When Diffuse Large B-Cell Lymphoma Comes Back: Where Columvi Fits in Later-Line Treatment
Introduction
For many people with diffuse large B-cell lymphoma (DLBCL), initial treatment can be effective. However, some patients may experience a relapse (when the lymphoma returns) or refractory disease (when it does not respond adequately to treatment).1,2 In such cases, other treatment options may be considered.3,4
What It Means When DLBCL Comes Back
Learning that DLBCL has returned can feel overwhelming. It is natural to have questions about what happens next and whether other treatment options are available.
In some patients, DLBCL may return after initially responding to treatment or may not respond adequately to therapy from the beginning. When this happens, other treatment options may be considered based on previous treatments received and individual treatment needs.1,2
Understanding the available treatment options may help you feel more prepared when discussing the next steps in care with your healthcare team.
Understanding Relapsed and Refractory DLBCL
If DLBCL returns after treatment or does not respond as expected, doctors may describe it as relapsed or refractory disease. Understanding what these terms mean may help you better understand the next steps in treatment.
- Relapsed DLBCL: The cancer first responded to treatment, went into remission, and returned later.1,2
- Refractory DLBCL: The cancer never fully responded to the initial treatment or continued to grow while you were receiving it5
Why Later-Line Treatment Decisions Are Different
Treatment decisions may become more individualized when DLBCL returns or does not respond adequately to previous therapy. Your doctor may consider how the lymphoma responded to previous treatments, how long remission lasted, the number of prior therapies received, your overall health and fitness, and treatment-related factors such as monitoring requirements and potential side effects.4 Your preferences and treatment goals may also play an important role when discussing available options.6 Treatment selection in later lines is therefore highly individualized and may differ from one patient to another.
Understanding these considerations can help you and your caregivers have more informed conversations with your healthcare team when planning the next steps in treatment.
What Is Columvi?
Columvi® is a prescription medicine used in adults with relapsed or refractory DLBCLor large B-cell lymphoma (LBCL) arising from follicular lymphoma. It is intended for patients whose disease has returned or has not responded after two or more lines of systemic therapy.7,8
Unlike chemotherapy, Columvi treatment works by engaging the body's immune system to recognize and attack lymphoma cells. It is administered intravenously using a carefully designed step-up dosing schedule intended to help reduce the risk of certain treatment-related side effects. 7,8
Importantly, treatment decisions involving Columvi should always be individualized and discussed with an oncology team experienced in managing lymphoma therapies.
Where Columvi Fits After Previous Lymphoma Treatments
After a patient has already received two or more previous treatments for DLBCL and the lymphoma has either come back (relapsed) or stopped responding to treatment (refractory), Columvi may be considered as a later-line treatment option. It is intended for patients who have already received CAR-T therapy (a treatment that uses modified immune cells to fight cancer), cannot receive CAR-T therapy, or choose not to receive it.8
How Columvi Works as a Bispecific Antibody Treatment
Columvi is a type of immunotherapy called a bispecific antibody. It works by bringing the body's immune cells closer to lymphoma cells, helping the immune system recognize and attack the cancer.7
Unlike chemotherapy, Columvi is designed to target specific cells involved in the disease. As a result, you may experience a different treatment schedule, monitoring requirements, and side effect profile during treatment.9
Understanding how Columvi works may help you feel better prepared when discussing treatment expectations with your healthcare team.
What To Expect Before Starting Columvi
Before starting Columvi treatment, your healthcare team will discuss what to expect during therapy. Columvi is given as an intravenous infusion using a step-up dosing schedule, and you may receive medications before treatment to help reduce certain side effects.10
Your healthcare team will monitor you closely during treatment and explain any symptoms that should be reported promptly.10
Important Side Effects and Warning Signs to Discuss
Like all cancer treatments, Columvi may cause side effects. One important boxed warning associated with Columvi involves cytokine release syndrome, which can occasionally become serious and requires prompt medical attention. Check yourself for the following symptoms and report your doctor promptly7:
- Fever
- Chills
- Dizziness
- Difficulty breathing
- Severe fatigue
- Confusion or any neurological symptoms
- Early communication with the healthcare team is essential if new symptoms develop during treatment.
Follow-Up Care During Later-Line Lymphoma Treatment
Regular follow-up remains an important part of relapsed DLBCL treatment. Follow-up appointments may involve:
- Monitoring treatment response
- Managing side effects
- Laboratory testing
- Imaging studies when required
- Discussions regarding ongoing supportive care needs
- Patients should feel comfortable discussing physical symptoms, emotional concerns, and practical challenges that may arise throughout treatment.
How Rx4u May Support Access Through Named Patient Program Guidance
For patients prescribed Columvi, accessing treatment may involve several administrative and documentation requirements. Rx4U can help patients and caregivers understand the process and navigate the practical steps involved in treatment access.
Rx4U may assist with:
- Understanding the Named Patient Program (NPP) process,12 where applicable.
- Guiding patients on the documents required for access requests.
- Coordinating prescription, medical records, and supporting paperwork.
- Providing updates on request status and next steps.
- Helping patients and caregivers navigate regulatory and import-related requirements.
- Offering support throughout the treatment access journey to reduce administrative burden.
By assisting with these non-clinical aspects, Rx4U helps make the access process more streamlined and easier to navigate for patients and their families.
