Diagnosis
A primary mediastinal large B-cell lymphoma (PMBCL) diagnosis, like other B-cell lymphoma diagnoses, often begins with a physical exam to check for swollen lymph nodes or masses in the neck, underarms and groin, and an enlarged spleen or liver. Other tests and procedures include blood tests, imaging tests and taking a sample of tissue for laboratory tests.
Biopsy
A biopsy is a procedure to remove a sample of tissue for testing in a lab. For PMBCL, a biopsy from the mass is taken. The sample is tested in a lab to look for cancer cells.
Imaging tests
An imaging test takes pictures inside the body. It can show the location and extent of PMBCL. Tests might include CT scan and positron emission tomography (PET) scan.
Testing lymphoma cells in the lab
Lymphoma cells collected from a biopsy go to a lab for testing. In the lab, specialized tests look for specific things about the cells. When viewed under a microscope, the cancer cells have a different appearance compared with healthy cells. The healthcare team uses the results to find out the type of lymphoma that you have.
To decide whether the cells are PMBCL cells, the healthcare professionals in the lab look for:
- Proteins on the surface of the cancer cells. Primary mediastinal large B-cell lymphoma cells can be identified by the presence of certain proteins on their surfaces. These proteins are known as markers.
- Changes in the cancer cells' DNA. Cancer happens when cells get changes in their DNA. A cell's DNA holds the instructions that tell a cell what to do. Gene changes cause the cancer cells to multiply rapidly.
Treatment
Primary mediastinal large B-cell lymphoma (PMBCL) treatments may include chemotherapy, immunotherapy, radiation therapy, targeted therapy, CAR-T cell therapy and bone marrow transplant, also called bone marrow stem cell transplant. Your treatment depends on several factors. These include the cancer's stage, your overall health and shared decision-making with your healthcare professional.
Chemotherapy
Chemotherapy treats cancer with strong medicines. There are many types of chemotherapy medicines. Most chemotherapy medicines are given through a vein. Some come in pill form.
Chemotherapy, usually combined with immunotherapy, is often the first line of treatment for primary mediastinal large B-cell lymphoma (PMBCL). This combination is often referred to as chemoimmunotherapy.
Chemoimmunotherapy also may be an option for PMBCL that comes back after treatment, called relapsed PMBCL, or when other treatments haven't worked, known as refractory PMBCL.
Immunotherapy
Immunotherapy for cancer is a treatment with medicine that helps the body's immune system fight cancer cells. Typically, the immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells recognize and kill the cancer cells.
Radiation therapy
Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points in your body.
Some people with primary mediastinal large B-cell lymphoma (PMBCL) may need radiation therapy after chemoimmunotherapy to help get rid of any remaining cancer cells. Radiation therapy can be used as part of the treatment for relapsed PMBCL. In people who can't have other treatments, radiation therapy may help ease symptoms.
Targeted therapy
Targeted therapy for cancer is a treatment that uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die.
Targeted therapy can be used in relapsed and refractory PMBCL.
CAR-T cell therapy
Chimeric antigen receptor (CAR)-T cell therapy trains the immune system cells to fight lymphoma cells. This treatment begins with removing some white blood cells called T cells from the blood.
The cells are sent to a lab. In the lab, the cells are treated so that they make special receptors. The receptors help the cells recognize a marker on the surface of the lymphoma cells. Then the cells go back into the body similar to a blood transfusion. They find and destroy the primary mediastinal large B-cell lymphoma cells in the body.
CAR-T cell therapy may be an option for refractory or relapsed PMBCL.
Clinical trials
Clinical trials are studies of new treatments or combinations of drugs. These studies provide a chance to try the latest treatments. The risk of side effects might not be known. Ask your healthcare team if you might be a good fit for a clinical trial.
Bone marrow transplant
A bone marrow transplant, also called a bone marrow stem cell transplant, involves putting healthy bone marrow stem cells into the body. These cells replace cells hurt by chemotherapy and other treatments.
In some people, a bone marrow transplant can be used for relapsed or refractory PMBCL.
Monitoring after treatment
Primary mediastinal large B-cell lymphoma (PMBCL) has a risk of coming back after treatment, known as a relapse. After treatment, you have follow-up appointments to monitor for relapse. You may need repeat biopsies and imaging.
More Information
Coping and support
With time, you'll likely find what helps you cope with the uncertainty and worry of a cancer diagnosis. Until then, you may find that it helps to do the following:
Prepare to make decisions
Ask your healthcare team about your cancer, including your test results, treatment options and, if you want, your prognosis. As you learn more about primary mediastinal large B-cell lymphoma, you may become more confident in making treatment decisions.
Stay connected to friends and family
Keeping in touch with friends and family may give comfort during a time that is difficult for everyone. Your friends and family will likely ask if there's anything they can do to help you, so think of tasks you might like help with. For example, you may ask a friend to be there for you when you want to talk. You may ask for help caring for your home if you must stay in the hospital.
Find someone to talk with
Find someone you can talk to who has experience helping people facing a life-threatening illness. Ask your healthcare team to suggest a counselor, clergy member or medical social worker you can talk with about your hopes and worries.
Also ask your healthcare team about support groups in your area, or contact organizations such as the American Cancer Society, Blood Cancer United and the Lymphoma Research Foundation. Find support online through Mayo Clinic Connect, which is a community where you can connect with others for support, practical information and answers to everyday questions.
Preparing for your appointment
Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you.
If your healthcare professional thinks you might have primary mediastinal large B-cell lymphoma (PMBCL), you may be referred to a doctor who specializes in diseases that affect blood cells, called a hematologist. If a cancer diagnosis is made, you also may be referred to a doctor who specializes in treating cancer, called an oncologist.
Because appointments can be brief, it's a good idea to be prepared. Here's some information to help you get ready.
What you can do
- Be aware of anything you need to do ahead of time. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
- Write down symptoms you have, including any that may not seem related to the reason for which you scheduled the appointment.
- Write down important personal information, including major stresses or recent life changes.
- Make a list of all medicines, vitamins and supplements you're taking and the doses.
- Take a family member or friend along. It can be hard to remember all the information you get during an appointment. Someone who goes with you may remember something that you missed or forgot.
- Write down questions to ask your healthcare team.
For primary mediastinal large B-cell lymphoma (PMBCL), some basic questions to ask include:
- Do I have PMBCL?
- What is the stage of my PMBCL?
- Has my PMBCL spread to other parts of my body?
- Will I need more tests?
- What are the treatment options?
- How much does each treatment prolong my life or increase my chances of a cure?
- What are the potential side effects of each treatment?
Other questions to ask include:
- How will each treatment affect my daily life?
- Is there one treatment option you believe is the best?
- What would you recommend to a friend or family member in my situation?
- Should I see a specialist?
- Are there any brochures or other printed materials that I can take with me? What websites do you recommend?
- What will determine whether I should plan for a follow-up visit?
Don't hesitate to ask other questions.
What to expect from your doctor
Be prepared to answer questions, such as:
- When did your symptoms begin?
- Do your symptoms happen all the time or do you have them now and then?
- How bad are your symptoms?
- What, if anything, seems to make your symptoms better?
- What, if anything, seems to make your symptoms worse?
- Have you had any fevers, night sweats or weight loss?
- Have you noticed any lumps, swelling or pain anywhere in your body?
- What are your biggest worries about your diagnosis or treatment?