Mediastinal large B-cell lymphoma

Mediastinal large B-cell lymphoma (MLBCL) is a rare type of non-Hodgkin lymphoma (NHL). It mainly affects young adults, and is more common in women.

MLBCL develops when the body makes abnormal B-lymphocytes – the lymphoma cells. (B-lymphocytes are white blood cells that fight infection.) The lymphoma cells start as a growth between the lungs and behind the breast bone, in an area called the mediastinum. This may cause symptoms including:

  • a cough
  • aching in the chest
  • breathlessness
  • hoarseness
  • swelling in the neck, arm and face.

To diagnose MLBCL, a doctor removes some tissue from the area and checks it for lymphoma cells. You will also have tests and scans to find out whether the lymphoma has spread. This is called staging.

MLBCL is fast-growing and needs to be treated quickly. This is usually with a combination of chemotherapy drugs and a targeted therapy drug called rituximab. Some people may also have radiotherapy. You may be invited to join a clinical trial looking at new ways of treating MLBCL. You can talk about this with your haematology doctor.

What is mediastinal large B-cell lymphoma (MLBCL)?

Mediastinal large B-cell lymphoma (MLBCL) is a rare type of non-Hodgkin lymphoma (NHL).

The mediastinum is an area inside the chest, between the lungs and behind the breast bone. It contains the thymus, the heart, some large blood vessels, the gullet, the windpipe and lymph nodes.

MLBCL usually affects younger people aged 25 to 40, and is more common in women than in men.

This information is best read with our general information about NHL. We hope it answers your questions. If you have any further questions, you can ask your doctor or nurse at the hospital where you are having treatment.

What is non-Hodgkin lymphoma (NHL)?

Non-Hodgkin lymphoma (NHL) is a cancer of the lymphatic system. The lymphatic system is made up of organs such as the bone marrow, thymus, spleen, and lymph nodes (or lymph glands). Lymph nodes are connected by a network of tiny lymphatic vessels that contain lymph fluid. There is also lymphatic tissue in other organs, such as the skin, lungs and stomach.

There are lymph nodes all over the body. As lymph fluid flows through the lymph nodes, the nodes collect and filter out anything harmful or that the body doesn't need. This includes bacteria, viruses, damaged cells and cancer cells.

The lymphatic system
The lymphatic system

View a large version

Read a description of this image

Lymph fluid contains cells called lymphocytes. These are a type of white blood cell that helps the body fight infection and disease.

Lymphocytes start to grow in the bone marrow, where blood cells are made. The two main types of lymphocytes are B-cells and T-cells. B-cells mature in the bone marrow, while T-cells mature in the thymus gland behind the breast bone. When they're mature, both B-cells and T-cells help fight infections.

Lymphoma is a disease where either T-cells or B-cells grow in an uncontrolled way.

There are many different types of NHL. They're grouped (or classified) according to things like the type of cell involved (B-cells or T-cells) and how quickly the lymphoma grows.

The most common type of NHL is called diffuse large B-cell lymphoma. Mediastinal large B-cell lymphoma (MLBCL) is a rare type of diffuse large B-cell lymphoma. It starts as a growth (mass) in the mediastinum. This is caused by abnormal B cells growing in an uncontrolled way. They keep on dividing and making more and more abnormal cells. These cells form a lump, which is called a tumour.

Causes of mediastinal large B-cell lymphoma

The causes of MLBCL are unknown. Like other cancers, it is not infectious and cannot be passed on to other people.

Signs and symptoms of mediastinal large B-cell lymphoma

Symptoms may be caused by the lymphoma pressing on nearby structures in the chest. This can cause:

  • a cough
  • aching in the chest
  • breathlessness.

Sometimes it may cause hoarseness. Some people develop swelling in their neck, arm and face due to the lymphoma pressing on the veins in the chest. This is known as superior vena cava obstruction (SVCO).

Other symptoms include loss of appetite and tiredness.

Some people have more general symptoms, such as drenching night sweats, unexplained high temperatures (fevers) and unexplained weight loss. These are known as B symptoms.

Diagnosing mediastinal large B-cell lymphoma

A diagnosis is made by removing a sample of tissue from the tumour (a biopsy) and examining the cells under a microscope.

The biopsy may be taken during a CT scan to help the doctor find the affected area. Some people will have their biopsy taken under a general anaesthetic.

If the lymph nodes in the mediastinum are the only ones affected, the biopsy is likely to be taken during a procedure known as a mediastinoscopy. The doctor makes a small cut in the chest and inserts a thin, flexible tube with a camera attached. Tissue samples of the lymph nodes can then be taken.

Additional tests include:

  • blood tests
  • x-rays
  • scans
  • bone marrow biopsy
  • heart tests, such as an ECG and an echocardiogram.

The results of these tests are used to find out more about the lymphoma and how far it has spread in the body. This information is used to help decide which treatment is most appropriate.

