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3 standard-of-care settings across 2 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 | Splenic marginal zone lymphoma: hepatitis C first, then rituximab, then splenectomy | An indolent disease of the spleen, marrow and blood. A patient with no symptoms, no cytopenias and a spleen that is not troublesome is watched, sometimes for years. When treatment is needed, the order is: test and treat hepatitis C if present, because direct-acting antivirals alone produce lymphoma remission in a proportion of hepatitis C-associated cases and that is a reason to check before giving any chemotherapy. Then rituximab alone, weekly for four to eight doses, which corrects cytopenias and shrinks the spleen in the large majority and has displaced splenectomy as first treatment. Chemoimmunotherapy with bendamustine and rituximab is used for disease that does not respond or that transforms. Splenectomy is now reserved for patients who cannot have rituximab, whose disease is confined to the spleen and who need a diagnosis, or who have refractory painful splenomegaly. It requires pneumococcal, Haemophilus influenzae type b and meningococcal vaccination at least two weeks beforehand where possible, and lifelong penicillin prophylaxis afterwards. Zanubrutinib has activity in relapsed disease across marginal zone subtypes. | RituximabBendamustineZanubrutinibWatch and wait in lymphoma: when the right treatment is none yetInfection prophylaxis in lymphoma: PJP, herpes, fungal risk and vaccinationMAGNOLIA: zanubrutinib in relapsed or refractory marginal zone lymphomaMarginal zone lymphomas: ESMO clinical practice guidelines | ESMO marginal zone lymphomas; NCCN B-Cell Lymphomas | 84 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Asymptomatic | Watch and wait; antiviral therapy first if hepatitis C is present. | - | ||
| All comers | Symptomatic | Rituximab alone or with chemotherapy; splenectomy for selected patients; BTK inhibitors or lenalidomide-rituximab later. | 91 |
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.