Diffuse large B-cell lymphoma (DLBCL) is a fast-growing cancer that starts in white blood cells called B lymphocytes. These cells are an important part of the immune system. DLBCL is the most common type of non-Hodgkin lymphoma .e60dc2a1-f33c-4a05-9b50-8e3e8e597629bbc40d16-0828-4bb7-822c-f8e99fd08cf7 About 30 percent of all non-Hodgkin lymphoma diagnoses in the United States are DLBCL. Although it is an aggressive cancer that can spread quickly, it is treatable.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ac7a70cb-fb9c-4090-8485-af1f3e6b64e3
Types of Diffuse Large B-Cell Lymphoma Types DLBCL is divided into subtypes based on how it looks, where it starts, and where it spreads. Many of these subtypes are rare:e60dc2a1-f33c-4a05-9b50-8e3e8e597629ef26c8cd-35a1-422f-ab01-a83da00282bbe60dc2a1-f33c-4a05-9b50-8e3e8e5976292eca3f88-d7cb-4955-a5de-d060cfd722f0 Primary mediastinal B-cell lymphoma: This type starts in the mediastinum, the part of the chest that sits between the lungs. The tumor can make it hard to breathe if it presses on the lungs. T-cell/histiocyte-rich B-cell lymphoma: Under a microscope, this rare type looks like a few cancerous B cells surrounded by many normal T cells (part of the immune system). The cancer is made up of more immune cells than abnormal B cells. Double-hit or triple-hit lymphoma: These cancer cells have either two (double-hit) or three (triple-hit) genetic changes, but the symptoms are the same as DLBCL. Primary DLBCL of the central nervous system: This type starts in the brain or eye. Secondary DLBCL of the central nervous system can occur if the lymphoma spreads to the brain or spinal cord. Primary cutaneous DLBCL, leg type: This type looks like a bluish-red growth or tumor on the skin of the lower legs, trunk, arms, or buttocks. It is especially aggressive, because it can spread from the skin to other parts of the body. Epstein-Barr virus–positive DLBCL: This rare type mainly affects people ages 50 and older who have tested positive for the Epstein-Barr virus . DLBCL not otherwise specified: This umbrella term includes DLBCL that doesn’t fit into any other subtype.
Signs and Symptoms of Diffuse Large B-Cell Lymphoma Symptoms The first symptom of DLBCL is often a painless lump in the neck, armpit, abdomen, or groin. The lump gets larger as B cells multiply inside the lymph node, and it can grow quickly. Other symptoms include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629e8d27e5a-9717-4947-ab4e-be34fc7c0464e60dc2a1-f33c-4a05-9b50-8e3e8e597629d6e912d0-00e2-465b-85b7-181967dc8c37 Cough Difficulty breathing Abdominal pain Fever Night sweats Unexplained weight loss Fatigue Appetite loss Nausea Diarrhea These can be symptoms of many different conditions. They don’t mean that you have DLBCL. Even so, contact your doctor if these symptoms don’t go away after a couple of weeks.
Causes and Risk Factors of Diffuse Large B-Cell Lymphoma Causes Like other cancers, diffuse large B-cell lymphoma starts when the DNA in cells changes in ways that allow the cells to multiply out of control. Researchers don’t know why this happens in most patients. A few factors increase the risk of DLBCL, including:e60dc2a1-f33c-4a05-9b50-8e3e8e5976294771f2a5-c8d4-4160-85fd-81776a4da698 Age: Although people of any age can get this kind of cancer, the average age when people are diagnosed is their mid-60s.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d06e1cf0-e0d4-477f-b0c7-5fb335c9e502 Sex: Men are slightly more likely to get this cancer than women. Race: White people are diagnosed more often than people of African or Asian descent. Immune system disorders: Having an autoimmune disorder like rheumatoid arthritis , Sjögren’s syndrome , or lupus weakens the immune system and increases the risk of DLBCL, as does taking antirejection drugs after an organ transplant. Infections: Human immunodeficiency virus (HIV) , Epstein-Barr virus , hepatitis B , and hepatitis C are all linked to an increased risk of this cancer. Family history: DLBCL isn’t an inherited disease, but you might be at slightly higher risk if one of your parents or siblings has had lymphoma. Personal history: You’re more likely to get this form of cancer if you’ve had lymphoma in the past. Obesity: A high body mass index (BMI) in young adults is linked to an increased risk. Toxic exposures: People who work or live around toxins like trichloroethylene or benzene may be more likely to develop DLBCL.
