Diffuse large B-cell lymphoma (DLBCL) 

What is diffuse large B-cell lymphoma cancer?

Diffuse large B-cell lymphoma (DLBCL) is a type of blood cancer. It is so named because it develops from abnormal B cells which are larger than normal, healthy B cells. These cells can move to other locations of the body through the blood and lymphatic system, the term ‘diffuse’ refers to how the cells spread. Although DLBCL is aggressive, it is potentially curable.³ DLBCL is the commonly used medical abbreviation for diffuse large B cell lymphoma cancer.

How common is DLBCL?

What are the symptoms of diffuse large b-cell lymphoma?

The clinical manifestation of a DLBCL can vary from patient to patient and depends on the disease localisation and diffusion in the body.⁸ The primary symptom is swollen glands (lymph nodes), which is unlikely to be painful. Swollen lymph nodes are most likely to appear in the neck, armpit, or groin.⁹

Other areas may be affected by swollen lymph nodes, but these might be harder to see if they are deeper in the body. These swollen lymph nodes can cause symptoms depending on where they are and which organs they are pressing on.¹⁰ 

DLBCL symptoms might include: 

• chest or stomach (abdomen)pain
• bone pain
• skin lumps
• coughing or breathlessness

B symptoms

For some people with DLBCL, doctors might diagnose B symptoms. These symptoms are not common to all patients and are not an indication of how advanced the condition is.¹¹
These can include:

• excessive and drenching night sweats (that require a change of nightwear and bed covers)
• fever with no obvious cause
• unexplained weight loss

If the doctor knows about these symptoms, it might help them to identify the stage of the lymphoma and plan treatment¹².

How is DLBCL diagnosed?

The first indications of DLBCL are usually lumps or swelling in the lymph nodes. A diagnosis usually is made by an oncologist and is confirmed through a biopsy of an abnormal lymph node which has been analysed under a microscope to check for cell and tissues abnormalities.

Additional diagnostic tests might include:

• A complete blood count to show the different blood cell levels and identify irregularities
• A comprehensive metabolic profile to see how the kidneys and liver are function and measure the fluid balance and electrolyte levels
• Measuring lactate dehydrogenase serology (LDS) levels, an important enzyme in anaerobic metabolism that is released by cancer cells 
• Infection tests to check for different infections including hepatitis B, hepatitis C, or HIV. If a person is living with one of these infections, the treatment involves immunosuppression which could affect treatment planning for DLBCL
• Lumbar puncture to check for lymphoma cells in the fluid around the brain and spinal cord
• A bone marrow test to check for lymphoma cells in the bone marrow
• Imaging tests to help map the stage of the DLBCL. These could include PET and CT/MRI scans^13,14,15

The stages of diffuse large B-cell lymphoma

Establishing the stage of cancer determines how far a cancer has spread. DLBCL has four stages. Stage one is the least advanced and stage four is the most advanced.

Prognosis and survival rate for DLBCL

The prognosis for DLBCL in people with limited-stage disease is excellent, with an overall 10-year survival rate of at least 70% to 80%.  Around 25% - 30% of people with DLBCL are diagnosed with localised disease.²⁹However, if left untreated, the average lifespan for someone diagnosed with DLBCL is less than a year.³⁰Around 55% of people with an advanced stage diagnosis are alive five years after diagnosis.³¹ 

Is DLBCL curable?

Around half of all patients with DLBCL are cured. People who are diagnosed at an earlier stage have a better survival rate³².

How fast does DLBCL grow?

DLBCL is a fast-growing cancer and often grow in just a few weeks³³.

How can DLBCL be detected early?

The first sign of DLBCL is often a quick-growing, painless mass or lump in a lymph node in the neck, groin, or abdomen. Seeing a doctor quickly if there are symptoms will help to diagnose and detect DLBCL in the early stages. There are no recommended screening tests³⁴.

Is it possible to prevent DLBCL?

There is no way to prevent DLBCL, but there are ways to lower the risk of developing it.³⁵While autoimmune diseases or immunodeficiencies which put people at risk of developing DLBCL cannot be controlled, avoiding certain infections might lower the risk. In some cases, the condition often occurs when specific genes mutate and create cancerous cells, and this cannot be prevented.³⁶

What treatments are available for DLBCL?

A combination of treatments is usually taken as part of the treatment plan. The best treatment options will be defined by the stage, symptoms, age, and general conditions of the patient.

Relapsed DLBCL and refractory treatment

If the DLBCL comes back after the first treatment it is called relapsed DLBCL. If the first treatment doesn’t work and the cancer does not go in remission, this is called refractory DLBCL.⁴⁰ 

In these situations, different combinations of chemotherapy might be given. A stem cell transplant may be an option if the patient is fit, and they lymphoma has gone into remission following salvage therapy. Salvage therapy is usually a second round of chemotherapy that differs from the first treatment therapy.⁴¹CAR-T cell therapy may also be an option if the patient is fit. Other treatment options include medications that specifically target and attack certain parts of the disease. These can be powerful proteins called monoclonal antibodies or targeted therapies designed to focus on specific areas of the illness.⁴² 

Treatments for elderly people

Most people with DLBCL are over 65 years of age. For fitter older people, standard immunochemotherapy is most often used. For frailer people or patients with several comorbidities, there might be a need to reduce doses or substitute particular treatments.⁴⁴ 

How can people living with DLBCL improve their lives?

A healthy lifestyle might help to speed up recovery and improve well-being and long-term health for people living with DLBCL.⁴⁵
 

Getting support

Practical, physical, and emotional support often helps people with DLBCL and their family and friends.⁴⁹Speaking to doctors and medical practitioners about treatment and side effects is an important part of living with DLBCL. Organisations that focus on helping people with blood cancers include Blood Cancer UK, the American Cancer Society, Leukaemia & Lymphoma Society, and CancerCare. They often have online, in person, and telephone support.