DLBCL Relapsed Again? What Later-Line Treatment With Columvi® Actually Involves
Diffuse large B-cell lymphoma (DLBCL) is the most common type of aggressive non-Hodgkin lymphoma. It develops when a type of white blood cell called a B cell grows and multiplies uncontrollably, forming cancer in the lymph nodes or other parts of the body. 1,2 Many patients respond well to their first treatment. However, in some cases, the lymphoma returns (relapses) or does not respond as expected (refractory), making further treatment necessary. 1,3 For patients and caregivers navigating a second or third relapse, understanding what later-line treatment involves can make the road ahead feel more manageable.
Why Another DLBCL Relapse Can Feel Overwhelming for Patients
After two or more lines of treatment, some patients may have diseases that have returned (relapsed) or have not responded well to treatment (refractory).4,6,7 Newer treatment options, including bispecific antibodies such as Columvi® (glofitamab), are now available for eligible patients in this setting.4-6
What Happens When Lymphoma Returns After Multiple Treatments?
When DLBCL comes back after two or more treatments or does not respond to treatment, finding the next treatment can become more challenging.8 Before recommending another treatment, such as Columvi® or other targeted therapies, the doctor will review the patient's overall health, previous treatments, organ function, and any active infections to help choose the most appropriate option.4
Understanding Later-Line Treatment in DLBCL and What Columvi® Is
Columvi®, with glofitamab as its active ingredient, is a bispecific monoclonal antibody approved for adults with relapsed or refractory DLBCL, not otherwise specified, or large B-cell lymphoma arising from follicular lymphoma, after two or more lines of systemic therapy.9
Glofitamab is designed to bind two targets simultaneously: CD20 on the surface of B cells, including cancerous ones, and CD3 on T cells.2 3 By bringing these two cell types together, it forms what is described as an immunological synapse, activating and multiplying T cells and triggering the release of cytolytic proteins that destroy CD20-expressing B cells.9,10
Preparing for Columvi® Treatment: Tests, Review and Treatment Planning
Before Columvi® is initiated, clinicians evaluate patients for the following tests:9,10
- Blood counts, kidney function and liver function
- Any current or recurring infection
- Pregnancy status, since effective contraception is required during and for a period after treatment
Treatment always begins with a single 1,000 mg dose of obinutuzumab, administered by intravenous infusion seven days before the first Columvi® dose, to reduce circulating and lymphoid B-cell counts ahead of therapy.9,10
Step-Up Dosing, Infusion Visits and Monitoring: What Patients Should Know
Columvi® is not started at full strength. Dosing follows a step-up schedule intended to reduce the risk of cytokine release syndrome (CRS).9,10
Recommended Dosage9,10
| Cycle | Day | Dose | Duration of infusion |
| Cycle 1 | Day 1 | Pre-treatment with obinutuzumab 1000 mg | |
| Day 8 | Columvi® 2.5 mg | Duration of infusion: 4 hours | |
| Day 15 | Columvi® 10 mg | Duration of infusion: 4 hours | |
| Cycle 2 | Day 1 | Columvi® 30 mg | Duration of infusion: 4 hours |
| Cycle 3 to 12 | Day 1 | Columvi® 30 mg | Duration of infusion: 2 hours |
- Each treatment cycle lasts 21 days.9,10
- Infusions are generally given over 4 hours initially, extending or shortening depending on how earlier doses were tolerated.9,10
- Treatment continues for a maximum of 12 cycles, or until disease progression or unacceptable toxicity occurs, whichever happens first.9,10
Cytokine Release Syndrome and Neurological Symptoms: Key Safety Points
The most common signs of CRS include fever, chills, a fast heartbeat, low blood pressure, and low oxygen levels. CRS is most likely to occur during the first two step-up doses of Columvi®, which is why patients are monitored closely during this time.9,10
Standard precautions include9,10
- Premedication with a corticosteroid, antihistamine and fever-reducing medicine before relevant infusions
- Ensuring at least one dose of tocilizumab, used to manage CRS, is available before infusions in Cycles 1 and 2
- Advising patients to seek medical attention immediately if fever, chills, rapid heartbeat, dizziness or breathing difficulty occur
What Follow-Up Looks Like During Columvi® Treatment
Monitoring does not end when the infusion is over. Depending on the treatment cycle and how well previous doses were tolerated, some patients may need to stay under observation for several hours or up to 24 hours after certain doses. Patients are also given a patient card that should be carried at all times and shown to the doctor involved in their care.9,10
Questions Patients May Wish to Raise With Their Doctor
- Is Columvi® a suitable treatment based on the patient's previous treatments and overall health?
