, fluorescence in situ hybridisation for MYC, BCL2 and BCL6 rearrangements, because a high-grade B-cell lymphoma with MYC and BCL2 rearrangements is treated differently from diffuse large B-cell lymphoma. Staging is by FDG-PET-CT reported by the Lugano classification, with a bone marrow biopsy only where PET leaves a question. Bloods include LDH, which is an IPI factor, and hepatitis B surface antigen and core antibody, hepatitis C and HIV, because all three change treatment. Cardiac function is assessed before doxorubicin. Fertility preservation is offered before the first cycle, not after it. The IPI (age over 60, stage III or IV, more than one extranodal site, performance status 2 or worse, raised LDH) sets the risk group, and the CNS-IPI adds kidney or adrenal involvement to estimate the risk of relapse in the brain.","refs":["lugano-classification","ipi-score","fdg-pet","double-hit-lymphoma","lymphoma-tx-cns-prophylaxis","lymphoma-tx-hepatitis-b-reactivation","lymphoma-tx-fertility-preservation"],"guideline":{"version":"NCCN B-Cell Lymphomas; ESMO; BSH; NCI PDQ adult non-Hodgkin lymphoma","url":"https://www.cancer.gov/types/lymphoma/hp/adult-nhl-treatment-pdq"}},{"setting":"Limited stage (I to II), non-bulky, low risk: four cycles, and often no radiotherapy","approach":"Four cycles of R-CHOP with two extra doses of rituximab, rather than six cycles, for patients aged 18 to 60 with stage I or II disease, normal LDH, performance status 0 to 1 and no mass of 7.5 cm or more. FLYER randomised 588 such patients and found three-year progression-free survival of 96 per cent with the four-cycle arm, non-inferior to six cycles, and with fewer adverse events recorded in the four-cycle group (294 haematological and 1,036 non-haematological events against 426 and 1,280). Radiotherapy is not given routinely; an involved-site 30 to 40 Gy field is added where the end-of-treatment PET is positive, or for a bulky or skeletal site. The practical point is that a young person with truly limited, low-risk disease is now finished in about three months.","refs":["r-chop","rituximab","cyclophosphamide","doxorubicin","vincristine","prednisone","fdg-pet","imrt-igrt","lymphoma-tx-radiotherapy"],"guideline":{"nccn":"Category 1 (R-CHOP x 4 with rituximab x 2 in this group)","version":"NCCN B-Cell Lymphomas; ESMO; FLYER","url":"https://doi.org/10.1016/S0140-6736(19)33008-9"}},{"setting":"Advanced stage, IPI 0 to 1: R-CHOP for six cycles","approach":"Six cycles of R-CHOP every 21 days. This has been the reference regimen since rituximab was added to CHOP in 2002, and every attempt to improve on it in this risk group has failed: DA-EPOCH-R was no better and more toxic in Alliance/CALGB 50303 (491 patients, progression-free survival hazard ratio 0.93, febrile neutropenia 35.0 against 17.7 per cent), and obinutuzumab in place of rituximab was no better in GOYA (1,418 patients, hazard ratio 0.92). POLARIX, which established polatuzumab vedotin in place of vincristine, enrolled only patients with IPI 2 to 5, so there is no randomised evidence for pola-R-CHP in IPI 0 to 1 disease. Cure is the aim and is achieved in the large majority.","refs":["r-chop","rituximab","doxorubicin","cyclophosphamide","vincristine","prednisone","ipi-score","lymphoma-tx-failed-and-negative","lymphoma-tx-regimen-alphabet"],"guideline":{"nccn":"Category 1","version":"NCCN B-Cell Lymphomas; ESMO; BSH","url":"https://doi.org/10.1200/JCO.18.01994"}},{"setting":"Advanced stage, IPI 2 to 5: pola-R-CHP or R-CHOP, and where polatuzumab did and did not win","approach":"Six cycles of polatuzumab vedotin with rituximab, cyclophosphamide, doxorubicin and prednisone (pola-R-CHP), or six cycles of R-CHOP. POLARIX randomised 879 previously untreated patients aged 18 to 80 with IPI 2 to 5: two-year progression-free survival 76.7 against 70.2 per cent (hazard ratio 0.73) and five-year progression-free survival 64.9 against 59.1 per cent (hazard ratio 0.77). Overall survival has not separated: the five-year figures are 82.3 against 79.5 per cent, hazard ratio 0.85, not significant. So polatuzumab prevents some relapses without yet being shown to prevent deaths, and the prespecified subgroup analyses suggested the benefit sat with activated B-cell subtype and with IPI 3 to 5 rather than with germinal centre or IPI 2 disease. That is the whole argument, and it is a reasonable one to have out loud with the patient: an extra drug, more peripheral neuropathy, fewer relapses, no proven survival gain.