Staging and grading of mediastinal large B-cell lymphoma


The stage of non-Hodgkin lymphoma describes how many groups of lymph nodes are affected, where they are in the body, and whether other organs such as the bone marrow or liver are involved. A group of lymph nodes refers to lymph nodes in one area of the body, such as in the armpit, on one side of the neck, or in the groin.

When lymphoma starts outside the lymph nodes, this is called extranodal lymphoma, and the stage will include the letter E (for extranodal).

There are four stages:

Stage 1

One group of lymph nodes is affected


The lymphoma is in one area of a single organ outside the lymphatic system (called stage 1E).

Stage 2

Two or more groups of lymph nodes are affected and they are either above or below the diaphragm (a sheet of muscle under the lungs that separates the chest from the abdomen)


The lymphoma is in one organ or area of the body and is in lymph nodes on the same side of the diaphragm (called stage 2E).

Stage 3

The lymphoma is in lymph nodes both above and below the diaphragm.

Stage 4

The lymphoma has spread to other organs, such as the bone marrow, liver, brain or the lining of the lungs (pleura).

Doctors also add the letter A or B to show whether you have any of the following symptoms: weight loss, fevers or night sweats.

If you don't have any of these symptoms, the letter A will be added next to the stage. If you do have these symptoms, the letter B is added next to the stage.


Non-Hodgkin lymphomas are divided into two groups:

  • indolent (sometimes called low-grade) – these grow slowly
  • aggressive (sometimes called high-grade) – these grow quickly.

Mediastinal large B-cell lymphoma is an aggressive lymphoma. This means it is fast-growing and usually needs treatment with chemotherapy straightaway.

Treating mediastinal large B-cell lymphoma

Chemotherapy with monoclonal antibody treatment, called immunochemotherapy, is the main treatment for MLBCL.

Other treatments such as radiotherapy are also used. You may have a combination of different treatments.

MLBCL usually responds well to immunochemotherapy, but in some people the lymphoma comes back and further treatment is needed. This may include a stem cell transplant.


Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. You will usually have a combination of different chemotherapy drugs given into the vein (intravenously), either as injections or through a drip (infusion). Your specialist will explain which combination of drugs is most appropriate for you. 

A commonly used treatment is a combination of drugs is called R-CHOP. This includes:

Another chemotherapy combination that may sometimes be used is DA-EPOCH-R. This includes:

  • etoposide 
  • vincristine
  • cyclophosphamide
  • doxorubicin 
  • prednisolone 
  • rituximab.

‘DA’ stands for ‘dose-adjusted’, as the dose of drugs can be adjusted depending on how your body responds to the treatment. 

Targeted therapy

You might have a type of targeted therapy called a monoclonal antibody. Monoclonal antibodies are drugs that recognise, target and stick to particular proteins on the surface of cancer cells, and can stimulate the body’s immune system to destroy these cells

Rituximab is the main monoclonal antibody drug used to treat MBLCL. It's given as a drip (infusion). Rituximab is usually given with chemotherapy as part of the R-CHOP regimen.

Stem cell treatment (transplants)

Some people with lymphoma may have treatment using stem cells. This treatment is not suitable for everyone. Stem cells are blood cells at their earliest stage of development. All blood cells develop from stem cells. There are two different types of stem cell treatment.

Some people have some of their own stem cells collected and stored. This allows them to have higher doses of chemotherapy to destroy the lymphoma cells. After the chemotherapy, their stem cells are returned by a drip (like a blood transfusion) to help their blood cells recover from the effects of chemotherapy. This is called high-dose treatment with stem cell support (autologous stem cell transplant).

Some people may have treatment using stem cells from another person (a donor). This is called a donor (allogeneic) stem cell transplant.


Radiotherapy is the use of high-energy rays to destroy cancer cells while doing as little harm as possible to the healthy cells. Radiotherapy is sometimes given to the area where the lymphoma was after chemotherapy treatment.


Steroids are often given with chemotherapy to help treat lymphomas. They can also help you feel better and reduce feelings of sickness (nausea).

Follow-up for mediastinal large B-cell lymphoma

Often, scar tissue develops in the affected lymph nodes after treatment for lymphoma. The scar tissue can make it difficult to assess whether or not there are still lymphoma cells there.

A scan known as a PET scan may be used after treatment is finished. It checks whether there's any active lymphoma still present.

Clinical trials for mediastinal large B-cell lymphoma

New treatments for MBLCL are being researched all the time.

You may be invited to join a clinical trial looking at new ways of treating MLBCL. You can talk about this with your haematology doctor.

Your feelings

Everyone has their own way of dealing with their 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 contact our cancer support specialists or the organisations below for more information and support:

  • 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.
  • Leukaemia CARE is a national group promoting the welfare of people with leukaemia and other blood disorders, including non-Hodgkin lymphoma. It has regional support groups in many counties.