Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma. There are several types of DLBCL, each with their own treatment options.
Diffuse large B-cell lymphoma (DLBCL) is 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, 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
- lymph nodes
- bone marrow
- thymus
- spleen
There are 2 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
It 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.
There are
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 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
- blood in stools
- 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.
Experts don’t know exactly what causes DLBCL, but certain risk factors can 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.
If you receive a diagnosis of DLBCL, a 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’ll 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.
Before the biopsy, they’ll ask you about your symptoms and medical history and give you a physical exam.
If the biopsy shows that DLBCL is present, they’ll 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
A doctor might recommend one or more of the following treatments:
Chemotherapy drugs
The most common treatment for stage 1 or stage 2 DLBCL is a type of chemotherapy known as R-CHOP. It involves a combination of
- 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. This regimen includes the following medications:
- immunotherapy drugs polatuzumab vedotin-piiq (Polivy) and Rituxan
- chemotherapy drugs cyclophosphamide and doxorubicin
- prednisone, a steroid
Immunotherapy for DLBCL
Immunotherapy drugs may be given to target groups of cancer cells with proteins known as antibodies. They help your immune system recognize and kill cancer cells.
Immunotherapy drugs for DLBCL typically include Rituxan and Polivy. Polivy may be combined with R-CHOP to treat DLBCL in adults who have not received 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
A doctor may prescribe targeted therapy drugs, such as selinexor (Xpovio), if your cancer has not responded to other treatments or has returned following treatment. This can help prevent cancer cells from growing.
Radiation therapy for DLBCL
A doctor may prescribe radiation therapy to help shrink tumors and manage symptoms. Sometimes, radiation therapy alone is enough to treat stage 1 DLBCL when the cancer is only affecting one lymph node area.
Radiation therapy may be used along with other treatments if you have stage 3 or stage 4 DLBCL.
Stem cell transplant for DLBCL
A stem cell transplant may be suggested as a way to replace cancerous white blood cells in your bone marrow with new healthy white blood cells. 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, a doctor might order surgery to remove the affected areas.
DLBCL is a fast-growing but
The American Cancer Society reports that the
The 5-year relative survival rate for people who have DLBCL that has spread to distant parts of the body is 58%.
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 a 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 a healthcare professional 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.
Where to find support
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:
If you’re experiencing stress, anxiety, depression, or other mental health challenges, consider speaking with your care team. They can refer you to a mental health professional or recommend support resources.
Your care team can also help you make other lifestyle changes to support your overall health.
You should speak with a healthcare professional 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.
A 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.
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.
A 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.