Overview
Diffuse large B-cell lymphoma (DLBCL) is a type of lymphoma. Lymphoma is cancer that affects the lymphatic system. The lymphatic system is made up of organs, glands, tubelike vessels and clusters of cells called lymph nodes. It's part of the body's germ-fighting immune system. Diffuse large B-cell lymphoma can affect lymph nodes, bone marrow, and other tissues throughout the body, such as in the gastrointestinal system, central nervous system, bones or skin.
There are many types of lymphoma. Lymphoma types are often divided into two categories: Hodgkin lymphoma and non-Hodgkin lymphoma. Diffuse large B-cell lymphoma is the most common type of non-Hodgkin lymphoma. There are many subtypes of DLBCL.
Diffuse large B-cell lymphoma gets its name from the kind of cell that makes up this cancer. This cancer starts in germ-fighting white blood cells called B cells. B cells also are called B lymphocytes. When healthcare professionals look at the cells with a microscope, the cancer cells are larger than healthy cells. The cancer cells spread out in the tissue, so healthcare professionals say they are diffuse.
DLBCL is a fast-growing cancer. However, it can often be treated and sometimes cured, especially when diagnosed early and treated right away. Treatment may include immunotherapy, chemotherapy, radiation therapy, targeted therapy, chimeric antigen receptor (CAR)-T cell therapy and bone marrow transplant, also called bone marrow stem cell transplant.
Types
Diffuse large B-cell lymphoma is a heterogeneous group of lymphomas. This means that the different subtypes have different genetic features, behaviors and responses to treatment. The subtypes depend on where the cancer is in the body, which genes and proteins are involved, and whether the cancer involves a virus such as Epstein-Barr virus (EBV). The subtypes of diffuse large B-cell lymphoma include:
- Diffuse large B-cell lymphoma, not otherwise specified.
- 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 lymphoma.
Symptoms
Diffuse large B-cell lymphoma symptoms can vary depending on where the lymphoma develops. The most common signs and symptoms include:
- Fast-growing mass in the neck or belly.
- Painless swelling in the neck, armpit or groin.
- Fever.
- Fatigue.
- Drenching night sweats.
- Losing weight without trying.
If DLBCL is in the gastrointestinal system, symptoms may include:
- Pain or fullness in the belly.
- Nausea.
- Vomiting.
- Loss of appetite.
- Losing weight without trying.
DLBCL of the nervous system can affect the brain, cranial nerves, spinal cord and the protective coatings on the brain and spinal cord, called the meninges. It also may affect the eyes. When the nervous system is involved, symptoms may include:
- Headaches.
- Confusion.
- Vision changes.
- Troubles with thinking and speaking.
- Changes in behavior.
- Seizures.
DLBCL can affect other parts of the body and cause symptoms such as:
- In the chest, cough, shortness of breath, trouble swallowing and pain when breathing.
- In the bones, bone pain with risk of fracture.
- In the liver, belly pain.
- In the kidneys, blood in the urine, increased urination, frequently waking up to urinate, and belly or lower back pain.
- In the skin, skin changes and a rash on the legs.
Causes
It's not clear what causes diffuse large B-cell lymphoma. Cancer happens when cells develop changes in their DNA. A cell's DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA gives instructions to grow and multiply at a set rate. The instructions tell the cells to die at a set time. In cancer cells, the DNA changes give different instructions. The changes tell the cancer cells to make many more cells quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells.
Some diffuse large B-cell lymphomas start as other types of lymphoma, such as chronic lymphocytic leukemia, lymphoplasmacytic lymphoma, follicular lymphoma and marginal zone lymphoma. These slow-growing lymphomas can become more aggressive, turning into diffuse large B-cell lymphomas.
Risk factors
Factors that can increase the risk of diffuse large B-cell lymphoma include:
- Older age. DLBCL can happen at any age. But it's most common in people 60 or older.
- A family history of lymphoma. Having a blood relative, such as a parent or sibling, with lymphoma may increase your risk of DLBCL.
- A weakened immune system or an autoimmune condition. Having a condition that affects the immune system can increase the risk of DLBCL. Conditions may include ataxia-telangiectasia, Wiskott-Aldrich syndrome, rheumatoid arthritis and lupus.
- Some infections. Some infections have been linked to types of DLBCL. These include HIV and Epstein-Barr virus.
Complications
Complications of diffuse large B-cell lymphoma can include side effects of treatment and risk of relapse.
Side effects of treatment
Treatments for diffuse large B-cell lymphoma may have side effects. These may include nausea, vomiting, fatigue, fever, rash, diarrhea and others. Harmful side effects from treatments may include:
- Bone marrow suppression. When the bone marrow is suppressed, it can't produce enough blood cells, including white blood cells. White blood cells help fight infections, so with a lower amount, you are at a higher risk of infections.
- Febrile neutropenia. Febrile neutropenia is a serious condition that can happen in people being treated for cancer. Febrile means having a fever. Neutropenia means having a low number of neutrophils, which are white blood cells that help fight infections. In febrile neutropenia, the body is trying to fight an infection but doesn't have enough white blood cells.
- Medicine toxicity. Some medicines used to treat cancer can be harmful to the body. They can cause organ damage and other issues. Whether a medicine is toxic depends on the type and how much you take. There are many different medicine options, so your healthcare team can work with you to find the best ones for you.
- Reactivating viruses. If you have had a virus such as hepatitis B or hepatitis C in the past, some treatments can cause the virus to become active again. This can lead to liver inflammation, liver damage and other complications.
- Tumor lysis syndrome. Tumor lysis syndrome is a serious condition that can happen when cancer cells break down quickly during or after treatment. When these cells die, they release substances into the bloodstream that can overwhelm the body. This can lead to problems with the kidneys and other organs.
Medicines may be given to treat or prevent harmful side effects.
Risk of relapse
Even after successful treatment, diffuse large B-cell lymphoma may come back. This is called a relapse. Sometimes the relapse happens years later. Some people may have multiple relapses.