Diffuse large B cell lymphoma (DLBCL) is the most common type of non-Hodgkin’s lymphoma. It’s a fast-growing blood cancer that requires treatment as soon as possible.
Treatments for DLBCL are improving. They typically include a combination of chemotherapy and immunotherapy. You might also receive radiation therapy, targeted therapy, a stem cell transplant, or surgery in some cases.
Read on to learn more about DLBCL, including the symptoms, treatment options, and outlook.
DLBCL is a type of lymphoma, which is a group of blood cancers. Lymphomas affect the organs of your lymphatic system, such as your:
- lymph nodes
- bone marrow
- thymus
- spleen
There are two main types of lymphomas: Hodgkin’s and non-Hodgkin’s lymphoma.
DLBCL is the most common form of non-Hodgkin’s lymphoma. It accounts for roughly
DLBCL develops when your body produces abnormal B lymphocytes, which are also known as B cells. They’re white blood cells that make antibodies to fight infections. They play an important role in your immune system.
DLBCL usually starts in your lymph nodes, but it may also develop in other tissues or organs. It may spread from one site to other lymph nodes, lymph structures, or organs.
Types of diffuse large B cell lymphoma (DLBCL)
There are several subtypes of DLBCL. Many cases of DLBCL are not otherwise specified (DLBCL-NOS), which means they don’t fall into a specific subtype.
DLBCL subtypes include:
- T-cell/histiocyte-rich B cell lymphoma: In this type, the abnormal B cells form tumors that also contain many T-cells or histiocytes, which are other types of white blood cells.
- Primary DLBCL of the central nervous system: This type starts in the brain or spinal cord.
- Primary cutaneous DLBCL, leg type: This type starts in the skin on the legs or other parts of the body, such as the buttocks, arms, or trunk.
- Primary mediastinal B cell lymphoma (PMBCL): This type develops in the thymus or lymph nodes in the center of the chest, which is known as the mediastinum. The thymus is a gland that produces white blood cells and hormones to help your immune system work properly.
- Primary effusion lymphoma (PEL): PEL most often develops in people with a compromised immune system, such as people living with untreated HIV, the Epstein-Barr Virus (EBV), or someone who has received organ transplants.
- Intravascular large B cell lymphoma: The abnormal B cells of this type circulate throughout the blood and may block small blood vessels in organs.
The specific subtype of DLBCL that you have may affect your symptoms, treatment, and outlook.
Common symptoms of DLBCL include:
- enlarged lymph nodes
- tiredness or fatigue
- unusual weight loss
- loss of appetite
- night sweats
- fever
- itchiness
You may also experience other symptoms, such as:
- abdominal pain
- diarrhea
- blood in stools
- cough
- shortness of breath
- chest pain
- swelling of your face or arms
- a swollen mass on your skin
- skin rash
The location of the cancer can affect which symptoms you experience.
What causes diffuse large B cell lymphoma (DLBCL)?
Experts don’t know exactly what causes DLBCL, but certain risk factors increase your chances of developing it.
Risk factors include:
- Age: It usually affects people in their 60s or older, but it can also affect younger people.
- Sex at birth: It’s slightly more common in males than in females.
- Ethnicity: It’s more likely to affect white people than other groups in the United States.
- Family history: Most people with DLBCL have no family history of the condition, but some have a parent or sibling who has a history of lymphoma or chronic lymphocytic leukemia.
- Weakened immune system: You have a greater risk of developing DLBCL if your immune system is weakened by chronic conditions such as HIV or you have had an organ transplant.
Research in 2023 has also linked obesity to an increased risk of non-Hodgkin’s lymphoma, including DLBCL. More research is necessary to explore this potential link.
Some other forms of slower-growing lymphomas can transform into DLBCL.
These include:
- follicular lymphoma
- MALT lymphoma
- splenic marginal zone lymphoma
- small lymphocytic lymphoma
- lymphoplasmacytic lymphoma
If you have a slower-growing lymphoma, your treatment team can help you learn whether there’s a risk of it transforming into DLBCL. They can help you manage this risk.
If you receive a diagnosis of DLBCL, your doctor will order tests to determine the stage of the cancer. This will tell them how far the cancer has spread throughout your lymphatic system.
