Diffuse Large B-Cell Lymphoma

Diffuse large B-cell lymphoma (DLBCL) develops when B lymphocytes, white blood cells that normally help fight infection, become abnormal and turn into aggressive cancer cells. These cells grow larger than healthy B cells and can form tumors in the lymph nodes or other organs. Healthcare professionals say these cells are “diffuse,” as they spread throughout the tissue across the body.

DLBCL is considered a fast-growing form of non-Hodgkin's lymphoma (NHL), which means symptoms can progress quickly if left untreated. Despite its aggressive nature, DLBCL is also one of the most treatable types of lymphoma and many patients respond well to therapy.^{1 2}

The World Health Organization (WHO) has classified several subtypes of diffuse large B-cell lymphoma (DLBCL) based on genetic changes, where in the body DLBCL presents and if there’s an association with a virus.¹ These subtypes include:

• Diffuse large B-cell lymphoma, not otherwise specified (NOS)
• T-cell-histiocyte-rich large B-cell lymphoma
• Anaplastic lymphoma kinase (ALK) positive large B-cell lymphoma
• Large B-cell lymphoma with IRF4 rearrangement
• EBV-positive diffuse large B-cell lymphoma
• Diffuse large B-cell lymphoma associated with chronic inflammation
• Fibrin-associated large B-cell lymphoma
• Fluid overload-associated large B-cell lymphoma
• Primary large B-cell lymphoma of immune-privileged sites
• Primary cutaneous diffuse large B-cell lymphoma, leg type
• Primary diffuse large B-cell lymphoma of the central nervous system
• Intravascular large B-cell lymphoma²

The most common subtype is diffuse large B-cell lymphoma, not otherwise specified (NOS). About 25-30% of non-Hodgkin lymphoma diagnoses fall into this subtype.³ While the treatment for most subtypes is similar, it is important to understand with your provider how your specific type will impact your care plan.¹

While medical professionals don’t know what exactly causes diffuse large B-cell lymphoma (DLBCL) or other non-Hodgkin lymphomas, there are common risk factors. DLBCL is most common in males who are 60 years or older with a family history of lymphoma. Those with viral infections, like Epstein-Barr and human immunodeficiency virus (HIV), have also been linked to some types of DLBCL. Similarly, conditions that weaken the immune system tend to be the most significant risk factor for DLBCL.^{1 2}

Healthcare providers use grades and stages to determine the severity of the cancer and create a tailored treatment plan. Non-Hodgkin lymphoma is classified into two grades to determine how quickly it will spread, low grade and high grade. Since diffuse large B-cell lymphoma (DLBCL) is fast-growing, it is a high-grade lymphoma.⁵

The stages of DLBCL help to identify where in the body and how many places the lymphoma is present in. The stages range from 1 to 4:

Stage I – One lymph node or one single area in an organ outside of the lymph nodes is affected

Stage II – Two or more lymph node regions on the same side of the diaphragm are affected

Stage III – Lymph node regions on both side of the diaphragm are affected

Stage IV – DLBCL has spread outside of the lymph nodes to organs like the liver, lungs, or bone marrow

Providers often refer to stages I and II as “early stage” and stages III and IV as “advanced stage.”^{1 2 5}

Diagnosis begins with a physical exam, feeling for lumps in the neck, groin, or underarms. Confirmation of a diagnosis of diffuse large B-cell lymphoma (DLBCL) requires a lymph node biopsy. This is a procedure that removes all or part of the lymph node for a pathologist to examine for cancer cells.⁴

To determine the stage and see if the cancer has spread beyond your primary lymph node, your provider may also perform:

• Blood tests (testing for viruses and lactate dehydrogenase levels)
• Imaging tests (MRI, CT, or PET scans to show the location and spread of DLBCL)
• Bone marrow aspiration and biopsy (tests for bone involvement)
• Lumbar puncture (tests for DLBCL in the central nervous system^{)1 2 4 5}

While the outlook for diffuse large B-cell lymphoma (DLBCL) depends on factors like stage, lab results and age, the chance of survival and remission tend to be favorable. About 60% of people are cured by front-line treatment.¹ For the 30% to 40% of patients who show relapses, it tends to occur within the first 2 years after treatment. Risk of recurrence is higher in those who are older, have an advanced stage, have high serum lactate dehydrogenase (LDH) levels, have specific genetic mutations and whose overall health is compromised.⁴ Following treatment, doctors will schedule regular follow up appointments to examine you for recurring symptoms of lymphoma in the body.

Researchers are continuously investigating potential new and more effective treatments. For guidance on the best treatment options for you—and to determine if you may qualify for a clinical trial—please speak with your healthcare provider.