Decisions and supportDiffuse large B-cell lymphoma

Back to the Diffuse large B-cell lymphoma hub →59 questions · 6 red cards

The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask.

Decisions and support

top

The first 60 days →Appointment prep sheet →Side effects →Help with costs →

Decisions you may face

19 with more than one option · full decision page →

One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.

Frontline Early relapse Later2 Limited stage (I-II, non-bulky)3 Advanced stage, IPI 0-12 Advanced stage, IPI 2-52 Frail or elderly3 Primary refractory or relapse within 12 months2 Late relapse (>12 months), transplant-eligible2 Relapse, transplant-ineligible6 Third line and beyond5 Before the first dose: the tests that change the plan Limited stage (I to II), non-bulky, low risk: four cycles, and often no radiotherapy7 Advanced stage, IPI 0 to 1: R-CHOP for six cycles5 Advanced stage, IPI 2 to 5: pola-R-CHP or R-CHOP, and where polatuzumab did and did not win4 High-grade B-cell lymphoma with MYC and BCL2 rearrangements (double-hit), and MYC with BCL69 Older or frail patients: R-mini-CHOP and the comprehensive geriatric assessment6 Central nervous system prophylaxis: who is offered it, and the evidence against it Primary refractory disease or relapse within twelve months: CAR-T, not transplant5 Late relapse (after twelve months), transplant-eligible: salvage chemotherapy then autologous transplant12 Relapsed and not fit for transplant or CAR-T: bispecific antibodies and antibody-drug conjugates11 Third line and beyond, including relapse after CAR-T9 Response assessment, follow-up and what a scan is for2

Red cards

What to watch for and who to call, from the labels and guidelines behind the standard of care. Your team's thresholds win.

Emergency services now
Bleeding or bruising
Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
Bendamustine Carboplatin Carmustine Cisplatin Cyclophosphamide Cytarabine Doxorubicin Etoposide Gemcitabine Ifosfamide Melphalan (including hepatic delivery system)Methotrexate Oxaliplatin Pegylated liposomal doxorubicin Vincristine source
Emergency services now
Cytokine release syndrome
Fever of 38 C or higher is grade 1 CRS; fever with low blood pressure, fast heartbeat, breathlessness or low oxygen is grade 2 or higher. The labels carry a boxed warning and say to report fever immediately.
Axicabtagene ciloleucel Lisocabtagene maraleucel Tisagenlecleucel source
Emergency services now
Cytokine release syndrome
Fever of 38 C or higher, chills, low blood pressure, fast heartbeat or breathlessness, especially after a step-up dose. Boxed warning on teclistamab, epcoritamab, glofitamab, tarlatamab and blinatumomab.
Epcoritamab Glofitamab Mosunetuzumab source
Emergency services now
Blood clot (lenalidomide, pomalidomide, thalidomide)
A swollen painful calf, or sudden breathlessness with chest pain; venous and arterial thromboembolism is a boxed warning and blood-thinning prophylaxis is recommended.
Lenalidomide source
Call the 24-hour line now
Neutropenic fever
Temperature of 38 C or higher, or feeling shivery and unwell even without a fever. Antibody-drug conjugates suppress the bone marrow, and several carry a boxed warning for severe neutropenia.
Loncastuximab tesirine Polatuzumab vedotin Zilovertamab vedotin source
Call the team today
Numbness or weakness
Tingling, numbness or weakness that affects walking or using the hands; peripheral neuropathy is common with the vedotin (MMAE) payload and doses are reduced or stopped at grade 2 to 3.
Polatuzumab vedotin source

See all on the product pages:Axicabtagene ciloleucel Bendamustine Carboplatin Carmustine Cisplatin Cyclophosphamide Cytarabine Doxorubicin Epcoritamab Etoposide Gemcitabine Glofitamab Ifosfamide Lenalidomide Lisocabtagene maraleucel Loncastuximab tesirine Melphalan (including hepatic delivery system)Methotrexate Mosunetuzumab Oxaliplatin Pegylated liposomal doxorubicin Polatuzumab vedotin Tisagenlecleucel Vincristine Zilovertamab vedotin·Printable cards in the navigator

Treatment journeys

What the next twelve months look like, phase by phase, with the decision points.

