Diffuse large B-cell lymphoma

Diffuse large B-cell lymphoma (DLBCL) is a common type of non-Hodgkin lymphoma (NHL). It develops when the body makes abnormal B-cells called lymphoma cells. B-cells are white blood cells that fight infection. The lymphoma cells usually build up in lymph nodes, but they can affect other parts of the body.

The most common symptom is a painless swelling in the neck, armpit or groin. Other symptoms may include:

  • tiredness
  • weight loss
  • night sweats
  • high temperatures (fevers).

To diagnose DLBCL, a doctor removes part or all of an enlarged lymph node and checks it for lymphoma cells. You will also have tests to find out more about the lymphoma and to help plan your treatment.

Most people have targeted therapy, chemotherapy and steroids. Some people also have radiotherapy to treat an area of the lymphoma. 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. If this happens, chemotherapy can be used again. Some people will then have high-dose chemotherapy and stem cell support.

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

It is best to read this information with our general information about non-Hodgkin lymphoma (NHL). If you have any more questions, you can ask your doctor or nurse at the hospital where you are having treatment.

Diffuse large B-cell lymphoma (DLBCL) is a common type of fast-growing NHL. 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.


Causes and risk factors for 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.

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, brother or sister with DLBCL may increase your risk of developing it. We don’t 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.


Signs and symptoms of DLBCL

Usually, the first sign of DLBCL is a painless swelling in the neck, armpit or groin. This 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.

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.

B symptoms

Some people also have:

  • drenching night sweats
  • high temperatures (fevers) with no obvious cause
  • unexplained weight loss.

These are called B symptoms.


Diagnosing 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.

Other tests may include:

  • blood tests
  • x-rays and scans
  • bone marrow samples.

Doctors use the information from all these tests to find out more about the lymphoma, such as its stage and grade.


Staging and grading DLBCL

Staging

The stage of the lymphoma describes which areas of the body are affected by lymphoma. This information helps doctors plan the right treatment for you.

The stage of a lymphoma is usually described using numbers from 1 to 4. Stages 1 and 2 are also called early-stage, limited or localised lymphoma. Stages 3 and 4 are also called advanced lymphoma.

As well as giving each stage a number, doctors often add the letters A or B. A means you do not have B symptoms. B means you do have B symptoms.

Sometimes the lymphoma can affect areas outside the lymph nodes. This is called extranodal lymphoma, and the stage will include the letter E (for extranodal).

Grading

Non-Hodgkin lymphomas are divided into two groups:

  • Low-grade (indolent) lymphomas, which usually grow slowly.
  • High-grade (aggressive) lymphomas, which grow more quickly.

DLBCL is a high-grade, fast-growing lymphoma.


Treating DLBCL

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.

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 high-dose chemotherapy and stem cell support.

Targeted therapy

The drug Rituximab is often used with chemotherapy to treat this type of lymphoma. It works by targeting proteins on the surface of B-cell lymphocytes. This makes the body destroy these cells.

Rituximab is given as a drip into a vein or an injection under the skin.

Chemotherapy

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells.

DLBCL is usually treated with R-CHOP. This is a combination of chemotherapy and other drugs.

R-CHOP is named after the initials of the drugs used. It contains:

  • rituximab – a targeted therapy drug
  • cyclophosphamide, doxorubicin (hydroxydaunomycin) and vincristine (Oncovin®) – chemotherapy drugs
  • prednisolone – a steroid.

The chemotherapy drugs are given into a vein (intravenously). You take the steroid as tablets. You usually have treatment every three weeks (every 21 days). You have up to eight treatments over several months.

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. They also help you feel better and can make you feel less sick.

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 (transplants)

This treatment is sometime used to treat lymphoma that has come back after treatment. It is an intensive treatment, so it is not suitable for everyone.

Stem cells are a type of blood cell that can make all other types of blood cells. There are two different types of stem cell treatment:

High-dose treatment with stem cell support (autologous stem cell transplant)

Some people have treatment to put the lymphoma into remission. Then some of their own stem cells are collected from their blood and stored. Then they have high doses of chemotherapy to try to destroy any remaining lymphoma cells. After this, their stem cells are returned through a drip (like a blood transfusion). The stem cells help their blood cell numbers recover from the effects of chemotherapy.

Donor transplant (allogeneic transplant)

Some people have chemotherapy to put the lymphoma into remission and are then given stem cells from another person (a donor).

Clinical trials

Your lymphoma doctor may talk to you about having treatment as part of a clinical trial. Clinical trials test new treatments or new ways of giving treatments.

I was stage 4 with DLBC NHL diagnosed in 2009 and am still here alive and kicking, as are many others who went through treatment at the same time.

John


Follow-up after treatment

After treatment, you will have regular check-ups. 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. We have more information about follow-up.


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. You can also call our cancer support specialists free on 0808 808 00 00. The organisations below also offer information and support:

  • Bloodwise offers support and information to people affected by blood cancers, including lymphoma.
  • The Lymphoma Association gives emotional support, advice and information on all aspects of Hodgkin lymphoma and non-Hodgkin lymphoma. It has a national network of people with lymphoma, and local groups.