Diffuse large B-cell lymphoma
Diffuse large B-cell lymphoma (DLBCL) is a specific type of non-Hodgkin lymphoma.
This information should ideally be read with our general information about non-Hodgkin lymphoma. We hope this information answers your questions. If you have any further questions, you can ask your doctor or nurse at the hospital where you are having treatment.
Non-Hodgkin lymphoma is a cancer of the lymphatic system. Non-Hodgkin lymphoma is a cancer of the lymphatic system. This system is part of the body’simmune system, which helps us fight infection. It is made up of organs such as the bone marrow, thymus, spleen and the lymph nodes (sometimes called lymph glands).
There are lymph nodes all over the body. They are connected by a network of tiny tubes (lymphatic vessels) that contain lymph fluid. As lymph fluid flows through the lymph nodes, the nodes collect and filter out things that the body doesn't need. These include bacteria, viruses, damaged cells and cancer cells.
Lymph fluid contains lymphocytes. These are white blood cells that help the body fight infection and disease.
Lymphocytes grow in the bone marrow, where blood cells are made. The two main types of lymphocyte are B-cells and T-cells. B-cells mature in the bone marrow. T-cells mature in the thymus gland behind the breastbone. When they are mature, both B-cells and T-cells help fight infections.
Lymphoma is a disease in which either T-cells or B-cells grow in an uncontrolled way.
There are many different types of non-Hodgkin lymphoma. They're grouped (or classified) according to things like the type of cell involved (B-cells or T-cells) and how quickly the lymphoma grows.
Diffuse large B-cell lymphoma (DLBCL)
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Diffuse large B-cell lymphoma is a type of non-Hodgkin lymphoma that affects the B-cells. DLBCL can occur at any time between adolescence and old age. The most common age to be diagnosed is around 60. It is slightly more common in men than in women.
The causes of DLBCL are unknown. Like other cancers, it’s not infectious and can’t be passed on to other people.
Signs and symptoms of DLBCL
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The first sign of DLBCL is often a painless swelling in the neck, armpit or groin. This is caused by enlarged lymph nodes. Often, lymph nodes in more than one part of the body are affected.
Sometimes, DLBCL doesn't begin in the lymph nodes but in another part of the body instead. This is called extranodal disease. The most common place for DLBCL to develop outside of the lymph nodes is the stomach or bowel. Symptoms depend on where the lymphoma is in the body.
General symptoms of DLBCL may include loss of appetite and tiredness.
Some people may also have night sweats, high temperatures (fevers) or weight loss. These are known as B symptoms.
How DLBCL is diagnosed
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The most common test to diagnose DLBCL is a lymph node biopsy. A doctor removes part or all of an enlarged lymph node. This involves a small operation, which may be done under local or general anaesthetic. The lymph node will be examined under a microscope. The doctors may also take biopsies from other areas of the body.
You may have some other tests, such as:
bone marrow samples
You may also have a lumbar puncture to check for lymphoma cells in your central nervous system (CNS).
The CNS consists of your brain and spinal cord. These are surrounded by a fluid called cerebrospinal fluid (CSF). In some types of lymphoma, the lymphoma cells may get into this fluid. To check this, your doctor uses a lumbar puncture. They use a local anaesthetic to numb the lower part of your back and then pass a needle gently into the spine. They take a small sample of the CSF fluid to check for lymphoma cells.
Doctors use the information from all these tests to find out more about the lymphoma, such as its stage and grade (see below).
We have more information about further tests for non-Hodgkin lymphoma.
Staging and grading of DLBCL
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Your doctors will look at how many groups of lymph nodes are affected, and whether the lymphoma has spread to other organs. This is called staging.
A group of lymph nodes refers to lymph nodes in one area of the body, such as in the armpit, on one side of the neck or in the groin.
One group of lymph nodes in one area of the body is affected.
Two or more groups of lymph nodes are affected. All the affected nodes are either above the diaphragm or below the diaphragm. The diaphragm is a sheet of muscle under the lungs.
The lymphoma is in lymph nodes both above and below the diaphragm.
The lymphoma has spread beyond lymph nodes to other organs such as the bone marrow, liver or lungs.
Doctors add either the letter A or B after the stage number. This is to show whether you have any B symptoms such as night sweats, high temperatures (fevers) or weight loss.
If you don't have any of these symptoms, the letter A will be added next to the stage. If you do have them, the letter B is added.
Sometimes, the lymphoma can start outside the lymph nodes. This is called extranodal lymphoma. In this case, the stage will include the letter E (for extranodal).