Advanced stage (III-IV), first line

Questions to ask

Bring to your appointment

Questions to ask your oncologist about Diffuse large B-cell lymphoma

Generated from this cancer's standard of care, biomarkers, and pipeline · 59 questions

Newly diagnosed

What is my exact diagnosis, stage, and grade, and which tests established them?
Why: Everything else follows from an accurate stage and subtype.
Which biomarkers have been tested on my tumour (for example Cell of origin, Double-hit, CD19/CD20, ctDNA MRD, IPI / NCCN-IPI), and what were the results?
Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
Which subtype is my cancer, and does that change the recommended treatment?
Why: Recognised subtypes for this cancer include Germinal-centre B-cell-likevs activated B-cell-like, High-grade B-cell lymphoma with MYC and BCL2 rearrangements, LymphGen genetic subtypes: MCD, BN2, N1, EZB, ST2, A53.
Is germline (inherited) genetic testing recommended for me or my family?
Why: Inherited variants can change treatment and matter for relatives.

Frontline

For my situation (frontline), which of the standard options do you recommend and why?
Why: Guideline options include: R-CHOP or Pola-R-CHP.

Early relapse

For my situation (early relapse), which of the standard options do you recommend and why?
Why: Guideline options include: CD19 CAR-T.
Am I a candidate for Axicabtagene ciloleucel, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Later

For my situation (later), which of the standard options do you recommend and why?
Why: Guideline options include: CD20×CD3 bispecifics, loncastuximab, tafasitamab.
Am I a candidate for Glofitamab, Loncastuximab tesirine, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Limited stage (I-II, non-bulky)

For my situation (limited stage (i-ii, non-bulky)), which of the standard options do you recommend and why?
Why: Guideline options include: R-CHOP × 4 with PET-guided omission of radiation (FLYER, S1001): 4 cycles if interim PET negative; involved-site radiotherapy if PET positive.
Am I a candidate for Doxorubicin, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Advanced stage, IPI 0-1

For my situation (advanced stage, ipi 0-1), which of the standard options do you recommend and why?
Why: Guideline options include: R-CHOP × 6 (or Pola-R-CHP); consider 4 cycles plus 2 rituximab in young low-risk patients (FLYER).
Am I a candidate for Doxorubicin, Polatuzumab vedotin, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Advanced stage, IPI 2-5

For my situation (advanced stage, ipi 2-5), which of the standard options do you recommend and why?
Why: Guideline options include: 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).
Am I a candidate for Polatuzumab vedotin, Tafasitamab, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of POLARIX and frontMIND apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Frail or elderly

For my situation (frail or elderly), which of the standard options do you recommend and why?
Why: Guideline options include: R-mini-CHOP; epcoritamab-based regimens in trials for the elderly (EPCORE NHL-2 cohorts); tafasitamab-lenalidomide where transplant is never an option.
Am I a candidate for Epcoritamab, Tafasitamab, Lenalidomide, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Primary refractory or relapse within 12 months

For my situation (primary refractory or relapse within 12 months), which of the standard options do you recommend and why?
Why: Guideline options include: 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.
Am I a candidate for Axicabtagene ciloleucel, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of ZUMA-7 and TRANSFORM apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Late relapse (>12 months), transplant-eligible

For my situation (late relapse (>12 months), transplant-eligible), which of the standard options do you recommend and why?
Why: Guideline options include: Salvage chemotherapy (R-ICE, R-DHAP, R-GemOx) → high-dose therapy and autologous transplant if chemosensitive; CAR-T if not.

Relapse, transplant-ineligible

For my situation (relapse, transplant-ineligible), which of the standard options do you recommend and why?
Why: Guideline options include: CD20×CD3 bispecific (glofitamab, epcoritamab) or mosunetuzumab-polatuzumab (SUNMO); pola-BR; tafasitamab-lenalidomide; loncastuximab tesirine.
Am I a candidate for Glofitamab, Epcoritamab, Mosunetuzumab or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of SUNMO apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Third line and beyond

For my situation (third line and beyond), which of the standard options do you recommend and why?
Why: Guideline options include: 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.
Am I a candidate for Axicabtagene ciloleucel, Glofitamab, Epcoritamab or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of waveLINE-003 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Before the first dose: the tests that change the plan

For my situation (before the first dose: the tests that change the plan), which of the standard options do you recommend and why?
Why: Guideline options include: 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.

