Diffuse large B-cell lymphoma (DLBCL)

Diffuse large B-cell lymphoma (DLBCL) is a common type of non-Hodgkin lymphoma.

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)
How we can help

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

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.

What is cancer?

Symptoms of diffuse large B-cell lymphoma (DLBCL)

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.

Other symptoms

DLBCL may also affect other parts of the body outside the lymph nodes, such as the stomach or bowel. This is called extranodal disease. Symptoms depend on the area affected.

General symptoms of DLBCL may include loss of appetite and tiredness.

Do I have cancer?

Causes of diffuse large B-cell lymphoma (DLBCL)

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.
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 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.

Diagnosis of diffuse large B-cell lymphoma (DLBCL)

If you have symptoms that worry you, you should begin by going to your GP. They will examine you. If they think cancer may be causing your symptoms, they will refer you to a specialist doctor at a hospital.

The most important test for diagnosing lymphoma is a biopsy. This means testing a small piece of tissue or a sample of cells from an affected area of your body.

Find out more about having a biopsy and other tests in our general lymphoma information.

Waiting for test results

Waiting for test results can be a difficult time. It may take up to 2 weeks for the results to be ready.

You may find it helpful to talk with your partner, your family or a close friend. Your specialist nurse can also provide support.

You can talk to one of our cancer support specialists for free on 0808 808 00 00, 7 days a week, 8am to 8pm.

Booklets and resources

The stages and grades of diffuse large B-cell lymphoma (DLBCL)

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.

Treatment for diffuse large B-cell lymphoma (DLBCL)

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
DLBCL is usually treated with a combination of the immunotherapy drug rituximab, chemotherapy and other drugs. This is called chemoimmunotherapy.

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)

R-CODOXM

R-IVAC.

We have more information on chemotherapy and immunotherapies for lymphoma.

Intrathecal chemotherapy

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.

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 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
You may have a stem cell transplant to treat relapsed DLBCL. A stem cell transplant 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)

cells from a donor (allogeneic stem cell transplant).

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.

After treatment for diffuse large B-cell lymphoma (DLBCL)

Getting support

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:

Call the Macmillan Support Line on 0808 808 00 00.
Chat to our specialists online.
Visit our diffuse large B-cell lymphoma forum to talk with people who have been affected by diffuse large B-cell lymphoma (DLBCL), share your experience, and ask an expert your questions.