What is diffuse large B-cell lymphoma (DLBCL)?

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.

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Symptoms of diffuse large B-cell lymphoma (DLBCL)

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.

B symptoms

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.

Other 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.

Causes of diffuse large B-cell lymphoma (DLBCL)

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.

  • Autoimmune diseases

    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.

Diagnosis of diffuse large B-cell lymphoma (DLBCL)

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.

Staging and grading of diffuse large B-cell lymphoma (DLBCL)

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.

Treatment for diffuse large B-cell lymphoma (DLBCL)

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:

  • Targeted therapy

    Rituximab is often used with chemotherapy to treat this type of lymphoma.

  • Chemotherapy

    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.

  • Steroids

    Steroids are drugs that are often given with chemotherapy to treat lymphomas. They help make chemotherapy more effective.

  • Radiotherapy

    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.

After diffuse large B-cell lymphoma (DLBCL) treatment

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.

Late effects

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.

Well-being and recovery

Even if you already have a healthy lifestyle, you may choose to make some positive lifestyle changes after treatment.

Making small changes such as eating well and keeping active can improve your health and wellbeing and help your body recover.

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