Diagnostic and therapeutic pathways for lymphoma patients: expert consensus through Nominal Group Technique and Delphi methodology

Attilio Guarini¹Valentina Bozzoli²Sabino Ciavarella¹Michele Cimminiello³Francesca Donatelli⁴Angelo Fama⁵Vincenza Fernanda Fesce⁶Vincenzo Fraticelli⁷Francesco Gaudio⁸Giuseppina Greco⁴Augusto Martellini⁹Francesca Merchionne¹⁰Rosanna Maria Miccolis¹¹Carla Minoia^12*Elsa Pennese¹³Tommasina Perrone¹⁴Potito Rosario Scalzulli¹⁵Anna Scattone¹Tetiana Skrypets¹Mariarosaria Specchia¹⁶Lorenzo Tonialini¹Maria Rosa Valvano¹⁷Vincenzo Pavone⁴

• ¹IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
• ²Ospedale Vito Fazzi, Lecce, Italy
• ³AOR San Carlo di Potenza, Potenza, Italy
• ⁴UOC Ematologia e Trapianto di CSE Azienda Ospedaliera C. Panico Tricase, Lecce, Italy
• ⁵Ospedale "Giuseppe Mazzini" Hospital, Teramo, Italy
• ⁶Universitaria Policlinico Riuniti di Foggia, Foggia, Italy
• ⁷Unità Operativa Semplice a Valenza Dipartimentale di Onco-Ematologia Largo Gemelli n°1, Campobasso, Italy
• ⁸“F. Miulli” University Hospital, Bari, Italy
• ⁹Polistudium srl, Milan, Italy
• ¹⁰U.O. Ematologia Ospedale "Antonio Perrino", Brindisi, Italy
• ¹¹UOC Ematologia con Trapianto P.O. "Mons. Dimiccoli" Barletta, Barletta, Italy
• ¹²Hematology Unit - IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
• ¹³UOC Ematologia Clinica Dipartimento Oncologico Ematologico Presidio Ospedaliero Spirito Santo, Pescara, Italy
• ¹⁴AOUC Policlinico, Bari, Italy
• ¹⁵Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
• ¹⁶Ospedale “S. G. Moscati”, Taranto, Italy
• ¹⁷IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy

Lymphomas encompass a heterogeneous group of B-and T-cell malignancies necessitating a complex and precise management. With the aim to define standardized diagnostic and therapeutic pathways across multiple hematology centers in Italy, the "Right Path 4 Lymphomas" project was designed as a multidisciplinary expert platform designed to establish consensus-driven diagnostic and therapeutic pathways. Using a two-phase methodology -the Nominal Group Technique followed by a Delphi process -experts systematically evaluated and prioritized key diagnostic and therapeutic topics for five major lymphoma subtypes: classical Hodgkin lymphoma, diffuse large B-cell lymphoma, follicular lymphoma, mantle cell lymphoma, and peripheral T-cell lymphomas. The Delphi process achieved a high level of consensus on 264 of 270 statements (97.8%), reinforcing the importance of multidisciplinary collaboration in shaping evidence-based recommendations. Key areas of agreement included histopathologic and molecular diagnostic standards, risk-adapted treatment approaches integrating novel immunotherapies, and structured follow-up strategies. However, areas of debate remained over the clinical utility of minimal residual disease monitoring, optimal sequencing of immunotherapies, and the potential of CAR-T therapy versus bispecific antibodies. This project highlights the need for a structured, consensus-driven approach to lymphoma care that aligns with evolving international guidelines while addressing the distinct regulatory and healthcare landscape in Italy. The findings provide a valuable framework for clinicians and policymakers to optimize lymphoma management, balancing innovation with the allocation of resources and clinical feasibility.