Limited stage (I to II), non-bulky, low risk: four cycles, and often no radiotherapy

For my situation (limited stage (i to ii), non-bulky, low risk: four cycles, and often no radiotherapy), which of the standard options do you recommend and why?
Why: Guideline options include: 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.
Am I a candidate for Rituximab, Cyclophosphamide, Doxorubicin or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Advanced stage, IPI 0 to 1: R-CHOP for six cycles

For my situation (advanced stage, ipi 0 to 1: r-chop for six cycles), which of the standard options do you recommend and why?
Why: Guideline options include: 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.
Am I a candidate for Rituximab, Doxorubicin, Cyclophosphamide or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Advanced stage, IPI 2 to 5: pola-R-CHP or R-CHOP, and where polatuzumab did and did not win

For my situation (advanced stage, ipi 2 to 5: pola-r-chp or r-chop, and where polatuzumab did and did not win), which of the standard options do you recommend and why?
Why: Guideline options include: 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. The 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.
Am I a candidate for Polatuzumab vedotin, Rituximab, Tafasitamab or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of POLARIX and frontMIND apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

High-grade B-cell lymphoma with MYC and BCL2 rearrangements (double-hit), and MYC with BCL6

For my situation (high-grade b-cell lymphoma with myc and bcl2 rearrangements (double-hit), and myc with bcl6), which of the standard options do you recommend and why?
Why: Guideline options include: 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.
Am I a candidate for Etoposide, Doxorubicin, Cyclophosphamide or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Older or frail patients: R-mini-CHOP and the comprehensive geriatric assessment

For my situation (older or frail patients: r-mini-chop and the comprehensive geriatric assessment), which of the standard options do you recommend and why?
Why: Guideline options include: 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.
Am I a candidate for Rituximab, Prednisone, Pegylated liposomal doxorubicin or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Central nervous system prophylaxis: who is offered it, and the evidence against it

For my situation (central nervous system prophylaxis: who is offered it, and the evidence against it), which of the standard options do you recommend and why?
Why: Guideline options include: 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.
Am I a candidate for Methotrexate, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Primary refractory disease or relapse within twelve months: CAR-T, not transplant

For my situation (primary refractory disease or relapse within twelve months: car-t, not transplant), which of the standard options do you recommend and why?
Why: Guideline options include: 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. In 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.
Am I a candidate for Axicabtagene ciloleucel, Lisocabtagene maraleucel, Tisagenlecleucel, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of ZUMA-7 and TRANSFORM apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Late relapse (after twelve months), transplant-eligible: salvage chemotherapy then autologous transplant

For my situation (late relapse (after twelve months), transplant-eligible: salvage chemotherapy then autologous transplant), which of the standard options do you recommend and why?
Why: Guideline options include: 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.
Am I a candidate for Rituximab, Ifosfamide, Carboplatin or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Relapsed and not fit for transplant or CAR-T: bispecific antibodies and antibody-drug conjugates

For my situation (relapsed and not fit for transplant or car-t: bispecific antibodies and antibody-drug conjugates), which of the standard options do you recommend and why?
Why: Guideline options include: Several options, none of them curative on current evidence, and the choice turns on what the person wants from treatment. Fixed-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. Continuous 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). Combinations. 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. Antibody-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.
Am I a candidate for Glofitamab, Epcoritamab, Mosunetuzumab or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of STARGLO and EPCORE DLBCL-1 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Third line and beyond, including relapse after CAR-T

For my situation (third line and beyond, including relapse after car-t), which of the standard options do you recommend and why?
Why: Guideline options include: 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.
Am I a candidate for Axicabtagene ciloleucel, Glofitamab, Epcoritamab or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of ZUMA-1 and waveLINE-003 apply to someone like me?
Why: Trial populations differ from individual patients; ask how closely you match.

Response assessment, follow-up and what a scan is for

For my situation (response assessment, follow-up and what a scan is for), which of the standard options do you recommend and why?
Why: Guideline options include: 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.

Any stage

Are there clinical trials I could join, for example of Zilovertamab vedotin, Abexinostat, DZD8586, Rocbrutinib?
Why: Trials are how the next standard of care is set; asking early keeps options open.
Would a second opinion at a high-volume centre change anything, and can you help arrange it?
Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
Why: Supportive care improves quality of life and helps patients complete treatment.
I read that “Primary refractory disease”. How does that affect my plan?
Why: Open problems are where trials and second opinions matter most.
I read that “CAR-T access and cost”. How does that affect my plan?
Why: Open problems are where trials and second opinions matter most.

Newly diagnosed? Read the first 60 days with Diffuse large B-cell lymphoma, then print the one-page appointment sheet with room for the answers.

Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.

ProvenanceLast edited 2026-09-18 · Jude Gomila · Link cancer subtypes to their siblings and name parents i… · diff · file · history

Wikipedia

Diffuse large B-cell lymphoma

Sources & links

Wikipedia