Doctors also divide non-Hodgkin lymphomas into two groups depending on how quickly they grow:
indolent (low-grade) – these grow slowly
aggressive (high-grade) – these grow quickly.
DLBCL is an aggressive lymphoma. It is fast-growing and usually needs to be treated quickly.
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It is the main treatment for DLBCL.
DLBCL is usually treated with a combination of drugs called R-CHOP. You can have this treatment as an outpatient.
R-CHOP is named after the initials of the drugs used, which are:
The drugs are given into a vein (intravenously). The treatment is usually given to you every three weeks (every 21 days). You will have up to eight treatments over several months.
Chemotherapy can also be given into the spinal fluid to allow the drug to reach the spinal cord and brain (central nervous system). This is called intrathecal chemotherapy.
DLBCL usually responds well to chemotherapy and treatment may make it disappear (remission). Many people who go into remission are cured but there is a risk that the lymphoma may come back (relapse) in the future. If this happens, different chemotherapy treatments can be used, either with or without rituximab.
Monoclonal antibody therapy
Monoclonal antibodies such as rituximab target certain proteins on the surface of cancer cells. They can either make chemotherapy work better or they can stimulate the body’s immune system to destroy cancer cells.
Other types of monoclonal antibodies are being researched. Some monoclonal antibodies can have small radioactive substances attached to them. This allows them to deliver radiation directly to the lymphoma cells.
Steroids are drugs that are often given with chemotherapy to treat lymphomas. They also help you feel better and can reduce feelings of sickness.
Radiotherapy uses high-energy rays to destroy cancer cells, while doing as little harm as possible to nearby healthy cells. Radiotherapy only treats the area of the body that the rays are aimed at. It may be used when the lymphoma is confined to one or two areas of lymph nodes in the same part of the body (stage 1 or 2). It may be given after chemotherapy. Radiotherapy is also sometimes given to treat symptoms such as pain.
Stem cell treatment (transplants)
Some people with lymphoma may have treatment using stem cells. This treatment is not suitable for everyone. Stem cells are blood cells at their earliest stage of development. All blood cells develop from stem cells. There are two different types of stem cell treatment.
Some people have some of their own stem cells collected and stored. This allows them to have higher doses of chemotherapy to destroy the lymphoma cells. After the chemotherapy, their stem cells are returned to them by a drip, like a blood transfusion. This is to help the blood cells recover from the effects of chemotherapy. This treatment is called high-dose chemotherapy with stem cell support.
Some people may have treatment using stem cells from another person (a donor). This is called a donor (allogeneic) stem cell transplant.
There are some newer treatments available that may be used to help control DLBCL.
You may be invited to join a clinical trial looking at new ways of treating DLBCL. You can talk about this with your haematology doctor.
Follow-up after treatment for DLBCL
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Sometimes, there is a risk of scar tissue developing in the affected lymph nodes after treatment. The scar tissue can make it difficult to assess whether or not there are still lymphoma cells in the lymph nodes. A scan known as a PET scan may be used after treatment is finished to check if there is still any active lymphoma.
Information and support
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Everyone has their own way of dealing with their illness and the different emotions they experience. You may find it helpful to talk to family and friends, or your doctor or nurse. You can also contact our cancer support specialists or the organisations listed below for more information and support.
Other useful organisations
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The Lymphoma Association
The Lymphoma Association gives emotional support, advice and information on all aspects of non-Hodgkin lymphoma. Has a national network of people with lymphoma and local groups.
Leukaemia CARE is a national group promoting the welfare of people with leukaemia and other blood disorders, including non-Hodgkin lymphoma. Has regional support groups in many counties.
Leukaemia & Lymphoma Research
Leukaemia & Lymphoma Research provides information on non-Hodgkin lymphomas and other blood disorders.
This section has been compiled using information from a number of reliable sources, including:
Ansell S. Rare Hematological Malignancies. 2008. Springer, New York.
Parker A, et al. Best Practice in Lymphoma Diagnosis and Reporting (Specific disease appendix) [PDF]. British Committee for Standards in Haematology. 2010. (accessed 18 March 2014).
Tilly H, Vitolo U, et al. Diffuse large B-cell lymphoma (DLBCL): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2012. 21(suppl. 7): vii78–vii82.
Thanks to Dr Kirit Ardeshna, Consultant Haematologist, and the people affected by cancer who reviewed this edition.
Reviewing information is just one of the ways you could help when you join our Cancer Voices network.