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?
Diffuse large B-cell lymphoma (DLBCL) is a common type of blood cancer. It is a type of lymphoma called non-Hodgkin lymphoma.
DLBCL develops when blood cells called B-cell lymphocytes become abnormal. These blood cells normally help fight infection.
The abnormal B-cells usually build up in lymph nodes. But they can often affect other parts of the body.
Other large B-cell lymphomas
DLBCL is the most common large B-cell lymphoma. But there are others that may be treated in a similar way. The information on this page may be useful if you have one of the following types:
- high grade B-cell lymphoma
- grey zone lymphoma
- double-hit lymphoma – this is high grade B-cell lymphoma with certain genetic changes in the cells.
Lymphoma Action has more detailed information about these types.
Related pages
Booklets and resources
Symptoms of DLBCL
Usually the first sign of DLBCL is a painless swelling or lump in the neck, armpit or at the top of the leg (groin). This is caused by lymphoma cells building up in the lymph nodes. It usually affects lymph nodes in more than one part of the body.
DLBCL may also affect other parts of the body outside the lymph nodes, such as the stomach or bowel. Symptoms depend on the area affected.
You can find out more in our general information about lymphoma symptoms.
B symptoms
DLBCL may also cause the following symptoms:
- drenching night sweats
- unexplained weight loss.
These are called B symptoms. Along with staging and grading (below), B symptoms can help your cancer team understand:
- how the lymphoma might develop
- which treatments might help.
Worried about symptoms?
A change in how you feel or how your body works can be caused by conditions other than DLBCL. But always ask your GP to check any ongoing, new or unexplained symptoms. We are also here if you need someone to talk to. You can:
- call the Macmillan Support Line for free on 0808 808 00 00, 7 days a week, 8am to 8pm.
- chat to our specialists online.
Related pages
Causes of DLBCL
The causes of DLBCL are mostly unknown. But some things may increase your risk of developing it.
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Weak immune system
Your risk may be higher if your immune system is weak. Your immune system can be weakened by:
- conditions such as HIV
- drugs called immunosuppressants – these are used after an organ transplant, or to treat autoimmune disease.
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Having a parent or sibling with DLBCL
Having a parent, brother or sister with DLBCL may slightly increase your risk. But the risk is still very low. This may be because there is a genetic problem shared by families. Or it may be because people in a family often have similar lifestyles.
This 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. You cannot spread it to other people.
We have more about causes and risk factors in our non-Hodgkin lymphoma.
Diagnosis of 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 DLBCL 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 to family members 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 0000, 7 days a week, 8am to 8pm.
Related pages
Booklets and resources
Staging and grading of DLBCL
Your test results give your cancer team more information about the lymphoma. This includes:
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The stage
Staging describes how many areas of the body are affected by lymphoma and where these areas are.
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The grade
Grading describes how quickly the lymphoma cells are likely to grow. DLBCL is a high grade lymphoma. High grade lymphoma grows more quickly and needs urgent treatment.
Knowing the stage and grade of the lymphoma helps your cancer team plan the right treatment for you.
We have more information about staging and grading non-Hodgkin lymphoma.
Treatment for DLBCL
A team of specialists will meet to discuss the best possible treatment for you. They are called a multidisciplinary team (MDT).
After the MDT meeting, you will usually meet with your cancer doctor and specialist nurse. They will explain the different treatment options and possible side effects. They will also talk to you about things to consider when making treatment decisions.
Your treatment options will depend on:
- the stage of the lymphoma
- whether you have symptoms that are causing problems
- your general health
- your preferences.
You may only need one type of treatment. Or you may need a combination of treatments.
You may have some treatments as part of a clinical trial.
The following treatments are used to treat DLBCL:
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Cancer drug treatments
DLBCL is usually treated with a combination of targeted therapy, immunotherapy, chemotherapy and steroid drugs.These drug combinations are often used to treat newly diagnosed DLBCL:
Other combinations may also be used, such as:
- R-CVP with gemcitabine (R-GCVP)
- rituximab with CODOX-M and IVAC
- rituximab with dose-adjusted (DA)-EPOCH.
The aim of treatment is to make all signs of the lymphoma disappear. This is called remission. If treatment is not effective or the lymphoma comes back, you may have more cancer drug treatments. These are examples of drugs used to treat DLBCL that has come back:
- R-GDP
- R-ICE
- rituximab with gemcitabine and oxaliplatin (R-GemOx)
- pola-BR
- glofitamab
- epcoritamab
- loncastuximab tesirine.
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Intrathecal chemotherapy
DLBCL can sometimes affect the brain or spinal cord. If your cancer team thinks there is a risk of this, your treatment may involve having one of the following:
- chemotherapy given directly into the spinal fluid – this is called intrathecal chemotherapy
- a drug called high-dose methotrexate as a drip (infusion) into a vein.
