^{Sep 2025}

The new ESMO clinical practice guidelines for lymphomas have been published. The guidelines now include all types of lymphomas in one single document. Here we focus only on DLBCL.

A few selected DLBCL recommendations:

• A baseline electrocardiogram should be carried out on all patients. Echocardiogram (or multi-gated acquisition or gated heart pool scan if echocardiogram unavailable) can be considered for all patients
  and is recommended for older patients and those with cardiovascular risk factors
• Positron emission tomography (PET)–computed tomography (CT) can be recommended as the standard imaging modality for baseline and response assessment, and can be considered at interim assessment
• Assessment of the central nervous system (CNS) with contrast-enhanced cranial magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) examination can be carried out on a case-by-case basis based on clinical risk factors or presentation
• Assessment of the frail and elderly using the Elderly Prognostic Index can be considered
• Patients with early disease progression who relapse ≤12 months after completion of first-line treatment should receive CAR-T therapy, if suitable, including Breyanzi (lisocabtagene maraleucel)
• Patients relapsing after ≥2 prior lines of treatment should also receive CAR-T therapy, if suitable, for which Breyanzi is also recommended as one option
  

Click here to read the ESMO guidelines (text in english, estimated reading time 15 minutes)

_{^aRebiopsy at each relapse, where feasible, to confirm DLBCL [V, B]; ^bAxicabtagene ciloleucel and lisocabtagene maraleucel are FDA and EMA approved for second-line use; ^cGlofitamab-Gem-Ox is recommended after ≥1 line of therapy, if available [I, A]; ^dCaution when selecting Pola-BR for patients who may be candidates for CAR-T therapy as a subsequent treatment line. Bendamustine may have an impact on the quality of T-cells; ^eConsider palliative care at each treatment juncture in appropri ately selected patients [V, B]; ^fConsider DS 5 PMR as failure of second-line platinum-based immunoChT on a case-by-case basis; ^gConsider ISRT to initial isolated bulky relapse or residual isolated PET-avid disease pre- or post-ASCT [IV, B]; ^hAxicabtagene ciloleucel, lisocabtagene maraleucel and tisagenlecleucel are FDA and EMA app roved options for patients who have received ≥2 prior lines of therapy according to availability and patient preference; ⁱEpcoritamab and glofitamab are FDA and EMA approved for patients who have received ≥2 prior lines of therapy; ^jOption for patients relapsing after second- or third-line CAR-T therapy or relapsing after second-line treatment if CAR-T-unsuitable; ^kFor selected young, fit patients who relapse post-CAR-T therapy and who obtain a subsequent remission.}

New Swedish guidelines on aggressive B-cell lymphomas were presented in April 2025. Please also refer to the Swedish recommendations for additional guidance.²

Read Swedish Guidelines in R/R LBCL here