\n\nThe newer option is tafasitamab and lenalidomide added to R-CHOP for IPI 3 to 5. frontMIND randomised 899 such patients and reported two-year progression-free survival 71.1 against 62.9 per cent (hazard ratio 0.75). DA-EPOCH-R is used instead where the disease is a high-grade B-cell lymphoma with MYC and BCL2 rearrangements, or is primary mediastinal, testicular, or leukaemic.","refs":["polarix","polatuzumab-vedotin","r-chop","rituximab","frontmind","tafasitamab","lenalidomide","ipi-score","double-hit-lymphoma","lymphoma-tx-regimen-alphabet"],"guideline":{"nccn":"Category 1 (pola-R-CHP, IPI 2 or above)","version":"NCCN B-Cell Lymphomas; ESMO; POLARIX","url":"https://www.cancer.gov/types/lymphoma/hp/adult-nhl-treatment-pdq"}},{"setting":"High-grade B-cell lymphoma with MYC and BCL2 rearrangements (double-hit), and MYC with BCL6","approach":"Dose-adjusted EPOCH-R rather than R-CHOP, with central nervous system-directed treatment, on the basis of consistent retrospective series rather than a randomised trial; there has never been one, because the entity is uncommon and was only separated out in 2016. The diagnosis requires fluorescence in situ hybridisation, so it is missed wherever FISH is not done, which is the argument for testing every case that expresses MYC by immunohistochemistry. Dual expression of MYC and BCL2 protein without a rearrangement (double-expressor) carries a worse outlook but is not itself a reason to leave R-CHOP. MYC with BCL6 rearrangement is now classified separately and behaves less badly than MYC with BCL2. Relapsed disease follows the large B-cell lymphoma pathway: CD19 CAR-T, then bispecific antibodies.","refs":["double-hit-lymphoma","lymphoma-tx-regimen-alphabet","etoposide","doxorubicin","cyclophosphamide","vincristine","prednisone","rituximab","methotrexate","axicabtagene-ciloleucel","glofitamab","lymphoma-tx-cns-prophylaxis"],"guideline":{"version":"NCCN B-Cell Lymphomas; WHO fifth edition; no randomised evidence","url":"https://www.cancer.gov/types/lymphoma/hp/adult-nhl-treatment-pdq"}},{"setting":"Older or frail patients: R-mini-CHOP and the comprehensive geriatric assessment","approach":"Attenuated R-CHOP (R-mini-CHOP), typically at 50 per cent of the cyclophosphamide, doxorubicin and vincristine doses, is standard for patients over about 80 and for frail patients of any age, and is given with the intention to cure rather than to palliate. A comprehensive geriatric assessment before treatment predicts who can take full-dose therapy better than age does. A pre-phase of prednisolone with or without one dose of vincristine for a week before cycle 1 improves performance status and reduces early deaths. G-CSF is given from the first cycle. Where an anthracycline cannot be given at all, options include substituting etoposide or liposomal doxorubicin, or an anthracycline-free regimen; all are less effective and should be a considered choice rather than a default. Trials of mosunetuzumab consolidation after pola-R-mini-CHP in older patients with detectable circulating tumour DNA are open.","refs":["r-chop","performance-status","rituximab","prednisone","pegylated-liposomal-doxorubicin","etoposide","g-csf-growth-factors","lymphoma-tx-pjp-and-infection-prophylaxis","mosunetuzumab"],"guideline":{"version":"NCCN B-Cell Lymphomas; ESMO; BSH","url":"https://www.cancer.gov/types/lymphoma/hp/adult-nhl-treatment-pdq"}},{"setting":"Central nervous system prophylaxis: who is offered it, and the evidence against it","approach":"Relapse in the brain or spinal fluid occurs in roughly 2 to 5 per cent of patients overall and in about 10 per cent of those with a high CNS-IPI. The traditional response, intrathecal methotrexate with each cycle or two to four doses of systemic high-dose methotrexate, has not been shown to reduce it. In 1,162 adults across 21 United States academic centres who all received single-route prophylaxis, central nervous system relapse occurred in 5.7 per cent, with no difference between intrathecal (5.4 per cent) and systemic high-dose methotrexate (6.8 per cent), and the observed rate matched the rate predicted from CNS-IPI alone. There has never been a randomised trial. Practice has changed accordingly: intrathecal prophylaxis is largely abandoned in the United Kingdom, and systemic high-dose methotrexate is offered selectively, to testicular involvement, to high CNS-IPI and to high-grade B-cell lymphoma, and is increasingly framed as a choice. The interventions that do change outcome are an adequate systemic regimen and prompt investigation of any new neurological symptom.","refs":["lymphoma-tx-cns-prophylaxis","methotrexate","intrathecal-therapy","ipi-score","cns-penetration"],"guideline":{"version":"No randomised evidence; NCCN lists prophylaxis as an option for high CNS-IPI","url":"https://doi.org/10.1182/blood.2021012888"}},{"setting":"Primary