Follicular Lymphoma (FL)
- Third-Line and Beyond Therapy:
- T-cell engager bispecific antibodies: Added epcoritamab-bysp as a Category 2A preferred recommendation.
- CAR-T cell therapy: Added lisocabtagene maraleucel (CD19-targeted) as a Category 2A preferred recommendation.
Marginal Zone Lymphoma (MZL)
- Second-Line and Beyond Therapy (Including Elderly/Frail Patients):
- Non-covalent BTK inhibitors: Added pirtobrutinib (post-covalent BTK inhibitor therapy) as a Category 2A preferred recommendation.
Mantle Cell Lymphoma (MCL)
- Mant-1 Footnote C:
- Revised from “IHC-detected TP53 is not validated as a surrogate for TP53 mutation status or del(17p)” to “TP53 sequencing is preferred; however, in frontline therapy, IHC-detected TP53 may serve as a surrogate marker but should be confirmed by sequencing.”
- Mant-3 (Classic TP53 Mutations):
- Added zanubrutinib/obinutuzumab/venetoclax (applicable to all patients) as a Category 2A recommendation.
Burkitt Lymphoma (BL)
Induction Therapy
- Age <60 Years, Low-Risk:
- DA-EPOCH + Rituximab:
- Removed “at least 3 cycles, plus 1 additional cycle post-CR (includes intrathecal methotrexate)”.
- Added:
- CR after 2 cycles: Administer 1 additional cycle of DA-EPOCH-R (total 3 cycles).
- PR after 2 cycles: Add intrathecal methotrexate and 4 additional cycles of DA-EPOCH-R (total 6 cycles).
- Applies similarly to age ≥60 years, low-risk patients.
- DA-EPOCH + Rituximab:
- Age <60 Years, High-Risk:
- Revised DA-EPOCH + Rituximab:
- Dose-adjusted EPOCH (etoposide + prednisone + vincristine + cyclophosphamide + doxorubicin) + rituximab for 6 cycles + intrathecal methotrexate (for high-risk patients with baseline CNS involvement intolerant to intensive therapy).
- Revised DA-EPOCH + Rituximab:
- Age ≥60 Years, High-Risk:
- DA-EPOCH + Rituximab: Modified to include 6 cycles of intrathecal methotrexate.
Second-Line Therapy
- DA-EPOCH + Rituximab: Revised to dose-adjusted EPOCH (as above) + rituximab (if not previously administered) for at least 3 cycles, plus 1 cycle post-CR (includes intrathecal methotrexate).
- Low-risk patients:
- CR after 2 cycles: 1 additional cycle (total 3 cycles).
- PR after 2 cycles: Add intrathecal methotrexate and 4 additional cycles (total 6 cycles).
- High-risk patients: 6 cycles of intrathecal methotrexate.
- For symptomatic CNS involvement, incorporate CNS-penetrant agents into the initial regimen.
- Low-risk patients:
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