Primary ovarian lymphoma
ICD-10 C85.7 · ICD-11 2B33.5&XA1QK0

Treatment of Primary Ovarian Lymphoma with Diffuse Large B-Cell Lymphoma, Stage I–II, After First-Line Therapy Has Failed

This protocol addresses primary ovarian lymphoma presenting as diffuse large B-cell lymphoma (DLBCL), limited stage I–II, in patients whose disease has relapsed or progressed following completion of first-line treatment.

Clinical Scenario

The underlying lymphoma is diffuse large B-cell lymphoma (DLBCL), limited stage (stage I–II). The clinical situation is relapsed or refractory disease following first-line systemic therapy.

Previous Line Did Not Achieve or Sustain Remission

First-line management consisted of R-CHOP or R-Pola-CHP–based regimens, with or without involved-site radiotherapy (ISRT) or additional rituximab, selected according to patient age, IPI score, and disease bulk. The target of that treatment — complete metabolic response (Deauville score 1–3, assessed after two cycles) — was either not achieved or not maintained, resulting in disease relapse or progression. This failure triggers escalation to the present protocol.

Next-Step Approach — Partial Overview

Management at this stage is stratified by the timing of progression after first-line therapy. For patients with early progression, cellular immunotherapy is among the approaches considered in those who are eligible. The full protocol specifies the complete options, eligibility criteria, and sequencing.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.annonc.2025.07.014

  • Patients with early progression of disease (POD, i.e. relapse ≤12 months after completion of first-line treatment) should receive anti-cluster of differentiation (CD) 19 chimeric antigen receptor T-cell (CAR-T) therapy, if suitable [I, A].
  • Axicabtagene ciloleucel [I, A].
  • Lisocabtagene maraleucel [I, A].
  • Glofitamab—gemcitabine—oxaliplatin (glofitamab-Gem-Ox) (after one or more line of therapy) [I, A; European Medicines Agency (EMA) approved, not Food and Drug Administration (FDA) approved].
  • Pola—bendamustine—R (Pola-BR) if polatuzumab naive [II, B].
  • Patients with late POD (i.e. relapse >12 months after completion of first-line treatment) can receive platinum-based reinduction therapy [I, B] and autologous stem-cell transplantation (ASCT), if suitable.
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