Primary ovarian lymphoma confirmed as diffuse large B-cell lymphoma (DLBCL) at limited stage (I–II) calls for a risk-adapted first-line approach, with regimen selection based on patient age, fitness, IPI risk score, and disease bulk.

This protocol applies to diffuse large B-cell lymphoma presenting as primary ovarian lymphoma at stage I–II. Patient characteristics — including age, IPI or age-adjusted IPI (aaIPI) score, and the presence of bulky disease — drive treatment selection within this limited-stage setting.

First-line management centres on rituximab-based immunochemotherapy, with the specific regimen, cycle count, and any role for consolidative radiotherapy determined by individual risk profile and interim metabolic response — full details are in the protocol below.

The primary aim is complete metabolic response (Deauville score 1–3) assessed after two cycles of therapy.

References

DOI: 10.1016/j.annonc.2025.07.014

Limited-stage I–II:
For patients <60 years, fit with an IPI 0 and non-bulky disease, four cycles of rituximab—cyclophosphamide—doxorubicin—vincristine—prednisone (R-CHOP) plus two cycles of rituximab (R) is recommended [I, A].
Four cycles of R-CHOP without further R if complete metabolic response [CMR; Deauville score (DS) 1-3] achieved after two cycles [I, B].
Six cycles of R-CHOP followed by ISRT if DS 4-5 after two cycles [III, B].
Six cycles of R-CHOP [I, B].
Six cycles of R—polatuzumab vedotin—cyclophosphamide—doxorubicin—prednisone (R-Pola-CHP) (IPI ≥2) [I, B].
Three to four cycles of R-CHOP followed by ISRT [III, B].

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Treatment of Primary Ovarian Lymphoma in Diffuse Large B-Cell Lymphoma, Stage I–II