How Is Diffuse Large B-Cell Lymphoma Diagnosed? Diagnosis A biopsy is the test doctors use to confirm a diagnosis of diffuse large B-cell lymphoma. Your doctor will remove part or all of an enlarged lymph node. The cells from that lymph node will then undergo tests to identify certain proteins or other markers under a microscope.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292acb72cb-cae7-41ae-87f2-4918367598f0 Once you have a diagnosis, the next step is to stage your cancer, or figure out where it has spread, so your doctor can determine which treatments might be most effective against it. DLBCL has four stages:e60dc2a1-f33c-4a05-9b50-8e3e8e5976299f056de2-dc49-408f-af3b-d028eec73416 Stage 1: The cancer is in just one lymph node, one lymph structure (thymus, spleen, or tonsils), or one part of a single organ outside of your lymph system. Stage 2: The cancer is in two or more lymph nodes or lymph structures on the same side of your diaphragm. Stage 3: There is cancer in lymph nodes or structures on both sides of your diaphragm. Stage 4: The cancer has spread to other organs or tissues, such as the liver, lungs, or bone marrow. Tests used to stage DLBCL include:e60dc2a1-f33c-4a05-9b50-8e3e8e5976299f056de2-dc49-408f-af3b-d028eec73416 Complete blood count: This and and other blood tests are also used to check for infections like HIV and hepatitis B and C. Imaging tests: These include positron emission tomography and computed tomography scans, which look for cancer in the body. Bone marrow biopsy: This is used to check for lymphoma cells in the bone marrow.
Treatment and Medication Options for Diffuse Large B-Cell Lymphoma Treatment Because DLBCL spreads quickly, it is important to get treatment as soon as possible. Which treatment your doctor recommends depends on the subtype you have, but generally you can expect to receive a targeted therapy combination of chemotherapy and the monoclonal antibody rituximab (Rituxan). The most commonly used combo is nicknamed R-CHOP, and it is given with the goal of remission, which many can achieve with DLBCL.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ff9b958b-abdf-40a4-9da5-c9990c4930e9 Medication Options The first treatment most people with DLBCL get is the drug combination R-CHOP, which includes:e60dc2a1-f33c-4a05-9b50-8e3e8e597629840b1508-71ab-4ee4-9f19-071bd5e18dab R: Rituxan, a monoclonal antibody C: Cyclophosphamide (Cytoxan), a chemotherapy drug H: Doxorubicin hydrochloride (Adriamycin), a chemotherapy drug O: Vincristine (Oncovin), a chemotherapy drug P: Prednisone, a steroid You get the R-CHOP regimen in cycles spaced three weeks apart. Sometimes this treatment is followed by radiation therapy. Although R-CHOP is most commonly used, a couple of other drug combinations are used in certain cases, such as for the customized treatment of a specific subtype or if you have another condition too (such as HIV). These other drug combinations (all a mix of monoclonal antibodies, chemotherapy, and a steroid) include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629ff9b958b-abdf-40a4-9da5-c9990c4930e9 R-EPOCH: Rituximab, etoposide, prednisone, Oncovin, cyclophosphamide, and doxorubicin hydrochloride Pola-R-CHP: Polatuzumab vedotin-piiq (Polivy), rituximab, cyclophosphamide, doxorubicin hydrochloride, and prednisone R-DHAP: Rituximab, dexamethasone, cytarabine, and cisplatine60dc2a1-f33c-4a05-9b50-8e3e8e597629695b4c15-5d79-4c34-9566-0fbe254d32f0 Stem Cell Transplantation If the cancer doesn’t respond to these medications or comes back after treatment, a stem cell transplant immunotherapy treatment might be an option. First, doctors will remove stem cells from your bone marrow or blood. These are the cells that develop into new blood cells. Then, you’ll get high-dose chemotherapy to wipe out all the cancer cells in your body. Finally, your stem cells will be returned to your body so they can produce new blood cells.e60dc2a1-f33c-4a05-9b50-8e3e8e597629addcd625-2809-44b2-9ce9-c8f4376f30f0 A stem cell transplant offers the best chance for a cure, according to the American Cancer Society.e60dc2a1-f33c-4a05-9b50-8e3e8e597629841ab011-f4e8-4d93-9a11-a7f4b626c87a Patients who are ineligible for a stem cell transplant may be eligible for a targeted combination therapy, such as tafasitamab and lenalidomide. Tafasitamab behaves as a monoclonal antibody, binding to the lymphoma cells and destroying them. Lenalidomide enhances the immune response. Clinical trials may also be an option.e60dc2a1-f33c-4a05-9b50-8e3e8e59762981491c84-e401-49b2-bad4-f7d683d375d6 Chimeric Antigen Receptor T-Cell Therapy Chimeric antigen receptor (CAR) T-cell therapy is another option if the cancer isn’t responsive to the initial treatment. In this immunotherapy treatment, immune cells called T cells are removed from your body and reengineered in a lab