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)
- Staging and grading of diffuse large B-cell lymphoma (DLBCL)
- Treatment for diffuse large B-cell lymphoma (DLBCL)
- After diffuse large B-cell lymphoma (DLBCL) treatment
- About our information
- How we can help
Diffuse large B-cell lymphoma (DLBCL) is a common type of fast-growing non-Hodgkin lymphoma. It develops when B-cells (also called B-lymphocytes) become abnormal. B-cells are white blood cells that fight infection.
The abnormal B-cells (lymphoma cells) usually build up in lymph nodes, but they can affect other parts of the body. here are many types of B-cell lymphoma. DLBCL is one of the most common types of B-cell lymphoma.
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Painless swelling in neck, armpit or groin
This 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:
- drenching night sweats
- high temperatures (fevers) with no obvious cause
- unexplained weight loss
Doctors call this group of symptoms B symptoms.
DLBCL may also affect other parts of the body outside the lymph nodes. This is called extranodal disease. Symptoms depend on the area affected.
General symptoms may include loss of appetite and tiredness.
In most cases, the cause of DLBCL is unknown. Like other cancers, it is not infectious and cannot be passed on to other people. But some things may increase the risk of developing it.
Weak immune system
If the body’s immune system is weak, the risk of developing DLBCL may be higher. Conditions such as HIV infection can weaken the immune system. Drugs called immuno-suppressants also cause this. Some people need this type of drug after an organ transplant.
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 lymphoma. It may be because of the diseases themselves, or because of treatments used to control them.
Having a parent or sibling with DLBCL
Having a parent, brother or sister with DLBCL may increase your risk of developing it. We do not know why this is yet. It may be because there is a genetic change that runs in families. Or it may be because people in a family tend to have the same lifestyle factors.
DLBCL can affect people at all ages, but it is more common around the age of 60. It is slightly more common in men than in women.
Biopsy for lymphoma
The most common test for this lymphoma is to remove part or all of an enlarged lymph node (a biopsy). This may be done under local or general anaesthetic. The biopsy is then sent to a laboratory to be checked for lymphoma cells. You may also have biopsies taken from other areas of the 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 time. It may help to talk to your family, friends or specialist nurse.
The results of your tests help your doctors find out how many areas of the body are affected by lymphoma and where these areas are. This is called staging.
Lymphomas are also grouped as either low-grade or high-grade. Low-grade lymphomas are usually slow growing and high-grade lymphomas grow more quickly. DLBCL is a high-grade, fast growing lymphoma.
We have more information about staging and grading of non-Hodgkin lymphoma.
A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).
Your doctor or cancer specialist or nurse will explain the different treatments and their side effects. They will also talk to you about things to consider when making treatment decisions.
Your treatment may depend on:
- the stage of the lymphoma
- whether you have B symptoms
- the area of your body affected by lymphoma.
Most people have a combination of drugs that include targeted therapy, chemotherapy and steroids. Some people also have radiotherapy to treat an area of the lymphoma in the body. You usually have these treatments as an outpatient.
Treatments for DLBCL may include:
DLBCL is usually treated with R-CHOP This is a combination of chemotherapy and other drugs. 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. It may be given to treat lymphoma or to reduce the risk of lymphoma developing in these areas.
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 after chemotherapy to treat an area of lymphoma. This 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 treatment
Stem cell treatment (transplants) is sometimes used to treat lymphoma that has come back after treatment. It is an intensive treatment, so it is not suitable for everyone.You may have a transplant using your own stem cells (autologous stem cell transplant) or cells from a donor (allogeneic stem cell transplant).
You may have some treatments as part of a clinical trial.
These treatments may make all signs of the DLBCL disappear (called remission). Many people who go into remission are cured, but sometimes DLBCL comes back (called recurrence or relapse). If this happens, different chemotherapy treatments can be used, either with or without a targeted therapy called rituximab. Some people will then have a stem cell transplant.
You have regular follow-up appointments after treatment. These appointments are a good opportunity for you to talk to your doctor or nurse about any concerns you have. Your doctor will want to know how you are feeling generally, and to check you are recovering from any side effects of treatment.
Sometimes a side effect may continue or develop months or years after treatment. This is called a late effect.
We have more information about long-term and late effects of treatment for lymphoma.
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
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 firstname.lastname@example.org
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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