refractory disease or relapse within twelve months: CAR-T, not transplant","approach":"CD19 CAR-T is the second-line standard. ZUMA-7 randomised 359 patients with large B-cell lymphoma refractory to, or relapsing within twelve months of, first-line therapy to axicabtagene ciloleucel or to salvage chemotherapy with autologous transplant in responders: median event-free survival 8.3 against 2.0 months (hazard ratio 0.40) and four-year overall survival 54.6 against 46.0 per cent (hazard ratio 0.73). TRANSFORM randomised 184 transplant-eligible patients to lisocabtagene maraleucel or the same standard of care: complete response 74 against 43 per cent, progression-free survival hazard ratio 0.400, with grade 3 cytokine release syndrome in 1 per cent and grade 3 neurological events in 4 per cent. BELINDA, with tisagenlecleucel and a longer manufacturing interval, was negative (event-free survival hazard ratio 1.07), which is why product and pathway speed are treated as part of the treatment rather than a detail of it.\n\nIn practice: refer at the first suspicion of relapse, confirm with biopsy, collect cells early, and bridge with steroids, radiotherapy, polatuzumab-based chemotherapy or a bispecific antibody while the product is made. Where CAR-T is not available or the patient is not fit for it, salvage chemoimmunotherapy with autologous transplant, or a bispecific antibody, are the alternatives.","refs":["zuma-7","transform","belinda","axicabtagene-ciloleucel","lisocabtagene-maraleucel","tisagenlecleucel","car-t","lymphoma-tx-car-t-pathway","lymphoma-tx-crs-icans","autologous-stem-cell-transplant"],"guideline":{"nccn":"Category 1 (axi-cel and liso-cel, second line, early relapse)","version":"NCCN B-Cell Lymphomas; ESMO; ZUMA-7, TRANSFORM","url":"https://www.cancer.gov/types/lymphoma/hp/adult-nhl-treatment-pdq"}},{"setting":"Late relapse (after twelve months), transplant-eligible: salvage chemotherapy then autologous transplant","approach":"Two to three cycles of platinum-based salvage immunochemotherapy (R-ICE, R-DHAP or R-GDP), then, if the disease responds, high-dose therapy with BEAM conditioning and an autologous stem cell transplant. The randomised comparisons between the salvage regimens found no difference in response or survival, so the choice is made on toxicity: R-DHAP is harder on the kidneys and hearing, R-ICE on the marrow, R-GDP is the gentlest and can be given as an outpatient. Patients whose disease does not respond to salvage should be moved to CAR-T rather than given a second salvage regimen. Stem cells must be collected before the marrow is exhausted, which is a reason to avoid bendamustine in anyone who may need a transplant.","refs":["lymphoma-tx-regimen-alphabet","lymphoma-tx-transplant-role","autologous-stem-cell-transplant","rituximab","ifosfamide","carboplatin","etoposide","cytarabine","cisplatin","gemcitabine","dexamethasone","carmustine","melphalan","car-t"],"guideline":{"version":"NCCN B-Cell Lymphomas; ESMO; BSH","url":"https://www.cancer.gov/types/lymphoma/hp/adult-nhl-treatment-pdq"}},{"setting":"Relapsed and not fit for transplant or CAR-T: bispecific antibodies and antibody-drug conjugates","approach":"Several options, none of them curative on current evidence, and the choice turns on what the person wants from treatment.\n\nFixed-duration bispecific antibodies. Glofitamab for twelve cycles then stop, after a dose of obinutuzumab to blunt cytokine release. With gemcitabine and oxaliplatin, STARGLO reported median overall survival 25.5 against 12.9 months for rituximab-GemOx (hazard ratio 0.62). This is one of the places where England is ahead of the United States: NICE TA1113 allows glofitamab with gemcitabine and oxaliplatin for relapsed or refractory diffuse large B-cell lymphoma not otherwise specified after one line of treatment in adults who are not eligible for an autologous transplant, while glofitamab's only American indication remains the accelerated approval of 15 June 2023 for disease after two or more lines.\n\nContinuous bispecific antibodies. Epcoritamab, given subcutaneously; EPCORE DLBCL-1 randomised 552 transplant-ineligible patients against investigator's choice of R-GemOx or bendamustine-rituximab and improved progression-free survival (hazard ratio 0.74) without improving overall survival (hazard ratio 0.96).\n\nCombinations. Mosunetuzumab with polatuzumab vedotin in SUNMO gave progression-free survival 11.5 against 3.8 months for R-GemOx (hazard ratio 0.41), overall response 70 against 40 per cent and complete response 51 against 24 per cent. Polatuzumab with rituximab, gemcitabine and oxaliplatin in POLARGO improved overall survival, 19.5 against 12.5 months (hazard ratio 0.6), in 255 transplant-ineligible patients.