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Diffuse large B cell lymphoma

Diffuse large B cell lymphoma (DLBCL) is a type of non-Hodgkin lymphoma (NHL). NHL is a cancer of the lymphatic system. 

It develops when the body makes abnormal B lymphocytes. These lymphocytes are a type of white blood cell that normally help to fight infections.  When you have a lymphoma, the abnormal lymphocytes build up in lymph nodes or other body organs. 

DLBCL grows quickly and your treatment starts soon after diagnosis.

The lymphatic system

The lymphatic system is an important part of our immune system. It has tubes that branch through all parts of the body.

These tubes are called lymph vessels or lymphatic vessels and they carry a colourless liquid called lymph. This liquid circulates around the body tissues. It contains a high number of white blood cells (lymphocytes) which fight infection.

Parts of the lymphatic system

When you have lymphoma, some of your white blood cells (lymphocytes) don't work properly. They start to divide constantly but don't develop fully. So they can't fight infection as normal white blood cells do.

There are different types of NHL. The type you have depends on several factors including the type of cell it starts in and how fast growing it is.

There are two main types of lymphocytes – B cells and T cells. They both help us fight infections but in slightly different ways.

DLBCL affects the B cells and so is called a B cell lymphoma.

How common is it?

Each year about 5,500 people are diagnosed with DLBCL. This makes up about 40 out of 100 cases (40%) of NHL in adults.

DLBCL is more common in males than females.

Types of diffuse large B cell lymphoma (DLBCL)

As the name suggests, diffuse large B cell lymphoma (DLBCL) means this type of lymphoma has:

  • abnormal and enlarged B cells (a type of white blood cell)
  • cancer cells in a spread out (diffuse) pattern

There are some different sub types of DLBCL. Some sub types are quite rare, but most types are treated in a similar way.

These rare types include:

  • T cell / histiocyte large B cell lymphoma
  • Epstein Barr virus positive DLBCL of the elderly
  • ALK positive large B cell lymphoma
  • primary mediastinal (thymic) large B cell lymphoma
  • intravascular large B cell lymphoma

Symptoms

Symptoms can start or get worse in just a few weeks.

Painless swellings

The most common symptom is one or more painless swellings. These swellings can grow very quickly.

General symptoms (B symptoms)

You might have other general symptoms such as:

  • heavy sweating at night
  • high temperatures that come and go with no obvious cause
  • losing a lot of weight (more than one tenth of your total weight)

Doctors call this group of symptoms B symptoms. Some people may also have unexplained itching. It is important to tell your doctor about any symptoms like this.

Depending on where your lymphoma is, it might cause specific symptoms.

Lymphoma growing in your tummy (abdomen) or bowel might cause pain, diarrhoea or bleeding. If lymphoma is growing in your chest you might be breathless.

See your GP if you have these symptoms.

Getting diagnosed

The main tests are:

  • removal of the enlarged lymph node, or taking a sample of tissue from a lymph node (lymph node biopsy)
  • blood tests

You have other tests if lymphoma cells are found in the biopsy. You might have different scans and a bone marrow test.

Stages and grades

Grade
Doctors put NHL into 2 groups, depending on how quickly they are likely to grow and spread. The 2 groups are:

  • low grade (slow growing)
  • high grade (fast growing)

DLBCL is fast growing and is called a high grade lymphoma.

Stage

The stage of NHL tells you about the number and places in the body which are affected by lymphoma.

There are different staging systems for adults and children with DLBCL. The Lugano classification is used to stage adult NHL, including adult DBLCL.

If your child has DLBCL, ask your specialist to explain what the stage means. 

Risk of your lymphoma coming back

For DLBCL, doctors use the prognostic index to try to decide who has a greater risk of their lymphoma being cured with chemotherapy. It depends on:

  • your age
  • how lymphoma affects your everyday life
  • the level of an enzyme called lactose dehydrogenase (LDH) in your blood
  • whether your lymphoma is outside the lymph nodes (extranodal disease)
  • the stage of your lymphoma

These factors score points to give an overall score. This score helps your doctors work out whether your lymphoma is low, intermediate, or high risk. This helps your team to plan the best treatment for you. 

Treatment aims and decisions

Aims of treatment

The aim of treatment for DLBCL might be to:

  • cure the lymphoma
  • control the lymphoma for as long as possible
  • control symptoms
  • stop lymphoma spreading to other parts of the body (such as the cerebrospinal fluid)
  • stop lymphoma coming back

Talk to your doctor or specialist nurse if you want to find out more about the aim of treatment. This could be different for different people with DLBCL.

As DLBCL is fast growing (high grade) you have treatment soon after diagnosis.  If there is no sign of lymphoma following treatment, this is called remission.

Sometimes, lymphoma can come back (relapse). You would usually then have more treatment.

Treatment decisions

Your treatment depends on:

  • where your lymphoma is (the stage)
  • your symptoms
  • your general health
  • levels of some chemicals in your blood
  • whether your lymphoma is likely to come back after treatment

Chemotherapy and immunotherapy (chemoimmunotherapy)

DLBCL is usually treated with a number of different chemotherapy drugs, a steroid and a targeted immunotherapy drug called rituximab (Mabthera). You might hear this combination called chemoimmunotherapy.

There are different combinations. One of the main combinations is R-CHOP. This includes the drugs rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine and prednisolone.