so that they can find and destroy lymphoma cells once they are returned to the bloodstream.e60dc2a1-f33c-4a05-9b50-8e3e8e597629addcd625-2809-44b2-9ce9-c8f4376f30f0 Potential side effects of CAR T-cell therapy are cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). ICANS has neurological effects, such as impaired speech and confusion, that are not fully understood. With CRS, the reengineered T cells release a large amount of cytokines (a chemical messenger). While this is a normal role for T cells, when done in abundance, it can cause fevers and large drops in blood pressure. CRS is serious, and it can be fatal. Cytokine-blocking drugs, such as tocilzumab, can be used to manage these side effects. CAR T-cell therapies are often used if the cancer doesn’t respond to the initial treatments, but they are being studied for use in earlier stages of the cancer.e60dc2a1-f33c-4a05-9b50-8e3e8e597629781e35bb-91ef-47c6-be84-d2b3747b2985 Complementary Therapies Complementary therapies don’t treat lymphoma, but they can relieve symptoms and help you feel better during treatment. Examples of complementary therapies some people use for DLBCL include:e60dc2a1-f33c-4a05-9b50-8e3e8e5976297af65a54-23d3-4e4a-8a82-72d566097352 Acupuncture : Very thin needles are placed at specific points in your body, stimulating nerves, muscles, or connective tissue in a way that is believed to produce an immune response and relieve pain. Acupuncture can be helpful for managing cancer fatigue and chemotherapy-related nausea.e60dc2a1-f33c-4a05-9b50-8e3e8e597629afe7e057-aa2e-4615-84ca-9feefa7958be Aromatherapy: Using essential oils from plants may help you relax and sleep better. You can inhale their scent or rub them onto your skin. Massage: A gentle massage could be helpful for promoting relaxation and sleep, as well as for easing stress. Mindfulness techniques: Meditation , deep breathing , yoga , and tai chi are other ways to help you relax. Before you try any new complementary therapy, check with the doctor who treats your cancer to make sure it’s safe to use with your medications.
Prevention of Diffuse Large B-Cell Lymphoma Prevention You can’t always prevent diffuse large B-cell lymphoma. Many of the risk factors, such as age, sex, race, and family history, are not under your control. But there are things you can do to reduce other risk factors for DLBCL. Protect yourself from infections. Get vaccinated against hepatitis B. Use condoms every time you have sex to prevent hepatitis C and HIV infection. Don’t share personal items like razors, toothbrushes, and needles. And take preexposure prophylaxis, or PrEP, if you’re at risk of contracting HIV.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f015eb9d-c914-4db7-a4eb-2b66b8728d3de60dc2a1-f33c-4a05-9b50-8e3e8e59762931a22c2b-5372-4dbe-9a3f-0d18177f7c3d Try to stay at a healthy BMI. Work with your doctor on your diet and exercise routine to keep your weight within the recommended range. Staying at a healthy BMI is especially important during your teens and early 20s, as a high BMI that continues into adulthood can increase the risk of cancer.e60dc2a1-f33c-4a05-9b50-8e3e8e597629965d2a89-65a6-4071-b4fa-351ba0ae727e The optimal BMI range for an adult is 18.5 to 24.9, but note that this is a tool to help estimate body fat. It is not always an accurate representation of your health. Use this chart to help calculate yours.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c03935a3-826c-407a-a7bf-83eeca28ea0b Avoid toxic chemicals. Try to limit your exposure to substances like trichlorethylene (found in solvents and some household cleaning products) and benzene (found in tobacco smoke, industrial emissions, and some paints, among other products).e60dc2a1-f33c-4a05-9b50-8e3e8e5976293e4c63dd-85c3-4960-90b9-6336738824c3e60dc2a1-f33c-4a05-9b50-8e3e8e597629138c75ac-c6f2-4e6c-8f84-2d476bdba30ee60dc2a1-f33c-4a05-9b50-8e3e8e5976299ad1d02c-86fa-4183-af59-5b3b531857c6
Lifestyle Changes for Diffuse Large B-Cell Lymphoma Lifestyle Changes Lifestyle changes won’t treat DLBCL, but they can help you stay healthier during treatment. Eating a well-balanced diet, staying active, and managing stress can help you feel better while you’re undergoing therapy. Make Changes to Your Diet You need extra calories, protein, and nutrients to prevent weight loss, maintain muscle mass, and help your body heal from the cancer and its treatments. Lean meat, poultry, fish, eggs, beans, yogurt, and other dairy foods are good protein sources. Eating more fruits and vegetables can help ensure that you get adequate nutrition.