Emerging treatments

Chimeric antigen receptor (CAR) T-cell therapy

Anti-CD19 CAR T-cell therapy is being evaluated for the treatment of patients with relapsed or refractory B-cell lymphomas, including MALT lymphoma. Both axicabtagene ciloleucel and lisocabtagene maraleucel have been associated with durable responses in single-arm phase 2 studies of patients with relapsed/refractory indolent non-Hodgkin lymphoma (including follicular lymphoma and marginal zone lymphoma).[67][68]​​ Continued durable responses with axicabtagene ciloleucel were reported at 3-year follow-up.[69]​ The US Food and Drug Administration (FDA) has approved lisocabtagene maraleucel for the treatment of adults with relapsed or refractory marginal zone lymphoma who have received at least two prior lines of therapy.

Ibritumomab tiuxetan

A CD20-directed radiotherapeutic monoclonal antibody. In a small single-arm, single-centre, phase 2 clinical trial, an overall response rate of 94% (and complete response rate of 62.5%) was reported in patients with newly diagnosed or relapsed/refractory MALT lymphoma who received ibritumomab tiuxetan.[70]​ 

Acalabrutinib

A covalent Bruton tyrosine kinase (BTK) inhibitor. In an open-label phase 1b/2 trial, acalabrutinib-treated patients with relapsed/refractory marginal zone lymphoma had an overall response rate of 53% (and complete response rate of 13%).[71]​ 

Pirtobrutinib

A non-covalent BTK inhibitor. In a phase 1/2 trial of heavily pre-treated patients with relapsed/refractory marginal zone lymphoma, treatment with pirtobrutinib was associated with an overall response rate of 50% (and complete response rate of 2.8%).[72]​ 

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