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6 standard-of-care settings across 3 lines and 1 biomarker subgroup. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Localised extranodal disease | Low-dose involved-site radiotherapy (as little as 4 Gy in two fractions for some sites); surgery rarely. | 93 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Advanced or relapsed | Rituximab with bendamustine or chlorambucil, lenalidomide-rituximab; zanubrutinib or ibrutinib for relapsed disease. | 95 | ||
| All comers | Marginal zone lymphoma that is advanced, symptomatic or has relapsed | Treatment is indicated for symptoms, organ compromise, cytopenias or rapid progression, not for the presence of disease. Rituximab alone produces responses in about half. Chemoimmunotherapy with bendamustine and rituximab is the usual choice when more is needed, and rituximab with chlorambucil has the only randomised evidence in MALT (IELSG-19: five-year event-free survival 68 per cent for the combination against 51 per cent for chlorambucil and 50 per cent for rituximab alone, with five-year overall survival about 90 per cent in each arm, so the combination delays events without changing survival). At relapse, the BTK inhibitors are the newest class: MAGNOLIA treated relapsed or refractory marginal zone lymphoma of all subtypes with zanubrutinib and reported an objective response of 68 per cent, complete response 26 per cent and 15-month progression-free survival of 83 per cent, with fewer cardiac events than ibrutinib. Lenalidomide with rituximab is an option and marginal zone patients were included in AUGMENT. Lisocabtagene maraleucel received United States approval for relapsed or refractory marginal zone lymphoma after two or more prior lines on 4 December 2025. Local radiotherapy at 24 Gy remains the right answer for a single symptomatic site whatever the line. | RituximabBendamustineChlorambucilZanubrutinibIbrutinibLenalidomideLisocabtagene maraleucelAUGMENTRadiotherapy in lymphoma: involved-site fields, 24 Gy, 4 Gy and total skin electron therapyMAGNOLIA: zanubrutinib in relapsed or refractory marginal zone lymphomaMarginal zone lymphomas: ESMO clinical practice guidelines | ESMO marginal zone lymphomas; NCCN B-Cell Lymphomas; IELSG-19, MAGNOLIA | 95 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Gastric MALT lymphoma, H. pylori-positive | Eradication therapy and endoscopic follow-up; radiotherapy if the lymphoma persists or carries t(11;18). | - | ||
| All comers | Splenic marginal zone lymphoma | Watch and wait if asymptomatic; antiviral therapy if hepatitis C-positive; rituximab alone or with chemotherapy; splenectomy now rare. | 84 | ||
| All comers | Marginal zone lymphoma: three different diseases under one name | Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) arises at a site of chronic inflammation, most often the stomach, and is the one that can sometimes be cured with antibiotics. Splenic marginal zone lymphoma presents with a large spleen, cytopenias and circulating villous lymphocytes, and is associated with hepatitis C. Nodal marginal zone lymphoma behaves much like follicular lymphoma and is treated like it. The three share a cell of origin and very little else in the way of treatment, so the first question is which one it is. Two tests change the plan at diagnosis. Helicobacter pylori status in gastric MALT, because eradication is the first treatment. Hepatitis C status in splenic and nodal disease, because antiviral treatment alone can produce lymphoma remission in hepatitis C-associated cases. Other site-specific associations are recorded and occasionally actionable: Chlamydia psittaci in ocular adnexal MALT, Borrelia burgdorferi in cutaneous MALT, Campylobacter jejuni in immunoproliferative small intestinal disease. | ESMO marginal zone lymphomas (Zucca et al.); NCCN B-Cell Lymphomas | 84 |
Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.