You have these drugs on certain days over 3 weeks. Each 3 week period is called a cycle of treatment.

For an earlier stage DLBCB, you have 3 to 4 cycles. You have a longer course of treatment (6 to 8 cycles) if you have more advanced disease. For example, you might have:

  • R-CODOX-M (rituximab, cyclophosphamide, vincristine, doxorubicin and methotrexate)
  • followed by R-IVAC (rituximab, ifosfamide, etoposide and cytarabine)

You may have a less intensive combinations if you are older, or less fit and well. These might exclude certain drugs or have lower doses of drugs to reduce the side effects. For example, R-mini-CHOP.

Chemotherapy to stop spread to the brain

Some types of lymphoma (including DLBCL) are more likely to spread to the brain and spinal cord (central nervous system). If there is a high risk of your lymphoma spreading to your central nervous system, your doctor might want you to have treatment to prevent this.

The most common treatment is to have injections of the chemotherapy drug methotrexate into the fluid around your spinal cord. Or your doctor might suggest you have a high dose of methotrexate injected into your vein instead.

You might have this preventative treatment if your lymphoma is:

  • in your breast, testicles, adrenal gland or kidney
  • likely to come back after treatment (high risk)

Chemotherapy into the fluid that circulates around the brain and spinal cord is called intrathecal chemotherapy. It is very similar to having a lumbar puncture.

Radiotherapy

You might have radiotherapy:

  • after chemotherapy to stop lymphoma coming back
  • before a stem cell or bone marrow transplant 

Surgery

It is unusual to have surgery as part of your treatment for DLBCL.

You might have surgery to:

  • remove a lymph node for diagnosis and staging
  • relieve symptoms if a mass is pressing on an organ causing a blockage (obstruction)

Stem cell or bone marrow transplants

Bone marrow is the spongy substance inside your bones. It contains stem cells. Stem cells develop into red blood cells, white blood cells and platelets.

A stem cell transplant allows you to have very high doses of chemotherapy. You might have a transplant using:

  • your own stem cells (autologous stem cell transplant)
  • a donor’s stem cells (allogeneic stem cell transplant)

You might have a transplant if your DLBCL:

  • is in remission but is likely to come back
  • is in a second remission
  • has not responded to other treatment

You usually have a transplant using your own stem cells for DLBCL if you are fit and well enough for this treatment. You may have a transplant using a donor’s stem cells in one of the following situations:

  • your lymphoma has come back following an autologous transplant
  • it has not been possible to collect (harvest) you own stem cells

Follow up

You have regular follow up appointments after finishing treatment.

Your appointments might be every 3 to 4 months for at least 2 years.  Your doctor will examine you and ask about side effects. You usually have blood tests. Take the opportunity to ask any questions.

Contact your medical team if you have symptoms, or other concerns in between these times. Don’t wait for your booked appointment.

After 2 years, your lymphoma specialist might transfer your care to your GP (family doctor). This is because the risk of your disease coming back after 2 years is small. Talk to your GP if you have any symptoms or concerns. The GP can then contact a specialist again if they need to.

Research

There is research looking at how best to treat NHL.

Survival

The best person to talk to you about your outlook or prognosis is your doctor. Not everyone wants to know. People cope differently with their lymphoma and want different information.

Survival depends on many factors. So no one can tell you exactly how long you will live.  Your doctor might be able to give you some guide, based on their knowledge and experience.

Coping with DLBCL

DLBCL and treatment is likely to cause physical changes in your body. The treatment can be very intense. You might be in and out of hospital for at least a few months. These changes can be hard to cope with and can affect the way you feel about yourself.

You might also have to cope with feeling very tired and lethargic a lot of the time, especially for a while after treatment.

Ask your medical team about possible support and help.

It can help to talk to friends and family. Or join a support group to meet people in a similar situation.

Our discussion forum Cancer Chat is a place for anyone affected by cancer. You can share experiences, stories and information with other people who know what you are going through.

You might need practical advice about benefits or financial help. There is help and support available.

Last reviewed: 
12 Feb 2019
  • The incidence data were compiled by the Statistical Information Team at Cancer Research UK using data from the Office for National Statistics and the regional cancer registries in Wales, Scotland and Northern Ireland using the latest data for 2017

  • Diffuse large B-cell lymphoma (DLBCL): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
    H Tilly and others
    Annals of Oncology, 2015. Volume 26, Supplement 5, pages 116–v125

  • Clinical and treatment-related features determining the risk of late relapse in patients with diffuse large B-cell lymphoma
    L Modvig and others
    British Journal of Haematology , 2017. Volume 179, Issue 1, pages 75-82

  • Improved prognostic stratification using NCCN- and GELTAMO-international prognostic index in patients with diffuse large B-cell lymphoma
    J Hong and others
    Oncotarget, 2017. Volume 8 (Number 54) pages 92171-92182

  • The standard international prognostic index for predicting the risk of CNS involvement in DLBCL without specific prophylaxis
    N Tomita and others
    Leukaemia and Lymphoma, 2018. Volume 59, Issue 1, Pages 97-104

  • Guideline on the prevention of secondary central nervous system lymphoma: British Committee for Standards in Haematology
    A McMillan and others
    British Journal of Haematology, 2013. Volume 163, Issue 2, pages 168–18127

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. If you need additional references for this information please contact patientinformation@cancer.org.uk with details of the particular risk or cause you are interested in.

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