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291b3c9c8e-8656-4437-b312-68958b1c2ea7 To get enough calories, add foods like these to your diet:e60dc2a1-f33c-4a05-9b50-8e3e8e5976296508b41b-3852-4271-9801-1ffcb83f3df9 Peanut butter or other nut butters, nuts, and seeds Avocado Ice cream Butter and olive oil Cream Full-fat Greek yogurt Whole-grain pasta and bread Avoid foods that don’t offer much nutritional benefit, like:e60dc2a1-f33c-4a05-9b50-8e3e8e597629716cb222-c649-47d9-b6dc-0bb277bcd7b8 Processed foods Sodas and other sugary drinks Fatty and processed meats (like bacon and sausage) White bread, pasta, and rice You may not feel like eating due to side effects of chemotherapy like nausea and appetite loss. Instead of eating three big meals, eat smaller meals and snacks throughout the day. If the smell of food cooking nauseates you, eat food cold or at room temperature. Add sauces and seasonings to make foods taste more palatable, and avoid dishes that taste strange because of chemo.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291cd4f600-848b-4e9c-8bb4-8a369c7306b6 Also, drink plenty of fluids like water, fruit juice, and smoothies to stay hydrated. Aim for 8 cups of fluid a day. You don’t have to drink it all at once. Carry a water bottle with you and take small sips throughout the day.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291cd4f600-848b-4e9c-8bb4-8a369c7306b6 If you have questions about your diet, consult with your hematologist/oncologist or a cancer nutritionist. Get Regular Exercise Exercise is just as important during cancer treatment as it was before you were diagnosed. In fact, a study found that people with lymphoma who were more physically active lived longer than those who were less active.e60dc2a1-f33c-4a05-9b50-8e3e8e597629249d7430-4fc6-44f9-adf7-2b7224e259c3 You might feel too tired or weak to work out, but exercise can give you more energy and help you sleep better. It also helps improve appetite. Do as much exercise as you can manage, even if it’s just taking a 10-minute walk.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296508b41b-3852-4271-9801-1ffcb83f3df9 Work up to a goal of 150 minutes a week of moderate-intensity aerobic exercise. Add in strength training, balance, and flexibility exercises for a well-rounded workout program.e60dc2a1-f33c-4a05-9b50-8e3e8e5976293892f8e1-5b60-4019-b9ff-c2ebde75b0b3 Care for Your Mental Health Being diagnosed with cancer is a big adjustment. DLBCL can bring a lot of stress and anxiety into your life. Be gentle on yourself. Use techniques like meditation, yoga, tai chi , or art therapy to relax. If you feel overwhelmed, lean on friends and family. You can also get help from a mental health professional like a therapist or counselor, or join a support group for people with lymphoma.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296508b41b-3852-4271-9801-1ffcb83f3df9
Diffuse Large B-Cell Lymphoma Prognosis Prognosis and Outlook Diffuse large B-cell lymphoma is an aggressive cancer, but it is treatable. The initial treatment often puts it into remission, which means there are no longer any signs or symptoms of the cancer. Up to 60 percent of people are cured with the first treatment, meaning that there is no longer any cancer detected (whereas remission is a broader term, meaning that the cancer is responding to treatment, and signs and symptoms of the disease are lessening).e60dc2a1-f33c-4a05-9b50-8e3e8e5976297a38705b-009b-4219-a7f9-ff88a82e773ce60dc2a1-f33c-4a05-9b50-8e3e8e5976297a87d0d1-21bc-447f-9a17-d4ee2e5e7b54 DLBCL can come back months or years after treatment. Up to 40 percent of people who are successfully treated will have a recurrence.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ac020cad-6eb4-4ae1-9fef-5146ce1f56e3 If this happens, your doctor will treat you again. Worrying about whether your cancer will return can be stressful, but you’ll get regular follow-ups to ensure that if it does recur, your doctor can start you on another therapy quickly. DLBCL that doesn’t respond to the first treatment is more challenging to treat. But newer regimens like targeted therapies and immunotherapy are improving the outlook for those with treatment-resistant DLBCL.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fbe156a8-1a46-4df4-a8b6-60d7e8194f79 The survival rate depends on your cancer stage. Overall, people who are diagnosed with DLBCL are 65 percent as likely to be alive five years later as those without this cancer.e60dc2a1-f33c-4a05-9b50-8e3e8e5976293b7a1ead-7648-4685-8365-3e81f2fe4797 When the cancer is only in one lymph node, one lymph organ, or one organ outside the lymph system, the five-year relative survival rate is 73 percent. Once the cancer has spread to organs like the lungs or liver, that rate drops to 58 percent.e60dc2a1-f33c-4a05-9b50-8e3e8e5976293b7a1ead-7648-4685-8365-3e81f2fe4797 Keep in mind that every person with DLBCL is different. These statistics can’t predict how well you will respond to treatment or how long you will live. Your cancer doctor can give you a better idea of your expected outlook.