\n\nAntibody-drug conjugates and immunomodulatory pairs. Loncastuximab tesirine alone (LOTIS-2: response 48 per cent, complete response 24 per cent). Tafasitamab with lenalidomide (L-MIND: response 60 per cent, complete response 43 per cent), which suits someone who wants an outpatient oral-and-infusion regimen. Polatuzumab with bendamustine and rituximab, which should be avoided in anyone who may still go to CAR-T because bendamustine damages the T cells. Brentuximab vedotin with lenalidomide and a rituximab product, approved in the United States on 11 February 2025 on the ECHELON-3 trial, for people after two or more lines who are not eligible for an autologous transplant or for CAR-T.","refs":["starglo","epcore-dlbcl-1","sunmo","l-mind","lotis-2","glofitamab","epcoritamab","mosunetuzumab","polatuzumab-vedotin","zynlonta","tafasitamab","lenalidomide","obinutuzumab","bendamustine","gemcitabine","oxaliplatin","lymphoma-tx-bispecific-step-up"],"guideline":{"version":"NCCN B-Cell Lymphomas; ESMO; STARGLO, EPCORE DLBCL-1, SUNMO, POLARGO","url":"https://doi.org/10.1200/JCO-25-02849"}},{"setting":"Third line and beyond, including relapse after CAR-T","approach":"If CAR-T has not been given and the patient is fit, it is given now: ZUMA-1 reported an objective response of 82 per cent and complete response 54 per cent in refractory large B-cell lymphoma, with 42 per cent still in response at a median 15.4 months. After CAR-T, a CD20 bispecific antibody is the usual next step and retains activity where CD19 has been lost, provided CD20 is still expressed; a repeat biopsy is therefore worth doing rather than assuming. Other options are loncastuximab tesirine, selinexor, zilovertamab vedotin in a trial, an allogeneic transplant in a small number of fit younger patients with chemosensitive disease, and re-treatment with a drug that previously worked after a long interval. A clinical trial is a reasonable first choice at this point rather than a last resort. Where the aim changes from control to comfort, palliative radiotherapy to a symptomatic site works quickly and early palliative care alongside oncology is recommended.","refs":["zuma-1","axicabtagene-ciloleucel","glofitamab","epcoritamab","zynlonta","selinexor","zilovertamab-vedotin","waveline-003","allogeneic-hsct","palliative-radiotherapy","palliative-care","lymphoma-tx-bispecific-step-up"],"guideline":{"version":"NCCN B-Cell Lymphomas; ESMO","url":"https://www.cancer.gov/types/lymphoma/hp/adult-nhl-treatment-pdq"}},{"setting":"Response assessment, follow-up and what a scan is for","approach":"Interim PET is not used to change treatment in diffuse large B-cell lymphoma outside a trial, because no randomised trial has shown that switching on an interim scan helps. End-of-treatment PET-CT, reported on the five-point Deauville scale, decides whether treatment is complete: scores 1 to 3 are a complete metabolic response, 4 to 5 need biopsy of the residual site before any further treatment, because inflammation and brown fat both light up. Afterwards, follow-up is clinical: history, examination and bloods every three months for two years, then less often. Routine surveillance CT in a person without symptoms detects few relapses that the patient would not have brought forward, and both ESMO and NCCN advise against it. Most relapses occur in the first two years and most are announced by a symptom. Late effects of doxorubicin and of any radiotherapy are watched for over decades.","refs":["fdg-pet","deauville","deauville-score","lugano-classification","pet-ct","cardiotoxicity","late-effects","lymphoma-tx-hodgkin-late-effects"],"guideline":{"version":"NCCN B-Cell Lymphomas; ESMO; Lugano classification","url":"https://www.cancer.gov/types/lymphoma/hp/adult-nhl-treatment-pdq"}}],"stateOfArt":["CAR-T second line.","Bispecifics as off-the-shelf T-cell therapy.","Frontline has moved: Pola-R-CHP (POLARIX) is standard for IPI 2-5, and frontMIND (tafasitamab-lenalidomide-R-CHOP) is the first phase 3 to beat R-CHOP in IPI 3-5 disease since rituximab.","CD19 CAR-T is second-line standard for early relapse, with an overall survival benefit in ZUMA-7 (4-year OS 54.6% vs 46.0%).","Four CD20×CD3 bispecifics approved or conditionally approved worldwide give ~40% complete remissions off the shelf; chemotherapy-free doublets (mosun-pola) beat salvage chemotherapy.","ctDNA by phased-variant sequencing detects residual lymphoma below PET sensitivity and is entering response-adapted trials.","Regulators now scrutinise generalisability (STARGLO CRL) and demand overall survival