STEP 6: Managing relapsed or refractory disease


Most residual or relapsed disease will be detected via routine follow-up or by the patient presenting with symptoms.

Re-biopsy is strongly encouraged to confirm relapse and to clarify the nature of the relapsed lymphoma.


Evaluate each patient for whether referral to the original multidisciplinary team is appropriate. Treatment will depend on the location and extent of disease, previous management and the patient’s preferences.

Watchful waiting active surveillance of relapse rather than immediate treatment is commonly recommended.

Systemic therapy options depend on the duration of response to first-line therapy and include: chemotherapy with anti-CD20 monoclonal antibody with or without autologous transplantation, novel targeted treatments and enrolment onto a clinical trial.

Radiotherapy may be appropriate to treat localised relapse.

Advance care planning

Advance care planning is important for all patients but especially those with relapsed disease. It allows them to plan for their future health and personal care by thinking about their values and preferences. This can guide future treatment if the patient is unable to speak for themselves.

Survivorship and palliative care

Survivorship and palliative care should be addressed and offered early. Early referral to palliative care can improve quality of life and in some cases survival. Referral should be based on need, not prognosis.


The lead clinician and team’s responsibilities include:

  • explaining the treatment intent, likely outcomes and side effects to the patient and/or carer and the patient’s GP.


  • Treatment intent, likely outcomes and side effects explained to the patient and/or carer and the patient’s GP
  • Supportive care needs assessed and referrals to allied health and community support services actioned as required
  • Advance care planning discussed with the patient and/or carer
  • Patient referred to palliative care if appropriate
  • Routine follow-up visits scheduled