Lymphoma is one of the most common hematological malignancies (1). In China, an estimated 5,840 new cases and 2,232 deaths were attributable to Hodgkin lymphoma, whereas 108,327 new cases and 39,905 deaths were attributable to non-Hodgkin lymphoma in 2023 (2,3).
The Chinese Society of Clinical Oncology (CSCO) first issued its guidelines for the diagnosis and treatment of lymphoma in 2018 and has updated them annually thereafter, incorporating evidence from high-quality clinical studies as well as evolving treatment availability (4). This article summarizes the key updates introduced in the 2026 edition relative to the 2025 edition.
Overview of updates
The current revision focuses primarily on refining pathological diagnosis and incorporating novel therapeutic strategies. With respect to diagnosis, additional genetic and molecular assays are now recommended to support definitive pathological classification. With respect to treatment, several new agents and regimens have been added for high-risk and relapsed or refractory (r/r) disease. To further guide clinical practice and facilitate patient management, two new chapters—covering primary gastrointestinal lymphoma and elderly lymphoma—have been incorporated into the 2026 edition.
Updates in pathological diagnosis
For extranodal marginal zone lymphoma, the distinction between gastric and non-gastric subtypes has been clarified. In immunohistochemistry, sex-determining region Y-related high-mobility group box 11, cluster of differentiation 5, cluster of differentiation 8, and programmed death-1 have been upgraded to Class I recommendations for mantle cell lymphoma, extranodal natural killer (NK)/T-cell lymphoma, and nodular lymphocyte-predominant Hodgkin lymphoma, respectively (5). With respect to genetic and molecular testing, the detection of 11q aberrations by fluorescence in situ hybridization in high-grade B-cell lymphoma has been upgraded to a Class I recommendation, whereas targeted next-generation sequencing and molecular subtyping for diffuse large B-cell lymphoma have been added as Class III recommendations.
Updates in diffuse large B-cell lymphoma
The STARGLO trial demonstrated that the Glofit-GemOx regimen (glofitamab, gemcitabine, and oxaliplatin) conferred a superior survival benefit over the R-GemOx regimen (rituximab, gemcitabine, and oxaliplatin). The median overall survival (OS) were 25.5 and 12.9 months, while the median progression-free survival (PFS) were 13.8 and 3.6 months, respectively in the Glofit-GemOx and R-GemOx groups (6). The L-MIND trial reported that the Tafa-Len regimen (tafasitamab plus lenalidomide) achieved an overall response rate (ORR) of 57.5%, a complete remission (CR) rate of 41.3%, a median PFS of 11.6 months, and a median OS of 33.5 months (7). On the basis of these data, both the Glofit-GemOx and Tafa-Len regimens have been added as Class I recommendations for r/r diffuse large B-cell lymphoma.
A pivotal phase IIb study enrolled 80 patients with r/r diffuse large B-cell lymphoma who received ifupinostat, a dual histone deacetylase and phosphoinositide 3-kinase α inhibitor. The ORR and CR rate were 33.8% and 11.3%, respectively, with a median duration of response (DOR) of 4.8 months (8). Accordingly, ifupinostat has been added as a Class II recommendation for r/r diffuse large B-cell lymphoma.
Updates in follicular lymphoma
The IN-MIND study demonstrated that the Tafa-R2 regimen (tafasitamab, rituximab, and lenalidomide) yielded superior efficacy and survival outcomes compared with the R2 regimen (rituximab and lenalidomide). The ORR were 84% and 72%, while the median PFS were 22.4 and 13.9 months, respectively (9). Accordingly, the Tafa-R2 regimen has been added as a Class I recommendation for r/r follicular lymphoma.
Updates in mantle cell lymphoma
The BRUIN study reported that pirtobrutinib achieved an ORR of 57.8% and a median DOR of 21.6 months in patients previously treated with covalent Bruton tyrosine kinase (BTK) inhibitors (10). Based on these findings, pirtobrutinib has been upgraded to a Class I recommendation for r/r mantle cell lymphoma.
