Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin’s lymphoma (NHL). It’s a fast-growing blood cancer that requires treatment as soon as possible.
As a type of lymphoma, DLBCL affects your body’s white blood cells and ability to fight infections. Treatments for DLBCL are improving and typically include chemotherapy and radiation. You might also receive immunotherapy or have a stem cell transplant in some cases.
In this article, we take a closer look at this type of cancer, including symptoms, treatment options, and outlook.
Diffuse large B-cell lymphoma (DLBCL) is a type of blood cancer called lymphoma. There are two types of lymphoma: Hodgkin’s and non-Hodgkin’s. Diffuse large B-cell lymphoma is a non-Hodgkin’s lymphoma (NHL). In fact, it’s the most common type of NHL.
DLBCL is also an aggressive form of NHL. It can be fatal if left untreated.
All lymphomas, including DLBCL, affect the organs of your lymphatic system. Your lymphatic system is what allows your body to fight infections. Lymphomas such as DLBCL affect the organs in your lymphatic system. This includes your:
- bone marrow
- thymus
- spleen
- lymph nodes
B-cells are cells your immune system relies on to make antibodies and fight infection. When you have DLBCL, your normal B-cells get overwhelmed by the cancerous abnormal cells. This means your body can’t make the antibodies your immune system needs.
The cause of DLBCL isn’t known. However, there are a few factors that are known to increase your risk. These factors include:
- Age. It usually affects those who are middle-aged or older. The average age at diagnosis is 64.
- Ethnicity. DLBCL is more likely to affect white people than any other group in the United States.
- Sex at birth. Men have a slightly higher risk than women.
- A family member with DLBCL. Having a parent or sibling with DLBCL or another form of lymphoma increases your risk.
- A weakened immune system. You’re at greater risk if your immune system is weakened by chronic conditions like HIV or if you’ve had an organ transplant.
Some studies have also suggested there might be a link between the following factors and an increased risk of DLBCL:
- having obesity (more research is still need to confirm this link)
- exposure to radiation (more research is still needed to confirm this link)
- exposure to the herbicide glyphosate (Roundup)
In addition, low-grade, nonaggressive lymphomas have the potential to transform into DLBCL, with the rate of transformation estimated at 2 to 3 percent per year.
The following are the primary symptoms you may experience with DLBCL:
- enlarged lymph nodes
- night sweats
- unusual weight loss
- loss of appetite
- extreme tiredness or fatigue
- fever
- extreme itchiness
You may experience certain other symptoms depending on the location of your DLBCL. These additional symptoms may include:
- abdominal pain
- diarrhea
- blood in stools
- cough
- shortness of breath
DLBCL is diagnosed by performing a biopsy of part or all of the lump, swollen lymph node, or area with the abnormalities. A biopsy is the act of removing tissue and then examining the tissue under a microscope to determine if lymphoma is present.
Depending on various factors, including the location of the affected area, this procedure may be done under general or local anesthesia.
Your doctor will also interview you for details on your medical issues and symptoms, and give you a physical exam.
After confirmation from the biopsy, your doctor will perform some additional tests to determine the stage of your DLBCL.
Treatment of DLBCL is determined by several factors. However, the most important factor your doctor will use to determine treatment options is whether your disease is localized or advanced.
- Localized means it hasn’t spread.
- Advanced is usually when the disease has spread to more than one location in your body.
The treatments commonly used on DLBCL are described below. You might have treatments separately or in combination.
Chemotherapy for DLBCL
Chemotherapy works by slowing down the ability of the rapidly growing cancer cells to reproduce. You’ll take chemotherapy medication orally or through an IV.
The most common chemotherapy treatment is referred to as R-CHOP. R-CHOP stands for a combination of the chemotherapy and immunotherapy medications rituximab, cyclophosphamide, doxorubicin, and vincristine, along with prednisone.
R-CHOP is given through an IV for four of the medications, and prednisone is taken by mouth. R-CHOP is usually administered every 3 weeks for 4 to 6 cycles.
Radiation treatments for DLBCL
Radiation therapy is a treatment where high-intensity X-rays are aimed at the cancer cells. Radiation can help kill cancer cells quickly, especially when it’s used in combination with chemotherapy.
