Overview
B-cell neoplasms encompass a range of malignancies including lymphomas and leukemias characterized by uncontrolled proliferation of B-lymphocytes. These conditions require precise diagnosis and tailored treatment approaches, often involving targeted therapies and immunotherapies.Diagnosis
Serum Free Light Chains (FLC) Assays: Useful for diagnosis, staging, and prognosis assessment in B-cell disorders such as myeloma and lymphoma 5.
Imaging Studies: Essential for evaluating extent of disease, including CT, PET scans 6.
Biopsy: Core diagnostic tool for confirming malignancy and determining specific subtype 6.
Genetic Testing: Important for identifying specific mutations (e.g., TP53) that guide treatment decisions 6.Management
First-Line Treatments:
- CD20 Monoclonal Antibodies: Rituximab, ofatumumab, ocrelizumab, obinutuzumab, and ublituximab are commonly used 1.
- BTK Inhibitors: Ibrutinib and acalabrutinib for TP53-mutated mantle cell lymphoma 2.
Adjunctive Therapies:
- CD3 × CD20 Bispecific Antibodies: Added to chemoimmunotherapy for improved outcomes in relapsed/refractory diffuse large B-cell lymphoma (DLBCL) 2.
- CD19-Directed Agents: Monoclonal antibodies and antibody-drug conjugates for relapsed/refractory follicular lymphoma (FL) 2.Special Populations
Cardiovascular Monitoring: Increased vigilance for cardiovascular toxicities, particularly atrial fibrillation and arrhythmias, in elderly patients treated with ibrutinib 34.
Pregnancy: Limited data; caution advised due to potential risks associated with many B-cell neoplasm treatments 12.Key Recommendations
Utilize serum free light chain assays for monitoring and prognostic assessment in B-cell malignancies (Evidence: Moderate) 5.
Incorporate genetic testing, especially for TP53 mutations, to guide treatment strategies in mantle cell lymphoma (Evidence: Moderate) 6.
Monitor elderly patients closely for cardiovascular toxicities when treating with ibrutinib (Evidence: Strong) 34.
Consider CD3 × CD20 bispecific antibodies in combination with chemoimmunotherapy for patients with relapsed/refractory DLBCL (Evidence: Moderate) 2.
Evaluate skin involvement in B-cell lymphomas as it correlates with prognosis, except in medium-grade lymphomas (Evidence: Moderate) 7.References
1 Kuang Y, Guo Y, Liu Y, Li T, Xie J, Huang L et al.. Ocular toxicity associated with anti-CD20 monoclonal antibodies: A pharmacovigilance analysis using the FAERS database. Multiple sclerosis and related disorders 2026. link
2 Zelenetz AD, Gordon LI, Abramson JS, Advani RH, Andreadis B, Bartlett NL et al.. NCCN Guidelines® Insights: B-Cell Lymphomas 3.2025. Journal of the National Comprehensive Cancer Network : JNCCN 2025. link
3 Tuomi JM, Bohne LJ, Dorey TW, Jansen HJ, Liu Y, Jones DL et al.. Distinct Effects of Ibrutinib and Acalabrutinib on Mouse Atrial and Sinoatrial Node Electrophysiology and Arrhythmogenesis. Journal of the American Heart Association 2021. link
4 Salem JE, Manouchehri A, Bretagne M, Lebrun-Vignes B, Groarke JD, Johnson DB et al.. Cardiovascular Toxicities Associated With Ibrutinib. Journal of the American College of Cardiology 2019. link
5 Tillyer CR. Clinical applications of immunoglobulin free light chain estimations. International journal of clinical & laboratory research 1993. link
6 Croce CM. Genetics of B-cell neoplasia. European journal of epidemiology 1985. link
7 Sterry W, Krüger GR, Steigleder GK. Skin involvement of malignant B-cell lymphomas. The Journal of dermatologic surgery and oncology 1984. link