The aim is to treat any lymphoma cells and help reduce the risk of lymphoma developing in these areas.
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Steroids
Steroids are drugs that are often given with chemotherapy to treat lymphoma.
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Radiotherapy
Radiotherapy uses high-energy rays called radiation to treat cancer. It destroys cancer cells in the area you have it.
Some people have radiotherapy before or after cancer drug treatment to treat an area of lymphoma. Radiotherapy after cancer drug treatment can treat any remaining lymphoma cells in the area. It can also reduce the risk of lymphoma coming back in the area. Radiotherapy is sometimes given to treat symptoms such as pain.
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CAR T-cell therapy
CAR T therapy is a treatment made from your own white blood cells. A CAR T treatment called axicabtagene ciloleucel can be used to treat DLBCL that has come back after other treatments.
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Stem cell transplants
Stem cell transplants are sometimes used to treat DLBCL that has come back. A stem cell transplant is an intensive treatment, so it is not suitable for everyone.
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Drug treatments to protect the bones
DLBCL and some lymphoma treatments can affect bone health. For some people, this may weaken bones and increase their risk of fracture. Your cancer team will assess your bone health. If you have a higher risk of problems, they may give you drug treatments to protect your bones, such as:
- vitamin D
- bisphosphonates.
After DLBCL treatment
Follow-up after treatment for DLBCL
You will have regular check-ups during and after your treatment. Your cancer doctor or specialist nurse will explain what to expect.
Follow-up appointments are a good time for you to talk to your cancer doctor or specialist nurse about any concerns you have. Tell them as soon as possible if you have any problems or notice new symptoms between appointments. We have more information about follow-up care after treatment.
Sometimes side effects may continue or develop months or years after treatment. These are called late effects. We have more information about late effects of lymphoma treatment.
Wellbeing and recovery
Looking after yourself can help speed up your recovery after DLBCL treatment. Even small lifestyle changes may improve your wellbeing and long term health.
Even if you already have a healthy lifestyle, you may choose to make some positive changes after treatment. We have more information on leading a healthy lifestyle after treatment.
Support for people with DLBCL
People often have many different feelings during and after Burkitt lymphoma treatment. If you have finished treatment, you may feel relieved it has ended but worried about what might happen in the future.
It is important to know where to get support or information if you need it. People often need support even some time after Burkitt lymphoma treatment. But sometimes it is difficult to know who to ask for help.
You can:
- ask your GP or someone from your cancer team for advice about support in your area
- find cancer support services near you
- call the Macmillan Support Line for free on 0808 808 00 00.
- chat to our cancer information specialists online.
- visit our non-Hodgkin lymphoma forum to talk to people who have been affected by lymphoma, share your experience, and ask your questions.
You may also find the HOPE programme helpful. The programme is a free 6 week self-management course designed to help you develop techniques and strategies when living with or after cancer. Topics include goal setting, fatigue management, and wellbeing.
You can sign up for the online HOPE programme. Or to find out more about face to face programmes in your area, email ServiceOpsSupport@macmillan.org.uk
Other organisations who offer information and support
- Blood Cancer UK offers support and information to people affected by blood cancers, including lymphoma.
- Lymphoma Action provides high quality information and support for people affected by lymphoma. It provides helpline services and a range of peer support including online support meetings, educational events and webinars. Its website includes TrialsLink, a database of lymphoma clinical trials.
More information and advice
We know cancer can affect you physically, emotionally and financially. We have information and advice about different ways cancer might impact you, such as help with:
About our information
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.
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References
Below is a sample of the sources used in our lymphoma information. If you would like more information about the sources we use, please contact us at informationproductionteam@macmillan.org.uk
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Ferreri AJM, Illerhaus G, Doorduijn K, et al., on behalf of the EHA and ESMO Guidelines Committees. Primary central nervous system lymphomas: EHA–ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2024;35(6):491-507.
Fox CP, Ahearne MJ, Pettengell R, et al. Guidelines for the management of mature T- and natural killer-cell lymphomas (excluding cutaneous T-cell lymphoma): a British Society for Haematology Guideline. Br J Haematol. 2022;196:507-22.
Fox CP, Chaganti S, McIlroy G, et al. The management of newly diagnosed large B-cell lymphoma: A British Society for Haematology Guideline. Br J Haematol. 2024;204(4):1178–92.
McNamara C, Montoto S, Eyre TA, et al. The investigation and management of follicular lymphoma. Br J Haematol. 2020;191:363-81.
Pratt G, El-Sharkawi D, Kothari J, et al. Diagnosis and management of Waldenström macroglobulinaemia—A British Society for Haematology guideline. Br J Haematol. 2022;197:171–87.
Walewska R, Eyre TA, Barrington S, et al. Guideline for the diagnosis and management of marginal zone lymphomas: A British Society of Haematology Guideline. Br J Haematol. 2024;204(1):86–107.
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