for confirmatory bispecific trials (EPCORE DLBCL-1 missed OS).","Molecular classification. Cell of origin splits this disease into germinal-centre-like and activated B-cell-like forms with different survival, and in most laboratories it is called by three stains rather than by the expression profiling that defined it, which is why a report usually says non-germinal-centre rather than activated. The genetic subtypes, MCD for MYD88 L265P with CD79B mutation, BN2 for BCL6 fusions with NOTCH2 mutations, N1 for NOTCH1 mutations and EZB for EZH2 mutations with BCL2 translocations, explain far more and currently change nothing outside a trial.","The lesions that do change treatment. A MYC rearrangement with BCL2, with or without BCL6, is a separate WHO entity and usually moves a patient off R-CHOP; rates in 442 unselected cases were 8.8% for MYC, 13.5% for BCL2 and 28.7% for BCL6. Co-expression of MYC and BCL2 protein without rearrangement, about 21% of cases, is prognostic and is not the same thing.","What the medicines are aimed at. CD20 on essentially every case, CD19 on the same cells and retained when CD20 is lost, CD79b on more than 95% and chosen because it internalises and can carry a payload, and CD3 as the handle for the bispecific antibodies. None of the four is tested before treatment, and the one worth retesting at relapse is CD20."],"history":[{"year":1976,"title":"CHOP regimen introduced","note":"Cyclophosphamide, doxorubicin, vincristine, prednisone becomes the backbone for aggressive lymphoma.","refs":["doxorubicin","cytotoxic-chemotherapy"]},{"year":1993,"title":"CHOP proves equal to more intensive regimens; IPI published","refs":["ipi-score"]},{"year":1997,"title":"Rituximab: first antibody for cancer","refs":[]},{"year":1997,"title":"Rituximab: first monoclonal antibody approved for cancer","refs":["cd20","monoclonal-antibody"]},{"year":2000,"title":"Gene-expression profiling defines GCB and ABC subtypes","refs":["cell-of-origin"]},{"year":2002,"title":"GELA LNH-98.5: R-CHOP improves survival over CHOP","note":"Rituximab added to CHOP raises cure rates by ~15 points; the standard for the next twenty years.","refs":[]},{"year":2014,"title":"Lugano classification unifies PET-based staging and response","refs":["lugano-classification","fdg-pet"]},{"year":2017,"title":"Axi-cel CAR-T approved","refs":["axicabtagene-ciloleucel"]},{"year":2017,"title":"Axi-cel: first CAR-T approved for large B-cell lymphoma (ZUMA-1)","refs":["axicabtagene-ciloleucel","car-t"]},{"year":2019,"title":"Polatuzumab vedotin approved with BR for relapsed disease","refs":["polatuzumab-vedotin"]},{"year":2020,"title":"Tafasitamab-lenalidomide (L-MIND) approved for transplant-ineligible relapse","refs":["tafasitamab","l-mind"]},{"year":2021,"title":"Loncastuximab tesirine approved; BELINDA fails while ZUMA-7 and TRANSFORM succeed","refs":["zynlonta","lotis-2","belinda","zuma-7","transform"]},{"year":2022,"title":"ZUMA-7: CAR-T beats transplant","refs":[]},{"year":2022,"title":"POLARIX: first frontline improvement on R-CHOP in twenty years; CAR-T approved second line","refs":["polarix","polatuzumab-vedotin","axicabtagene-ciloleucel"]},{"year":2023,"title":"Glofitamab, epcoritamab approved","refs":["glofitamab"]},{"year":2023,"title":"Glofitamab and epcoritamab approved: off-the-shelf T-cell redirection","refs":["glofitamab","epcoritamab","epcore-nhl-1"]},{"year":2024,"title":"STARGLO shows OS benefit for glofitamab-GemOx; odronextamab approved in EU","refs":["starglo","odronextamab"]},{"year":2025,"title":"SUNMO positive (mosun-pola); FDA rejects STARGLO indication over applicability; POLARIX 5-year data","refs":["sunmo","starglo","polarix"]},{"year":2026,"title":"frontMIND published in Lancet; EPCORE DLBCL-1 misses OS; frontline bispecific data (EPCORE DLBCL-2) at EHA","refs":["frontmind","epcore-dlbcl-1","epcore-dlbcl-2"]}],"pipeline":["zilovertamab-vedotin","abexinostat","dzd8586","rocbrutinib","mk-1045","purinostat","sctb35","shr-a1912","hmpl-760","rondecabtagene-autoleucel","azd0486","ifupinostat","tqb2825","krt-232","zamtocabtagene-autoleucel","tc011","crc01","jnj-90014496","ctx112","allo-647","frontmind","tafasitamab","epcore-dlbcl-2","epcoritamab","golcadomide","golseek-1","mosunetuzumab","sunmo","odronextamab","waveline-003","ctdna-lymphoma-monitoring","idea-ctdna-guided-dlbcl-frontline","idea-bispecific-vs-car-t-second-line"],"openProblems":["Primary refractory disease.","CAR-T access and cost.","Primary refractory disease (~10-15%) still has poor outcomes even with CAR-T; CD19-negative and CD20-negative escape after targeted therapy.","No head-to-head comparison of bispecifics and CAR-T; sequencing is