Immunotherapy for DLBCL
Immunotherapy drugs target groups of cancer cells with antibodies and work to destroy them. Immunotherapy helps your body’s immune system recognize and kill cancer cells. The immunotherapy drug, rituximab, specifically targets the B-cells or lymphocytes. Rituximab can affect the heart and may not be an option if you have certain heart conditions.
Surgery for DLBCL
Surgery is rarely used to treat DLBCL. However, if the cancer has spread to organs, such as your spleen or kidney, surgery might be done to remove the affected areas. If the cancer hasn’t spread, you’ll like have radiation instead of surgery.
Stem cell transplants for DLBCL
A stem cell transplant replaces the cancerous white blood cells in your bone marrow with new healthy white blood cells. The cells develop from your own stems cells or donor stem cells.
This treatment is done in combination with a very high dose of chemotherapy to kill all remaining cancer cells. Once the chemotherapy has killed the cancer cells, the healthy stem cells will be returned to your body.
Stem cell transplants are only used in DLBCL that has relapsed after initial treatment.
Treatment for early-stage DLBCL
Initial treatment for early-state DLBCL will usually include approximately three rounds of R-CHOP chemotherapy. You’ll also have radiation therapy.
Treatment for advanced DLBCL
Advanced DLBCL is treated with the same R-CHOP combination of chemotherapy and immunotherapy medications. However, advanced DLBCL requires more rounds of the medications that are administered every 3 weeks.
Advanced DLBCL typically requires 6 to 8 rounds of the treatment. Your doctor will usually take another PET scan at the midway point of treatment to make sure it’s working effectively. Your doctor may include additional rounds of treatment if the disease is still active or it returns.
Two-thirds of people with DLBCL will be cured with first-line chemotherapy. (First-line treatment is the first treatment administered for a cancer.) The remainder of people will require further treatments.
Most people with DLBCL aren’t diagnosed until the later stages. This is because you may not have outward symptoms until later. After diagnosis, your doctor will perform tests to determine the stage of your lymphoma. These tests may include some of the following:
- a combination PET and CT scan, or a CT scan on its own
- blood tests
- bone marrow biopsy
Staging tells your medical team how far the tumors have spread throughout your lymphatic system. The stages for DLBCL are as follows:
| Stage | Definition |
| stage 1 | Only one region or site is affected; this includes lymph nodes, lymph structure, or extranodal sites. |
| stage 2 | Two or more lymph node regions or two or more lymph node structures are involved. At this stage, the involved areas are on the same side of the body. |
| stage 3 | The involved lymph node regions and structures are above and below the diaphragm. |
| stage 4 | Other organs besides the lymph nodes and lymph structures are involved throughout your body. These organs may include your bone marrow, liver, or lungs. |
These stages will also be accompanied by either an A or B after the stage number.
- The letter A means you aren’t having the common symptoms of fever, night sweats, or weight loss.
- The letter B means that you’re having these symptoms.
International Prognostic Index (IPI) scoring
In addition to the staging and the A or B status, your doctor will also give you an IPI score. IPI stands for International Prognostic Index. The IPI score ranges from 1 to 5 and is based on how many of the factors you have that may lower your survival rate. These five factors are:
- being over 60 years of age
- having a higher than normal level of lactate dehydrogenase, a protein found in your blood
- being in poor overall health
- having the disease in stage 3 or 4
- involvement of more than one extranodal disease site
All three of these diagnostic criteria will be combined to give you a prognosis. They will also help your doctor determine the best treatment options for you.
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Your exact risk of relapse depends on factors such as your age, overall health, and how well you respond to treatment. Talk with your doctor about the risk in your specific case.
DLBCL is considered a curable disease when treated early. The sooner you’re diagnosed, the better your outlook will be.
The treatments for DLBCL can have serious side effects. Be sure to discuss these with your doctor before starting your treatment.
Despite the side effects, it’s important that you treat your DLBCL quickly and as early as possible. Seeing your doctor at the first signs of symptoms and getting treated is crucial. If it’s left untreated, it can be life-threatening.