Glofitamab monotherapy [GLO1]

For the treatment of previously treated adult patients with diffuse large B-cell lymphoma who have received 2 or more lines of systemic therapy where the following criteria have been met:

1. I confirm that this application is being made by, and drugs prescribed by, a consultant or senior resident doctor specifically trained and accredited in the use of systemic anti-cancer therapy.
2. I confirm that the patient has a histologically confirmed diagnosis of diffuse large B cell lymphoma (DLBCL) or transformed follicular lymphoma to DLBCL. The definition of DLBCL includes the following: DLBCL not otherwise specified (NOS) [including germinal centre B-cell (GCB) and activated B-cell (ABC) subtypes] primary mediastinal large B cell lymphoma T cell rich B cell lymphoma Epstein-Barr virus (EBV) positive DLBCL intravascular large B cell lymphoma double hit and triple hit high grade B cell lymphoma

Note

Note: Primary CNS lymphoma, Burkitt lymphoma and plasmablastic lymphoma are NOT included for treatment with glofitamab. Please record in the box below whether the patient has DLBCL according to one of the above types of DLBCL or has transformed follicular lymphoma: - the patient has DLBCL according to one of the types within the above definition OR - the patient has transformed follicular lymphoma (TFL) to DLBCL

3. I confirm that the patient has DLBCL or TFL which has either relapsed following or is refractory to 2 or more lines of standard routinely commissioned systemic therapies and that within these 2 lines of therapy there has been treatment with an anti-CD20 regimen and an anthracycline-containing regimen, unless the use of an anthracycline is contraindicated or considered unsuitable due to a pre-existing condition.

Note

Note: patients with TFL must have received 2 or more lines of systemic therapy given specifically for the transformed follicular lymphoma.

4. I confirm below the number of lines of systemic therapy that the patient has received for the treatment of DLBCL.

Note

Note: induction chemotherapy prior to and then followed by stem cell transplantation counts as 1 line of systemic therapy. Similarly, bridging chemotherapy prior to and then followed by CAR T therapy counts as 1 line of systemic therapy. Note: patients who have had only 1 line of systemic therapy are not eligible for treatment with glofitamab, in this setting. Please record the number of lines of previous systemic therapy below: - 2 previous lines OR - 3 previous lines OR - 4 or more previous lines

5. I confirm below whether the patient has been previously treated with stem cell transplantation:

• No previous stem cell transplantation OR
• Yes, previous stem cell transplantation

6. I confirm below whether the patient has been previously treated with CAR T therapy and if so at which place in the treatment pathway:

• No previous CAR T therapy OR
• Yes, previous CAR T therapy as 2nd line therapy OR
• Yes, previous CAR T therapy as 3rd or more line of therapy

7. I confirm that the patient has not been previously treated with glofitamab unless glofitamab monotherapy was used specifically as bridging treatment prior to 3rd or more line of CAR T therapy.

Note

Note: glofitamab cannot be used as bridging therapy for 2nd line CAR T therapy. Please record in the box below which of the following applies to this patient: - no previous treatment with glofitamab OR - previous treatment with no more than 3 cycles of glofitamab monotherapy specifically used as bridging therapy prior to 3rd or more line CAR T therapy and the patient responded to this glofitamab bridging therapy

8. I confirm that the patient has not received any treatment with a bispecific antibody targeting both CD20 and CD3 other than glofitamab as specified above in criterion 7.

Note

Note: use of glofitamab after previous treatment with epcoritamab is NOT commissioned.

9. I confirm that the patient has an ECOG performance status score of 0 or 1.
10. I confirm that treatment with glofitamab monotherapy will be stopped at whichever of the following events occurs first: disease progression or unacceptable toxicity or withdrawal of patient consent or after a maximum of twelve 3-weekly cycles of glofitamab.

Note

Note: once glofitamab is stopped after 12 cycles of treatment, it cannot be re-started.

11. I confirm that when a treatment break of more than 6 weeks beyond the expected 3-weekly cycle length is needed, a treatment break approval form will be completed to restart treatment.
12. I confirm that glofitamab will be otherwise used as set out in its Summary of Product Characteristics (SPC).

NHS funded From: 16 November 2023

Additional information

Form version: er1.2

CDF Managed Access: NA

NICE Technology Appraisal: TA927 (17 October 2023)

Current Form Version

Note

The data on this page was produced using version 1.380 of the CDF list, downloaded from NHS England’s website on 25 December 2025 at 11:00.

If NHS England has published a new version of the CDF List but this site has not yet accessed that, this form may be out of date. Additionally, if any update has occurred without NHS England noting it as a change, this page will be out of date.