by access rather than evidence.","Overall survival is hard to demonstrate for bispecifics against chemotherapy with crossover and effective later lines (EPCORE DLBCL-1).","Trial generalisability: STARGLO's rejection shows regional enrolment can decide approvals.","CNS relapse: prophylaxis with high-dose methotrexate is of uncertain benefit and CNS-penetrant options are few.","Older and frail patients are underrepresented; R-mini-CHOP cure rates lag and cellular therapies carry toxicity.","Cost and access: CAR-T requires certified centres; bispecific CRS management needs infrastructure; lenalidomide-based triplets add expense.","Response-adapted therapy: interim PET is unreliable and ctDNA is not yet a regulatory endpoint.","Polatuzumab vedotin prevents relapses in first-line diffuse large B-cell lymphoma without a proven survival gain: POLARIX gave five-year progression-free survival of 64.9 against 59.1 per cent but overall survival of 82.3 against 79.5 per cent, hazard ratio 0.85, not significant. Nobody can yet tell an individual patient whether the extra drug will add years or only delay a relapse that is salvaged anyway.","Central nervous system prophylaxis has been given to tens of thousands of people for decades without a randomised trial, and the largest study of patients who received it found the relapse rate identical to the rate predicted without it. Whether any prophylaxis works, and for whom, is unanswered, and the trial that would answer it has never been run.","No treatment for relapsed large B-cell lymphoma after CAR-T has shown a survival benefit in a randomised trial. Bispecific antibodies produce durable remissions in a minority, and which minority cannot be predicted before treatment.","The trials that established CAR-T in second line disagreed with each other (ZUMA-7 and TRANSFORM positive, BELINDA negative) for reasons that are believed to be manufacturing time and permitted bridging rather than biology, which means a treatment's effect depends on a logistics chain that is not measured in the trial report.","Older and frail patients are systematically under-represented: POLARIX capped enrolment at 80 and required performance status 0 to 2, so the evidence for the commonest presentation of this lymphoma, a person in their late seventies or eighties, rests on single-arm and retrospective work."],"parent":"non-hodgkin-lymphoma"},"route":"/cancers/dlbcl/","neighbours":{"pairing":[{"id":"doxorubicin-cardio-caution","kind":"pairing","name":"Caution: cumulative anthracycline dose and the heart","route":"/pairings/doxorubicin-cardio-caution/"},{"id":"bispecific-plus-adc-lymphoma","kind":"pairing","name":"CD20 bispecific + CD79b ADC (mosunetuzumab + polatuzumab)","route":"/pairings/bispecific-plus-adc-lymphoma/"},{"id":"car-t-before-transplant-lbcl","kind":"pairing","name":"Early relapse: CAR-T before transplant","route":"/pairings/car-t-before-transplant-lbcl/"}],"collection":[{"id":"leukemia-lymphoma-society","kind":"collection","name":"Leukemia & Lymphoma Society (LLS)","route":"/collections/leukemia-lymphoma-society/"},{"id":"lymphoma-research-foundation","kind":"collection","name":"Lymphoma Research Foundation (LRF)","route":"/collections/lymphoma-research-foundation/"}],"cancer":[{"id":"advanced-stage-classical-hodgkin-lymphoma","kind":"cancer","name":"Advanced-stage classical Hodgkin lymphoma (stage III to IV)","route":"/cancers/advanced-stage-classical-hodgkin-lymphoma/"},{"id":"burkitt-leukaemia","kind":"cancer","name":"Burkitt leukaemia","route":"/cancers/burkitt-leukaemia/"},{"id":"burkitt-lymphoma","kind":"cancer","name":"Burkitt lymphoma","route":"/cancers/burkitt-lymphoma/"},{"id":"ebv-positive-dlbcl","kind":"cancer","name":"EBV-positive diffuse large B-cell lymphoma","route":"/cancers/ebv-positive-dlbcl/"},{"id":"malt-lymphoma","kind":"cancer","name":"Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma)","route":"/cancers/malt-lymphoma/"},{"id":"follicular-lymphoma","kind":"cancer","name":"Follicular lymphoma","route":"/cancers/follicular-lymphoma/"},{"id":"high-grade-b-cell-lymphoma-myc-bcl2","kind":"cancer","name":"High-grade B-cell lymphoma with MYC and BCL2 rearrangements (double-hit lymphoma)","route":"/cancers/high-grade-b-cell-lymphoma-myc-bcl2/"},{"id":"hiv-associated-lymphoma","kind":"cancer","name":"HIV-associated (AIDS-related) lymphomas","route":"/cancers/hiv-associated-lymphoma/"},{"id":"intravascular-large-b-cell-lymphoma","kind":"cancer","name":"Intravascular large B-cell lymphoma","route":"/cancers/intravascular-large-b-cell-lymphoma/"},{"id":"lymphomatoid-granulomatosis","kind":"cancer","name":"Lymphomatoid