DLBCL has four stages.
| Stage | Definition |
|---|---|
| Stage 1 | Only one group of lymph nodes or lymph structures is affected. |
| Stage 2 | Two or more groups of lymph nodes or lymph structures are affected. All of them are located either above or below the diaphragm. |
| Stage 3 | Two or more groups of lymph nodes or lymph structures are affected. The affected sites are located both above and below the diaphragm. |
| Stage 4 | Other organs besides the lymph nodes or lymph structures are affected. These may include your bone marrow, bones, lungs, liver, or other organs. |
The numbered stage of the cancer will be followed by the letter A or B, depending on your symptoms:
- A: You aren’t experiencing fever, night sweats, or weight loss.
- B: You are experiencing these symptoms.
Treatment tends to be most effective when DLBCL is diagnosed at stage 1 or 2, but later stages can also be treated. Most people receive a diagnosis after the cancer has already spread.
A doctor will diagnose DLBCL by performing a biopsy of the lump, swollen lymph node, or area with abnormalities. They will conduct the biopsy by removing a piece of the affected tissue and sending it to a laboratory, where an expert will examine it under a microscope to learn whether cancerous cells are present.
Your doctor may perform the biopsy under local or general anesthesia.
Before the biopsy, they will ask you about your symptoms and medical history and give you a physical exam.
If the biopsy shows that DLBCL is present, they will order additional tests to determine the stage of the cancer and learn whether it has spread in your body.
Staging tests may include:
Your recommended treatment for DLBCL will depend on multiple factors, such as:
- the specific subtype of DLBCL you have
- whether the cancer has spread
- where the cancer is located in your body
- your age and overall health
- your treatment goals
Your doctor might recommend one or more of the treatments described below.
Chemotherapy for DLBCL
Chemotherapy drugs work by slowing the ability of rapidly growing cancer cells to reproduce.
The most common chemotherapy regimen for stage 1 or stage 2 DLBCL is R-CHOP, which involves a combination of the following medications:
- rituximab (Rituxan), an immunotherapy drug
- chemotherapy drugs cyclophosphamide, doxorubicin, and vincristine
- prednisone, a steroid
Common chemotherapy regimens for stage 3 or stage 4 DLBCL include R-CHOP and Pola-R-CHP.
Pola-R-CHP includes the following medications:
- immunotherapy drugs polatuzumab vedotin-piiq (Polivy) and Rituxan
- chemotherapy drugs cyclophosphamide and doxorubicin
- prednisone, a steroid
If your doctor prescribes R-CHOP or Pola-R-CHP, you will take the prednisone by mouth and receive the other medications through an intravenous (IV) line. The treatment is usually administered every 3 weeks for 4–8 cycles, depending on the stage of the cancer.
In some cases, your doctor may prescribe other chemotherapy drugs.
Immunotherapy for DLBCL
Immunotherapy drugs target groups of cancer cells with proteins known as antibodies. They help your immune system recognize and kill cancer cells.
Rituxan is an immunotherapy drug that targets B cells. It’s one of the medications in R-CHOP, a common treatment for DLBCL.
Polivy is another immunotherapy drug that may be used to treat DLBCL. It may be combined with R-CHOP to treat DLBCL in adults who have not received other treatments. Or, it may be combined with Rituxan and the chemotherapy drug bendamustine to treat DLBCL that has persisted or returned after other treatments.
A 2022 clinical trial showed that the risk of this cancer returning, worsening, or causing death was lower in people with intermediate or high risk DLBCL who received treatment with Polivy and R-CHOP versus R-CHOP alone.
Targeted therapy for DLBCL
Targeted therapy drugs target the changes in cancer cells that help them grow and multiply.
Your doctor may prescribe a targeted therapy drug known as selinexor (Xpovio) if you have DLBCL that has not responded to other treatments or has returned following other treatments.
Radiation therapy for DLBCL
Radiation therapy is a treatment that uses high intensity X-rays to kill cancer cells. It’s often combined with chemotherapy or other treatments.
Your doctor may prescribe radiation therapy after chemotherapy if you have stage 1 or stage 2 DLBCL. Sometimes, radiation therapy alone is enough to treat stage 1 DLBCL when the cancer is only affecting one lymph node area.
Your doctor may prescribe radiation therapy along with other treatments if you have stage 3 or stage 4 DLBCL. Radiation therapy may help shrink tumors and manage symptoms.
