Diffuse large B-cell lymphoma
Diffuse large B-cell lymphoma 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. This is part of the body’s immune system and helps us fight infection. It's made up of organs such as the bone marrow, thymus, spleen and the lymph nodes (or lymph glands). Lymph nodes are connected by a network of tiny lymphatic vessels that contain lymph fluid.
There is also lymphatic tissue in other organs, such as the skin, lungs and stomach.
There are lymph nodes all over the body. As lymph fluid flows through the lymph nodes, the nodes collect and filter out anything harmful, or anything that the body doesn't need. This includes bacteria, viruses, damaged cells and cancer cells.
Lymph fluid contains lymphocytes. These are a type of white blood cell that help the body fight infection and disease.
Lymphocytes grow in the bone marrow, where blood cells are made. The two main types of lymphocytes are B-cells and T-cells. B-cells mature in the bone marrow, while T-cells mature in the thymus gland behind the breast bone. When they're 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 lymphomas. They're grouped (or classified) according to certain characteristics, such as the type of cell involved (B-cells or T-cells). The most widely used classification system is produced by the World Health Organisation.
What is diffuse large B-cell lymphoma
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Diffuse large B-cell lymphoma (DLBCL) is a common type of non-Hodgkin lymphoma and is a cancer of 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.
Causes of diffuse large B-cell lymphoma
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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 diffuse large B-cell lymphoma
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The first sign of the condition is often a painless swelling in the neck, armpit or groin, caused by enlarged lymph nodes. Sometimes lymph nodes in more than one part of the body are affected.
In some people, DLBCL doesn't begin in the lymph nodes but develops 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, but any area of the body can be affected. The lymphoma may spread to various organs in the body such as the liver, lungs or bones. Some people experience a loss of appetite and tiredness.
Other symptoms, known as B symptoms, include night sweats, unexplained high temperatures and weight loss.
How diffuse large B-cell lymphoma is diagnosed
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A diagnosis is made by removing an enlarged lymph node (biopsy) and examining the cells under a microscope. It is a very small operation and may be done under local or general anaesthetic. Biopsies may also be taken from other areas of the body. Additional tests - including blood tests, x-rays, scans and bone marrow samples - are done to find out more about the type of lymphoma and how far it has spread in the body. Doctors use this information to decide which treatment is most appropriate for you. You can read more about these tests in our general information about non-Hodgkin lymphoma.
Staging and grading of large B-cell lymphoma
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The stage of non-Hodgkin lymphoma describes how many groups of lymph nodes are affected, where they are in the body, and whether other organs such as the bone marrow or liver are involved.
The lymphoma is only in one group of lymph nodes, in one particular area of the body.
More than one group of lymph nodes is affected, but all the affected nodes are in either the upper or lower half of the body. The upper half of the body is above the diaphragm (the sheet of muscle underneath the lungs) and the lower half is below it.
The lymphoma is in lymph nodes above and below the diaphragm. The spleen is considered a lymph node in this staging system.
The lymphoma has spread beyond lymph nodes to other organs such as the bones, liver or lungs.
As well as giving each stage a number, doctors also use either the letter A or B to show whether or not you have specific symptoms. If you have weight loss, fevers or night sweats, the letter B is added next to the stage. If you don't have these symptoms, the letter A is added.
Sometimes the lymphoma can start in areas outside the lymph nodes. This is called extranodal lymphoma and the stage will include the letter E, for extranodal.
Non-Hodgkin lymphomas are divided into two groups: indolent (sometimes called low-grade) and aggressive (sometimes called high-grade). Indolent lymphomas are usually slow‑growing, and aggressive lymphomas grow more quickly.
Diffuse large B-cell lymphoma is an aggressive lymphoma. This means that 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 diffuse large B-cell lymphoma. The type of chemotherapy you have will depend on the extent of the lymphoma and other factors, such as your age and general health.
The most widely used combination treatment is called the R-CHOP regimen.
This is made up of the chemotherapy drugs doxorubicin, cyclophosphamide and vincristine, the steroid prednisolone, and a monoclonal antibody called rituximab.
The chemotherapy drugs and rituximab are given into a vein (intravenously). The treatment can usually be given to you at hospital as an outpatient and continues for 4–6 months.
Chemotherapy will lead to a cure in a large number of people with diffuse large B-cell lymphoma. Even when a cure is not possible, treatment can still usually control the disease for a number of years. Further chemotherapy can often be given if the lymphoma comes back after initial treatment. Chemotherapy regimes that are used in this situation include ICE, ESHAP and DHAP, all of which can be given with or without rituximab.
Monoclonal antibody therapy
Monoclonal antibodies are drugs that recognise, target and stick to specific proteins on the surface of cancer cells, and can stimulate the body’s immune system to destroy these cells.
Rituximab (Mabthera®) is a monoclonal antibody that is commonly used to treat diffuse large B-cell lymphoma. It is usually given with chemotherapy as part of the R-CHOP regimen.
Other types of monoclonal antibodies are being researched. Some are attached to
low doses of a radioactive substance, and deliver radiation into the lymphoma cells. The most commonly used radioactive monoclonal antibodies are 90Y-ibritumomab tiuxetan (Zevalin®) and Iodine131 tositumomab (Bexxar®).
Stem cell treatment (transplants)
Some people with lymphoma may have treatments using their own stem cells or stem cells from a donor. Stem cells are a special type of blood cell that can make all other types of blood cells.
This treatment is not suitable for everyone and is not done routinely. Doctors take into account a person's general health and fitness before recommending them.
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 by a drip (like a blood transfusion) to help their blood cells recover from the effects of chemotherapy. This 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.
Radiotherapy is the use of high-energy rays to destroy cancer cells, while doing as little harm as possible to the healthy cells. 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 also be given in addition to chemotherapy. Radiotherapy is also sometimes given to improve symptoms such as pain.
Steroids are drugs that are often given with chemotherapy to help treat lymphomas. They also help you feel better and can reduce feelings of sickness.
Follow-up after treatment for diffuse large B-cell lymphoma
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Sometimes there is a risk of developing scar tissue in the affected lymph nodes after treatment for DLBCL. 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 any active lymphoma are still present.
New treatments for diffuse large B-cell lymphoma are being researched all the time. Your doctor may invite you to take part in a clinical trial to compare a new treatment against the best available standard treatment.
Your doctor must discuss the treatment with you, and have your informed consent before entering you into a trial.
Before any trial is allowed to take place, it must be approved by a research ethics committee, which protects the interests of those taking part.
You may decide not to take part or to withdraw from the trial at any stage. You will then receive the best standard treatment available.
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 things over with 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:
Facilities for the treatment of adults with haematological malignancies - 'Levels of Care' British Committee for Standards in Haematology 2010.
Lee, et al. Wintrobe’s Clinical Haematology. 12th edition. 2009. Lippincott, Williams and Wilkins.
Tilly H, Dreyling M, and on behalf of the ESMO Guidelines Working Group. Diffuse large B-cell non-Hodgkin's lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2010. 21. 5: 172–174.
With thanks to: Professor Rajnish Gupta, Consultant Medical Oncologist; and all of the people affected by cancer who reviewed this edition.
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