All About Diffuse Large B-Cell Lymphoma

There are five subtypes of DLBCL:

• T-cell/histiocyte-rich B-cell lymphoma (histiocytes are cells that migrate from bone marrow into tissues)
• Primary DLBCL of the central nervous system (which starts in the brain or the eye)
• Primary cutaneous DLBCL, leg type (in spite of the name, the disease can appear anywhere on the body, and can spread beyond the skin)
• Epstein-Barr virus-positive DLBCL of the elderly
• DLBCL not otherwise specified

DLBCL occurs in both men and women although it is slightly more prevalent in men, according to the Lymphoma Research Foundation. The risk increases with age and about one-half of those diagnosed are over the age of 60.

Diffuse large B-cell lymphoma can have general NHL symptoms such as night sweats, fevers, weight loss, fatigue, loss of appetite, or shortness of breath. Often, the first sign of DLBCL is a rapid swelling of lymph nodes in the neck, armpit, or groin, which may be painful.

Your doctor will first need a tissue biopsy to diagnose DLBCL. Once diagnosed, a whole-body CT or PET scan will help determine where and how much lymphoma is present. Your doctor may also request a bone marrow biopsy or spinal tap to determine if lymphoma cells are present in the brain or spinal cord.

The stage of DLBCL is based on how much of the lymphatic system is involved.

• Stage 1 or 2 means that the cancer is confined to one side of the diaphragm and only one or two lymph node groups are involved.
• Stage 3 means that lymph nodes on both sides of the diaphragm are involved.
• Stage 4 means that and the lymphoma is widespread through organs and tissues, such as the liver, lung, or bone marrow.

The standard treatment most often used for DLBCL is a combination of chemotherapy and immunotherapy intravenous medications and pills known as R-CHOP, which may be followed by radiation therapy for the affected lymph nodes.

If the DLBCL doesn’t respond to the initial treatment or comes back, doctors may suggest high-dose chemotherapy followed by a stem cell transplant or CAR T-cell treatment, a new immunotherapy.

Despite DLBCL being an aggressive cancer that is fatal if not treated, R-CHOP therapy cures about one-half of all patients. Patients who survive more than two years after treatment are just as likely to survive a further five years as those who didn’t have DLBCL.

Clinical trials are currently looking at new drugs and treatment strategies for DLBCL. For example, some studies are researching which single or combination treatments work better for certain molecular subtypes and specific populations, such as the newly diagnosed or the elderly.