Stem cell transplant for DLBCL
A stem cell transplant replaces cancerous white blood cells in your bone marrow with new healthy white blood cells. A very high dose of chemotherapy is given before the stem cell transplant to kill the cancer cells.
The healthy stem cells may be taken from your own bone marrow or from donor bone marrow.
Stem cell transplants carry a high risk of side effects. It’s generally used only in young people who have a high risk of the cancer returning.
Surgery for DLBCL
Surgery is rarely used to treat DLBCL. But if the cancer has spread to organs such as your spleen or kidney, your doctor might order surgery to remove the affected areas.
DLBCL is a fast-growing but treatable cancer. Getting treatment can improve survival rates and quality of life.
Treatment can potentially cure DLBCL, especially if the cancer is diagnosed and treated before it has spread to distant parts of the body.
The
The 5-year relative survival rate for people who have DLBCL that has spread to distant parts of the body is
These survival rates were taken from 2012–2018 data and may have improved since they were published.
Researchers are continuing to develop and test new treatments to improve survival rates.
Your long-term outlook and risk of the cancer returning depends on factors such as your age, overall health, and how well the cancer responds to treatment. Talk with your doctor to learn more about your outlook.
Receiving a diagnosis of DLBCL may be very challenging. You might find that it negatively affects your sense of self or mental well-being. You might also experience financial challenges related to your diagnosis or treatment.
Talk with your healthcare team to learn about your treatment options and support resources. Let them know if you’re finding it difficult to follow your treatment plan or manage the side effects or costs of treatment. They may adjust your treatment, or they may recommend resources to help you manage the challenges of treatment.
You might find it helpful to join a support for people with DLBCL or connect with a nonprofit organization that provides information and support services.
Multiple organizations offer information and support services to people with lymphoma, including:
Let your doctor know if you’re experiencing stress, anxiety, depression, or other mental health challenges. They may refer you to a mental health professional. They may also recommend other treatments or support resources.
Healthy lifestyle habits may also help you manage the physical and mental health challenges of living with DLBCL. Try to:
- Eat a nutrient-rich, well-balanced diet.
- Get enough high quality sleep and rest.
- Do regular, low impact exercises.
- Avoid tobacco products.
- Limit or avoid alcohol.
- Limit sources of stress whenever possible.
- Spend time doing activities you enjoy.
You might experience fatigue or other symptoms or side effects of treatment that limit your ability to exercise. Your doctor or other members of your care team can help you develop a gentle fitness routine that works for you.
Your care team can also help you make other lifestyle changes to support your overall health.
Let your doctor or another healthcare professional know if you notice changes in your physical or mental health.
They can help you learn whether DLBCL or another condition is causing your symptoms and can recommend appropriate treatment.
Here are some questions that you may ask your doctor if you receive a diagnosis of DLBCL:
- What type of DLBCL do I have?
- What tests do I need to stage the cancer? What stage is the cancer at?
- What are my treatment options? What are the potential benefits and risks of different treatments?
- What will the treatment involve?
- Who will provide it?
- Where will I receive it?
- When will it start?
- How long will it take to complete?
- What are the potential side effects, and how can I manage them?
- What is my outlook? Are there steps I can take to improve my outlook?
- Are there any lifestyle changes that I can make to help manage this condition?
- Are there patient support groups or other resources that you would recommend?
- Are there financial support resources available to help cover the costs of care?
Your doctor will ask you to attend regular check-ups during treatment. They will order tests to learn how well the treatment is working. They may recommend a change in treatment if it’s not working well or you develop side effects that are difficult to manage.
Your doctor will also ask you to attend check-ups after your treatment is complete. Sometimes, the cancer returns after treatment. Your doctor will order tests and check for signs that the cancer has returned.
DLBCL is a fast-growing cancer that affects a type of white blood cell known as B lymphocytes, or B cells. It’s often curable when diagnosed and treated early. The sooner you receive treatment, the better your outlook will be.
Your doctor may recommend a combination of chemotherapy, immunotherapy, and other treatments for DLBCL. They can help you learn about the potential benefits and risks of different treatments, including the side effects.
You might also find it helpful to connect with a support group or other support resources to help you manage the challenges of living with DLBCL. Let your doctor know if you’re experiencing stress, anxiety, depression, or other mental health challenges. They may recommend counseling or other treatments.
Speak with your doctor to learn more about your treatment options, support resources, and outlook with DLBCL.