granulomatosis","route":"/cancers/lymphomatoid-granulomatosis/"},{"id":"mantle-cell-lymphoma","kind":"cancer","name":"Mantle cell lymphoma","route":"/cancers/mantle-cell-lymphoma/"},{"id":"marginal-zone-lymphoma","kind":"cancer","name":"Marginal zone lymphoma","route":"/cancers/marginal-zone-lymphoma/"},{"id":"mediastinal-grey-zone-lymphoma","kind":"cancer","name":"Mediastinal grey zone lymphoma","route":"/cancers/mediastinal-grey-zone-lymphoma/"},{"id":"angioimmunoblastic-t-cell-lymphoma","kind":"cancer","name":"Nodal T-follicular helper cell lymphoma, angioimmunoblastic type (angioimmunoblastic T-cell lymphoma)","route":"/cancers/angioimmunoblastic-t-cell-lymphoma/"},{"id":"non-hodgkin-lymphoma","kind":"cancer","name":"Non-Hodgkin lymphoma (all types)","route":"/cancers/non-hodgkin-lymphoma/"},{"id":"peripheral-t-cell-lymphoma","kind":"cancer","name":"Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma)","route":"/cancers/peripheral-t-cell-lymphoma/"},{"id":"plasmablastic-lymphoma","kind":"cancer","name":"Plasmablastic lymphoma","route":"/cancers/plasmablastic-lymphoma/"},{"id":"post-transplant-lymphoproliferative-disorder","kind":"cancer","name":"Post-transplant lymphoproliferative disorder (PTLD)","route":"/cancers/post-transplant-lymphoproliferative-disorder/"},{"id":"primary-cns-lymphoma","kind":"cancer","name":"Primary CNS lymphoma","route":"/cancers/primary-cns-lymphoma/"},{"id":"primary-cutaneous-follicle-centre-lymphoma","kind":"cancer","name":"Primary cutaneous follicle centre lymphoma","route":"/cancers/primary-cutaneous-follicle-centre-lymphoma/"},{"id":"primary-effusion-lymphoma","kind":"cancer","name":"Primary effusion lymphoma","route":"/cancers/primary-effusion-lymphoma/"},{"id":"primary-testicular-lymphoma","kind":"cancer","name":"Primary large B-cell lymphoma of the testis","route":"/cancers/primary-testicular-lymphoma/"},{"id":"primary-mediastinal-b-cell-lymphoma","kind":"cancer","name":"Primary mediastinal (thymic) large B-cell lymphoma","route":"/cancers/primary-mediastinal-b-cell-lymphoma/"},{"id":"relapsed-refractory-hodgkin-lymphoma","kind":"cancer","name":"Relapsed and refractory classical Hodgkin lymphoma","route":"/cancers/relapsed-refractory-hodgkin-lymphoma/"},{"id":"t-cell-histiocyte-rich-large-b-cell-lymphoma","kind":"cancer","name":"T-cell/histiocyte-rich large B-cell lymphoma","route":"/cancers/t-cell-histiocyte-rich-large-b-cell-lymphoma/"}],"biomarker":[{"id":"bcl2-rearrangement","kind":"biomarker","name":"BCL2 rearrangement, t(14;18)","route":"/biomarkers/bcl2-rearrangement/"},{"id":"cd19-expression","kind":"biomarker","name":"CD19 expression (CD19-positive)","route":"/biomarkers/cd19-expression/"},{"id":"cd20-expression","kind":"biomarker","name":"CD20 expression (CD20-positive)","route":"/biomarkers/cd20-expression/"},{"id":"cd22-expression","kind":"biomarker","name":"CD22 expression (CD22-positive)","route":"/biomarkers/cd22-expression/"},{"id":"cd79b-itam-mutation","kind":"biomarker","name":"CD79B ITAM mutation","route":"/biomarkers/cd79b-itam-mutation/"},{"id":"ctdna-mrd-positive","kind":"biomarker","name":"ctDNA MRD positivity (molecular residual disease after curative treatment)","route":"/biomarkers/ctdna-mrd-positive/"},{"id":"myc-bcl2-double-expressor","kind":"biomarker","name":"Double expressor: MYC and BCL2 protein together by immunohistochemistry","route":"/biomarkers/myc-bcl2-double-expressor/"},{"id":"double-hit-rearrangement","kind":"biomarker","name":"Double-hit and triple-hit: MYC with BCL2 and BCL6 rearrangement","route":"/biomarkers/double-hit-rearrangement/"},{"id":"ezh2-y646-mutation","kind":"biomarker","name":"EZH2 gain-of-function mutation (Tyr646, originally Tyr641)","route":"/biomarkers/ezh2-y646-mutation/"},{"id":"ig-tcr-clonality","kind":"biomarker","name":"Immunoglobulin and T-cell receptor clonality","route":"/biomarkers/ig-tcr-clonality/"},{"id":"tp53-del17p","kind":"biomarker","name":"TP53 mutation and del(17p)","route":"/biomarkers/tp53-del17p/"}],"term":[{"id":"lymphoma-decision-trial","kind":"term","name":"A clinical trial or standard treatment in lymphoma","route":"/terms/lymphoma-decision-trial/"},{"id":"anthracycline","kind":"term","name":"Anthracyclines (doxorubicin, epirubicin)","route":"/terms/anthracycline/"},{"id":"lymphoma-bio-antigen-escape","kind":"term","name":"Antigen escape: how a lymphoma loses the thing the drug was aimed at","route":"/terms/lymphoma-bio-antigen-escape/"},{"id":"autologous-transplant","kind":"term","name":"Autologous stem cell transplant (ASCT)","route":"/terms/autologous-transplant/"},{"id":"b-cell","kind":"term","name":"B cell","route":"/terms/b-cell/"},{"id":"lymphoma-b-versus-t-cell","kind":"term","name":"B-cell, T-cell