The ROCK-1 study showed that rocbrutinib achieved an ORR of 63.9% and an 18-month OS rate of 60.6% in patients previously exposed to covalent BTK inhibitors (11). In the BGB-11417-201 study, sonrotoclax achieved an ORR of 52.4% and a median DOR of 15.8 months in patients with r/r disease (12). On the basis of these results, both rocbrutinib and sonrotoclax have been added as Class II recommendations for r/r mantle cell lymphoma.
Updates in marginal zone lymphoma
A phase II study enrolled 16 patients with marginal zone lymphoma who were refractory to or ineligible for local therapy. The results demonstrated that orelabrutinib combined with rituximab achieved an ORR of 81.8% and a CR rate of 72.7% (13). Accordingly, the orelabrutinib plus rituximab regimen has been added as a Class II recommendation for marginal zone lymphoma.
Updates in chronic lymphocytic leukemia/small lymphocytic lymphoma
In the BGB-11417-202 study, sonrotoclax achieved an ORR of 77.0% and a 15-month PFS rate of 71.5% in patients with r/r disease (14). The APG2575CC201 study reported lisaftoclax achieved an ORR of 62.5% in the same patient population (15). On the basis of these data, both sonrotoclax and lisaftoclax have been added as Class I recommendations for r/r chronic lymphocytic leukemia/small lymphocytic lymphoma.
Updates in extranodal NK/T-cell lymphoma, nasal type
A phase I/II study demonstrated that tislelizumab combined with mitoxantrone hydrochloride liposome achieved an ORR of 75% and a CR rate of 50% in patients with r/r disease (16). Accordingly, the tislelizumab plus mitoxantrone hydrochloride liposome regimen has been added as a Class III recommendation for r/r NK/T-cell lymphoma.
Updates in peripheral T-cell lymphoma
A phase II study showed that the BV-CHEP regimen (brentuximab vedotin, cyclophosphamide, doxorubicin, etoposide, and prednisone) achieved an ORR of 91% and a 2-year PFS rate of 59% in patients with newly diagnosed CD30-positive peripheral T-cell lymphoma (17). Accordingly, the BV-CHEP regimen has been added as a Class II recommendation for treatment-naïve peripheral T-cell lymphoma.
Updates in primary central nervous system lymphoma
A phase II study reported that rituximab combined with orelabrutinib and high-dose methotrexate achieved an ORR of 94.4%, a CR rate of 72.2%, and a 2-year PFS rate of 74.9% (18). On the basis of these findings, the combination of a BTK inhibitor with high-dose methotrexate has been added as a Class II recommendation for primary central nervous system lymphoma.
Primary gastrointestinal lymphoma
The Lugano staging system is recommended for primary gastrointestinal lymphoma (19). Endoscopic biopsy is the preferred approach for establishing the diagnosis and assessing treatment response. Helicobacter pylori testing is prioritized for gastric mucosa-associated lymphoid tissue lymphoma. Individualized treatment strategies should be formulated through multidisciplinary team discussion. Chemotherapy-based comprehensive treatment is preferred for the majority of patients, whereas surgical intervention is indicated for those presenting with emergencies such as massive hemorrhage, perforation, or obstruction.
Elderly lymphoma
A comprehensive geriatric assessment should be performed, and chemotherapy doses should be adjusted according to risk stratification (20,21). Individualized treatment and whole-course management are essential.
Acknowledgements
This work was supported by the Beijing Research Ward Excellence Program (No. BRWEP2024W032150208), the National Key Research and Development Program of China (No. 2023YFF0613403), the Beijing Municipal Administration of Hospitals Incubating Program (No. PX2024038), and the Beijing Xisike Clinical Oncology Research Foundation (No. Y-XYN202502-0006).
Acknowledgments
Footnote
Conflicts of Interest: The authors have no conflicts of interest to declare.
Funding Statement
This work was supported by the Beijing Research Ward Excellence Program (No. BRWEP2024W032150208), the National Key Research and Development Program of China (No. 2023YFF0613403), the Beijing Municipal Administration of Hospitals Incubating Program (No. PX2024038), and the Beijing Xisike Clinical Oncology Research Foundation (No. Y-XYN202502-0006).
Author contributions
WP Liu and DL Zhao contributed equally to this work and were primarily responsible for drafting the original manuscript. J Ma and J Zhu contributed to manuscript review and editing. YQ Song was responsible for project administration and overall supervision. All authors read and approved the final manuscript.
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