- How often are hospital visits needed, especially during the first few treatment cycles?
- Which side effects require immediate medical attention, and which can be reported during a routine visit?
- How will the response to treatment be monitored, and how often will tests or scans be required?
- What happens if a scheduled Columvi® dose is delayed or missed?
How Rx4u May Help Patients Explore Named Patient Program Access
Columvi® is not yet widely available in India. However, eligible patients may still be able to receive it through the Named Patient Program (NPP). This program allows doctors to import medicines that are approved in other countries but are not yet commercially available in India.
Step-by-Step: Accessing Columvi® in India Through the Named Patient Program
- Meet a Cancer Specialist
Consult a hematologist or medical oncologist. They will check if Columvi® is the right treatment for your condition.
- Get a Prescription
If Columvi® is suitable, your doctor will write a prescription and explain why this treatment is needed.
- Submit Your Medical Reports
Your doctor will provide reports such as biopsy results, scan reports, blood tests, and details of the treatments you have already received.
- Apply for Import Approval
An application is submitted to the Central Drugs Standard Control Organization (CDSCO) to get permission to import Columvi® into India.
- Receive Support Throughout the Process
Authorized partners such as Rx4U India can help with the paperwork, coordinate the import process, and arrange for the medicine to be delivered to your treating hospital or healthcare provider.
- Moving Through Later-Line DLBCL Treatment With Clear Guidance
A DLBCL relapse after multiple prior treatments is a difficult juncture, but later-line options such as Columvi® reflect a structured, well-studied approach, complete with a defined step-up dosing schedule, an established safety monitoring protocol, and clear follow-up requirements. Understanding these mechanics in advance can help patients and their care teams approach the next stage of treatment with greater clarity.9,10
References:
- Ernst M, Dührsen U, Hellwig D, Lenz G, Skoetz N, Borchmann P. Diffuse Large B-Cell Lymphoma and Related Entities: Diagnosis, Treatment, and Follow-Up. Deutsches Ärzteblatt International. 2023;120(17):289.
- Leukaemia Foundation. Diffuse large B-cell lymphoma (DLBCL). Available at: https://www.leukaemia.org.au/types-of-blood-cancer/lymphoma/non-hodgkin-lymphoma/diffuse-large-b-cell-lymphoma/; Accessed on July 17, 2026.
- García-Sancho AM, Cabero A, Gutiérrez NC. Treatment of relapsed or refractory diffuse large B-cell lymphoma: new approved options. Journal of Clinical Medicine. 2023;13(1):70.
- Thieblemont C, Gomes Da Silva M, Leppä S, Lenz G, Cottereau AS, Fox C, Lopez‐Guillermo A, Illidge T, Jurczak W, Eich H, Aurer I. Large B‐cell lymphoma (LBCL): EHA Clinical Practice Guidelines for diagnosis, treatment, and follow‐up. Hemasphere. 2025;9(9):e70207.
- Kamdar M, Bartlett NL. From breakthroughs to blueprints: evolving evidence and future directions in relapsed and refractory large B-cell lymphoma. Blood. 2026;147(24):2879-94.
- Ansell SM, Nowakowski GS. Current treatment algorithm: diffuse large B cell lymphoma. Blood cancer journal. 2026;16(1):32.
- Refractory cancer. Available at: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/refractory-cancer; Accessed on July 17, 2026.
- Lim NA, Sun Y, Tan JY, Lim RM, Tan YH, Ng LC, Lim FL, Goh YT, Hoe JT, Chiang J, Chang EW. Outcomes in relapsed/refractory diffuse large B-cell lymphoma in an Asian tertiary cancer center: real-world interventions as benchmark for novel therapy. ESMO Real World Data and Digital Oncology. 2025;10:100195.
- Columvi® (glofitamab-gxbm). Full Prescribing Information. Genentech, Inc. Revised June 2025.
- Columvi®. Summary of Product Characteristics. Roche Registration GmbH. European Medicines Agency.
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.