Complications of Diffuse Large B-Cell Lymphoma Complications Diffuse large B-cell lymphoma affects the immune system and blood cells. Even with treatment, it can cause complications, including:e60dc2a1-f33c-4a05-9b50-8e3e8e597629a4b421d2-b44a-4e2b-b5e0-75df5386c5ee Infection Low blood cell count Kidney failure Spread of the cancer to the brain and spinal cord Chemotherapy and other treatments for DLBCL can cause side effects , such as:e60dc2a1-f33c-4a05-9b50-8e3e8e597629792c3225-ee9c-4f17-b208-bd3f125bc2ce Fatigue Nausea and vomiting Hair loss Increased risk of infection Mouth sores Brain fog, or “chemo brain” Nerve damage Your cancer treatment team can recommend treatments to manage any side effects you have.
Research and Statistics: How Many People Have Diffuse Large B-Cell Lymphoma? Research and Statistics DLBCL is the most common type of lymphoma. More than 1 in 4 lymphoma diagnoses in the United States are this type, and more than 25,000 people are newly diagnosed with DLBCL each year.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298f3e58bd-8306-4642-b15f-fdc610c19957
Conditions Related to Diffuse Large B-Cell Lymphoma Related Conditions Large B-cell lymphoma is linked to conditions that affect the immune system, including certain infections and autoimmune diseases like these:e60dc2a1-f33c-4a05-9b50-8e3e8e597629ea81a21a-84d7-4175-86e1-88ba8918c71c Epstein-Barr virus: This highly contagious virus causes mononucleosis and sometimes cancer. HIV: This virus attacks and damages the immune system. Hepatitis B and C: These viruses damage the liver. Rheumatoid arthritis: This inflammatory form of arthritis affects the joints and other organs. Lupus: This autoimmune disease attacks the joints and other body tissues.e60dc2a1-f33c-4a05-9b50-8e3e8e597629580d5627-301f-418e-b7aa-6418599278c4 Sjögren ’ s syndrome: This autoimmune disorder attacks the glands that produce saliva and other fluids, causing dry mouth and dry eyes.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d59813ab-ce45-4611-a263-158c94d4a21b
Support for Diffuse Large B-Cell Lymphoma Support Here are some organizations that offer support and resources for DLBCL: Leukemia & Lymphoma Society This is the largest nonprofit organization dedicated to blood cancers. It invests in leukemia and lymphoma research and offers free education and support services to people with these cancers and their families. Cancer Care This nonprofit organization has been around since 1944. Its mission is to help people navigate the emotional and financial challenges of a cancer diagnosis. It offers free support from oncology social workers, as well as other resources, to people with DLBCL.
The Takeaway Diffuse large B-cell lymphoma is the most common type of non-Hodgkin lymphoma in the United States. This cancer affects white blood cells called B lymphocytes, which are an important part of the immune system. DLBCL is an aggressive cancer, but it is treatable and even curable with a combination of chemotherapy and other medications. Because this cancer can come back after treatment, regular monitoring is important to catch a recurrence.
Resources We Trust Cleveland Clinic: Diffuse Large B-Cell LymphomaHealthTree Foundation: Real-World Data Shows Improved Outcomes for Black Patients With DLBCLCancerCare: Diffuse Large B-Cell LymphomaLymphoma Action: Exercise and Physical ActivityMayo Clinic: How to Make Life Easier During Diffuse Large B-Cell Lymphoma Treatments
