EvidenceFollicular lymphoma

CD20 x CD3 bispecifics gave patients whose lymphoma has failed CAR-T, or who cannot access it, an effective off-the-shelf treatment that can be started within days. Epcoritamab and glofitamab are now standard third-line options and are moving into earlier lines and combinations. They do not yet replace CAR-T, whose remissions appear more durable.

Confirms 24 Gy in 12 fractions as the optimal dose for indolent lymphoma when durable local control is the goal.

Rituximab-lenalidomide is an accepted chemotherapy-free first-line alternative for follicular lymphoma, chosen on toxicity profile and patient preference rather than efficacy.

Obinutuzumab-based immunochemotherapy is a first-line option for follicular lymphoma; the choice against rituximab weighs longer progression-free survival against toxicity and cost.

ZUMA-1 showed that CAR-T can cure a meaningful fraction of adults whose aggressive lymphoma no longer responds to chemotherapy, a group with a historical median survival of about six months (SCHOLAR-1). Axi-cel became the first CAR-T approved for lymphoma and later the first to beat standard second-line therapy in ZUMA-7. The comparatively high neurotoxicity of CD28-costimulated products was also first characterised here.

24 Gy in 12 fractions is the standard radiotherapy dose for indolent lymphoma when durable local control is the aim; 4 Gy remains useful for palliation.