NCCN Updates Clinical Practice Guidelines for B-Cell Lymphomas

The National Comprehensive Cancer Network (NCCN) recently published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for B-cell lymphomas. For version 5.2023, the panel added new treatment regimens for patients with diffuse large B-cell lymphoma (DLBCL) and histologic transformation of indolent lymphomas to DLBCL.

In the updated guidelines, glofitamab-gxbm was added as a 2A recommended treatment for third-line and subsequent therapy in the bispecific T-cell engager therapy category for patients with DLBCL. NCCN notes that glofitamab-gxbm has FDA approval for use with relapsed or refractory (R/R) DLBCL not otherwise specified (NOS) or DLBCL arising from follicular lymphoma (FL), and patients must be pretreated with obinutuzumab before receiving glofitamab-gxbm. See the complete updated guidelines for B-cell lymphomas for additional details and prescribing information.

In addition to this recommendation, language changes were made to the DLBCL section of the guidelines. The phrase “only after at least two lines of systemic therapy” was added to the qualifier “including patients with disease progression after transplant or CAR T-cell therapy,” under the bispecific T-cell engager therapy category in third-line and subsequent therapy, for clarification. Also, footnote “s” in the same section has been revised to include that tisagenlecleucel, epcoritamab, and glofitamab are not approved by the US Food and Drug Administration (FDA) for R/R primary mediastinal large B-cell lymphoma, and glofitamab is not FDA approved for high-grade B-cell lympghoma (HGBL) and HGBL-NOS.

For the section on histologic transformation of indolent lymphomas to DLBCL, the panel added glofitamab-gxbm as a 2A recommended systemic therapy regimen for patients with no intention to proceed to transplant, under the bispecific T-cell engager therapy category. Glofitamab-gxbm is recommended for the treatment of histologic transformation of FL or nodal marginal zone lymphoma (MZL). NCCN states that glofitamab-gxbm is FDA approved for R/R DLBCL-NOS or DLBCL arising from FL, and patients must be pretreated with obinutuzumab before receiving glofitamab-gxbm. See the complete updated guidelines for B-cell lymphomas for additional details and prescribing information.

Additionally, clarifications have been made to the same section of the guidelines. First, the panel has added that epcoritamab-bysp is also a treatment option for all subtypes of FL or MZL. Second, the phrase “including patients with disease progression after transplant or CAR T-cell therapy” has been added to the qualifier sentence “Bispecific T-cell engager therapy (only after at least two lines of systemic therapy)” under the preferred regimens section in the “no intention to proceed to transplant” section.

For a complete list of updates to the 5.2023 version, please visit the NCCN Guidelines for B-Cell Lymphoma web page.