Conclusion: Planning the Next Step After DLBCL Relapse
A diagnosis of relapsed or refractory DLBCL can bring uncertainty, but it does not mean that treatment options have come to an end. Advances in later-line lymphoma treatment have made more options available for some patients.3,4
Columvi is one such treatment option for certain adults with relapsed or refractory DLBCL who have received two or more previous systemic therapies.7,8 Understanding how a treatment works, what to expect during treatment, and discussing the available options with your healthcare team may help you feel more prepared as you plan the next steps in your care.
FAQs
- What is Columvi used for?
Columvi is used to treat certain adults with relapsed or refractory DLBCL after two or more previous systemic treatments.
- Can Columvi be used for relapsed DLBCL?
Yes. Columvi may be used in eligible adults with relapsed or refractory DLBCL following two or more prior systemic therapies. Treatment suitability should be determined by an oncologist.
- Is Columvi chemotherapy?
No. Columvi is a bispecific antibody immunotherapy that works differently from traditional chemotherapy.7,13
- How does Columvi work in lymphoma treatment?
It connects T cells of the immune system with lymphoma cells by binding CD3 and CD20 proteins, helping the immune system recognize and attack cancer cells.7,13
- Can Columvi be used during pregnancy or while breastfeeding?9
No. Columvi may harm an unborn baby. If you are pregnant, planning to become pregnant, or think you may be pregnant, speak with your healthcare provider before or during treatment. If you are able to become pregnant, your healthcare provider will perform a pregnancy test before treatment begins and advise you on effective birth control during treatment and for 1 month after your last dose of Columvi.
Do not breastfeed during treatment with Columvi and for 1 month after your last dose, as it may pass into breast milk.
- How can patients access Columvi with support?
If you have questions about accessing treatment, speak with your treating oncologist. Depending on local regulations and availability, some medicines may be accessed through a NPP pathway. Organizations such as Rx4u may help guide patients and caregivers through this process, where appropriate.12
References:
- Sarkozy C, Sehn LH. Management of relapsed/refractory DLBCL. Best Pract Res Clin Haematol. 2018;31(3):209-216. doi:10.1016/j.beha.2018.07.014
- Goh SC, Ngai S. The clinical challenge of relapsed diffuse large B-cell lymphoma with disseminated infection. Radiol Case Rep. 2023;18(9):3046-3053. Published 2023 Jun 22. doi:10.1016/j.radcr.2023.05.068
- Skrabek P, Assouline S, Christofides A, et al. Emerging therapies for the treatment of relapsed or refractory diffuse large B cell lymphoma. Curr Oncol. 2019;26(4):253-265. doi:10.3747/co.26.5421
- Skarbnik AZ, Patel K. Treatment selection for patients with relapsed or refractory follicular lymphoma. Front Oncol. 2023;13:1120358. Published 2023 Mar 7. doi:10.3389/fonc.2023.1120358
- Dickinson MJ, Carlo-Stella C, Morschhauser F, et al. Glofitamab for Relapsed or Refractory Diffuse Large B-Cell Lymphoma. N Engl J Med. 2022;387(24):2220-2231. doi:10.1056/NEJMoa2206913
- Mulvey E, Shafrin J, Than KS, et al. Patient preferences for attributes of bispecific antibodies for relapse/refractory diffuse large B-cell lymphoma in the US. Future Oncol. 2025;21(27):3523-3534. doi:10.1080/14796694.2025.2572784
- Genentech, Inc. Columvi (glofitamab-gxbm) prescribing information. Genentech, Inc; 2024. Accessed June 24, 2026. Columvi Prescribing Information
- Glofitamab (Columvi): CADTH Reimbursement Recommendation: Indication: For the treatment of adult patients with relapsed or refractory DLBCL not otherwise specified, trFL, or PMBCL, who have received 2 or more lines of systemic therapy and are ineligible to receive or cannot receive CAR-T cell therapy or have previously received CAR-T cell therapy [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2024 Feb. Available from: https://www.ncbi.nlm.nih.gov/books/NBK602510/
- Accessed July 16, 2026. https://www.columvi.com/
- Starting Treatment With COLUMVI. Columvi. Accessed July 16, 2026. https://www.columvi.com/starting-columvi/starting-treatment-with-columvi.html
- Thieblemont C, Gomes Da Silva M, Leppä S, et al. Large B-cell lymphoma (LBCL): EHA Clinical Practice Guidelines for diagnosis, treatment, and follow-up. Hemasphere. 2025;9(9):e70207. Published 2025 Sep 23. doi:10.1002/hem3.70207
- Patil S. Early access programs: benefits, challenges, and key considerations for successful implementation. Perspect Clin Res. 2016;7(1):4-8. doi:10.4103/2229-3485.173779
- European Medicine Agency. Accessed July 16, 2026. https://www.ema.europa.eu/en/medicines/human/EPAR/columvi
Note:
The information provided is for education purpose only and is subjected to prescribing information of the drug and the guidance of your treating physician. Always consult your health care provider before making any medical decision for starting your treatment.
Disclaimer:
Rx4U procures prescribed medicines directly from manufacturers or authorized distributors. It does not claim ownership of any trademarks and complies with the provisions of the Trademark Act, 1999, particularly Sections 30 and 30(1) concerning ‘Fair Use’. It solely facilitates access to new launches through named patient import.
