Diffuse large B-cell lymphoma (DLBCL)
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- What is diffuse large B-cell lymphoma (DLBCL)?
- Symptoms of diffuse large B-cell lymphoma (DLBCL)
- Causes of diffuse large B-cell lymphoma (DLBCL)
- Diagnosis of diffuse large B-cell lymphoma (DLBCL)
- The stages and grades of diffuse large B-cell lymphoma (DLBCL)
- Treatment for diffuse large B-cell lymphoma (DLBCL)
- After treatment for diffuse large B-cell lymphoma (DLBCL)
- About our information
- How we can help
Diffuse large B-cell lymphoma (DLBCL) is a common type of non-Hodgkin lymphoma.DLBCL develops when B-cells become abnormal (cancerous). B-cells are white blood cells that normally help fight infection. They are sometimes called B-lymphocytes.
The abnormal B-cells (lymphoma cells) usually build up in lymph nodes, but they can affect other parts of the body.
DLBCL can affect people of all ages, but it is more common around the age of 70. It is slightly more common in men than in women.
DLBCL develops quickly. You will usually start treatment soon after your diagnosis.
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Painless swelling in the neck, armpit or groin
Painless swelling in the neck, armpit or groin is often the first sign of DLBCL. It is caused by lymphoma cells building up in the lymph nodes, which makes them bigger. Often lymph nodes in more than one part of the body are affected.
Some people also have symptoms that doctors call B symptoms. These can include:
- drenching night sweats which require a change of nightwear and bed covers
- high temperatures (fevers) with no obvious cause
- unexplained weight loss.
Knowing if you have any B symptoms will help your doctor to stage the lymphoma and plan your treatment.
The causes of diffuse large B-cell lymphoma (DLBCL) are mostly unknown. But some things may increase your risk of developing it.
Weak immune system
Your risk of developing DLBCL may be higher if your immune system is weak. Your immune system can be weakened by
- conditions such as HIV infection
- drugs called immunosuppressants – these are wised after an organ transplant, or to treat autoimmune disease.
Some autoimmune diseases such as rheumatoid arthritis may increase your risk of DLBCL. Autoimmune diseases develop when the immune system attacks healthy body tissue by mistake. Doctors do not fully understand why these diseases increase the risk of developing lymphomas. It may be because of the diseases themselves, or because of the treatments used to control them.
Having a parent or sibling with DLBCL
Having a parent, brother or sister with DLBCL may slightly increase your risk of developing it. We do not know why this is. It may be because there is a genetic problem shared by families. Or it may be because people in a family often have similar lifestyles.
Like other cancers, DLBCL is not infectious. It cannot be passed on to other people.
We have more about causes and risk factors in our information about non-Hodgkin lymphoma.
Biopsy for lymphoma
The most common test for diagnosing lymphoma is a biopsy. A doctor will take a sample of tissue from the affected area. The most common place to take a biopsy from is an enlarged lymph node. This is called a lymph node biopsy). You may have all or a part of the lymph node removed. The tissue will be sent to a laboratory for testing. You may also have biopsies taken from other areas of your body.
You can read more about further tests you may have in our information about non-Hodgkin lymphoma.
Waiting for test results can be a difficult. You may find it helpful to talk to your family, friends or specialist nurse.
Your test results will help your doctors find out how many areas of your body are affected by lymphoma and where these areas are. This is called staging.
Knowing the stage of the lymphoma helps your doctor plan the right treatment for you.
Lymphomas are grouped as either low-grade or high-grade. Low-grade lymphomas are usually slow growing. High-grade lymphomas usually grow more quickly. Diffuse large B-cell lymphoma (DLBCL) is a high-grade, fast growing lymphoma.
We have more information about the stages of non-Hodgkin lymphoma.
A team of specialists will meet to discuss the best possible treatment for you. They are called a multidisciplinary team (MDT).
Your doctor, cancer specialist or nurse will explain the different treatments and their side effects to you. They will also talk to you about things to consider when making treatment decisions.
You may have some treatments as part of a clinical trial.
These are the most common treatments for DLBCL.
Immunotherapy and chemotherapy
A commonly used combination is called R-CHOP. Other combinations are sometimes used, such as:
- R-GCVP - rituximab, gemcitabine, cyclophosphamide, vincristine and prednisolone (a steroid)
A small number of people are at risk of having lymphoma in their brain or spinal cord. Chemotherapy can be given directly into the spinal fluid to treat lymphoma or to reduce the risk of lymphoma developing in these areas. This is called intrathecal chemotherapy.
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. Some people have radiotherapy before or after chemotherapy to treat an area of lymphoma. Radiotherapy after chemotherapy can treat any remaining lymphoma cells in the area. It can also reduce the risk of lymphoma coming back in the area. Radiotherapy is also sometimes given to treat symptoms, such as pain.
Stem cell transplants
CAR-T cell therapy
CAR-T cell therapy (chimeric antigen receptor therapy) involves collecting your own immune cells, reprogramming them, and then using them as a treatment to target the lymphoma cells. It can be used when the lymphoma is advanced and when other treatments have failed. CAR-T therapy is complicated and can have serious side effects. It is only suitable for a very small number of people. Currently, it is only available in a few specialist hospitals.
We have more information about treating lymphoma that has come back.
You will have regular follow-up appointments after your treatment. You can talk to your doctor or nurse about any concerns you may have at these appointments. Your doctor will want to know how you are feeling, and to check you are recovering from any side effects of treatment.
Sometimes side effects may continue or develop months or years after treatment. These are called late effects. We have more information about long-term and late effects of treatment for lymphoma.
Sex life and fertility
Cancer and its treatment can sometimes affect your sex life. There ways to improve your sexual well-being and to manage any problems.
Treatment for lymphoma may affect your fertility. If you are worried about your fertility it is important to talk with your doctor before you start treatment. We have more information about:
Everyone has their own way of dealing with 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.
Macmillan can offer emotional, practical and financial help and support. If you would like to talk, you can:
The organisations below also offer information and support:
Blood Cancer UK
Lymphoma Action gives emotional support, advice and information for people with Hodgkin lymphoma or non-Hodgkin lymphoma and those close to them. It has a national network of people with lymphoma, as well as local groups. Their website has a section called trialslink where you can see information about lymphoma clinical trials.
Below is a sample of the sources used in our diffuse large B-cell lymphoma (DLBCL) information. If you would like more information about the sources we use, please contact us at email@example.com
Tilly H, Gomes da Silva M, et al on behalf of the ESMO Guidelines Committee. Diffuse large B-cell lymphoma (DLBCL): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2015. Sept:26 (Supplement 5), v116-125. Available from www.annalsofoncology.org/article/S0923-7534(19)47184-6/pdf
Vitolo U, Seymour JF, et al. Extranodal diffuse large B-cell lymphoma and primary mediastinal B-cell lymphoma: ESMO Clinical Practice Guidelines. Annals of Oncology. 2016. 27 (Supplement 5), v91-v102. Available from: www.annalsofoncology.org/article/S0923-7534(19)31640-0/pdf
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Anne Parker, Consultant Haematologist.
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