and NK-cell lymphoma","route":"/terms/lymphoma-b-versus-t-cell/"},{"id":"lymphoma-tx-uk-versus-us","kind":"term","name":"British and American lymphoma practice: where they differ, and why","route":"/terms/lymphoma-tx-uk-versus-us/"},{"id":"cancer-related-fatigue","kind":"term","name":"Cancer-related fatigue (tiredness)","route":"/terms/cancer-related-fatigue/"},{"id":"cardiotoxicity","kind":"term","name":"Cardiotoxicity (LVEF decline, cardiomyopathy)","route":"/terms/cardiotoxicity/"},{"id":"lymphoma-tx-bispecific-step-up","kind":"term","name":"CD20 bispecific antibodies: step-up dosing, fixed duration and what it is like to take one","route":"/terms/lymphoma-tx-bispecific-step-up/"},{"id":"cell-of-origin","kind":"term","name":"Cell of origin (GCB vs ABC)","route":"/terms/cell-of-origin/"},{"id":"lymphoma-bio-cell-of-origin-in-practice","kind":"term","name":"Cell of origin in practice: Hans against expression profiling, and what it changes","route":"/terms/lymphoma-bio-cell-of-origin-in-practice/"},{"id":"central-venous-access","kind":"term","name":"Central venous access (port, PICC line)","route":"/terms/central-venous-access/"},{"id":"cns-penetration","kind":"term","name":"CNS penetration (brain-penetrant drugs)","route":"/terms/cns-penetration/"},{"id":"lymphoma-tx-cns-prophylaxis","kind":"term","name":"CNS prophylaxis in aggressive B-cell lymphoma, and the evidence against it","route":"/terms/lymphoma-tx-cns-prophylaxis/"},{"id":"crs","kind":"term","name":"Cytokine release syndrome (CRS)","route":"/terms/crs/"},{"id":"lymphoma-tx-crs-icans","kind":"term","name":"Cytokine release syndrome and ICANS: grading and management","route":"/terms/lymphoma-tx-crs-icans/"},{"id":"deauville-score","kind":"term","name":"Deauville five-point scale","route":"/terms/deauville-score/"},{"id":"deauville","kind":"term","name":"Deauville score and PET-adapted therapy","route":"/terms/deauville/"},{"id":"double-hit-lymphoma","kind":"term","name":"Double-hit / high-grade B-cell lymphoma","route":"/terms/double-hit-lymphoma/"},{"id":"ebv-term","kind":"term","name":"Epstein-Barr virus (EBV) in cancer","route":"/terms/ebv-term/"},{"id":"lymphoma-bio-ebv-latency","kind":"term","name":"Epstein-Barr virus latency programmes, and why they decide which lymphoma","route":"/terms/lymphoma-bio-ebv-latency/"},{"id":"lymphoma-living-fatigue","kind":"term","name":"Fatigue after lymphoma treatment, and why it is a symptom to report","route":"/terms/lymphoma-living-fatigue/"},{"id":"febrile-neutropenia","kind":"term","name":"Febrile neutropenia","route":"/terms/febrile-neutropenia/"},{"id":"lymphoma-tx-fertility-preservation","kind":"term","name":"Fertility before lymphoma treatment: what to ask for, and when","route":"/terms/lymphoma-tx-fertility-preservation/"},{"id":"lymphoma-decision-fertility-timing","kind":"term","name":"Fertility preservation before lymphoma treatment: a decision with a deadline in days","route":"/terms/lymphoma-decision-fertility-timing/"},{"id":"financial-toxicity","kind":"term","name":"Financial toxicity","route":"/terms/financial-toxicity/"},{"id":"lymphoma-living-returning-to-work","kind":"term","name":"Going back to work after lymphoma, and the money in the meantime","route":"/terms/lymphoma-living-returning-to-work/"},{"id":"lymphoma-tx-hepatitis-b-reactivation","kind":"term","name":"Hepatitis B reactivation before rituximab and other anti-CD20 antibodies","route":"/terms/lymphoma-tx-hepatitis-b-reactivation/"},{"id":"hypogammaglobulinaemia","kind":"term","name":"Hypogammaglobulinaemia and infection risk after B-cell therapies","route":"/terms/hypogammaglobulinaemia/"},{"id":"icans","kind":"term","name":"ICANS (neurotoxicity)","route":"/terms/icans/"},{"id":"lymphoma-tx-immunoglobulin-replacement","kind":"term","name":"Immunoglobulin replacement after CAR-T, bispecifics and long anti-CD20 treatment","route":"/terms/lymphoma-tx-immunoglobulin-replacement/"},{"id":"lymphoma-indolent-versus-aggressive","kind":"term","name":"Indolent and aggressive lymphoma","route":"/terms/lymphoma-indolent-versus-aggressive/"},{"id":"lymphoma-tx-pjp-and-infection-prophylaxis","kind":"term","name":"Infection prophylaxis in lymphoma: PJP, herpes, fungal risk and vaccination","route":"/terms/lymphoma-tx-pjp-and-infection-prophylaxis/"},{"id":"ipi-score","kind":"term","name":"International Prognostic Index (IPI)","route":"/terms/ipi-score/"},{"id":"intrathecal-therapy","kind":"term","name":"Intrathecal therapy (lumbar puncture, Ommaya reservoir)","route":"/terms/intrathecal-therapy/"},{"id":"late-effects","kind":"term","name":"Late effects and survivorship 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