Quick Links
About MyLymphomaTeam
Powered By
Diffuse Large B-Cell Lymphoma
To better understand diffuse large B-cell lymphoma, MyLymphomaTeam spoke with Dr. Timothy Fenske, a hematologist and medical oncologist.
00:00:00:00 - 00:00:32:23
Dr. Fenske
The big challenge for someone who's newly diagnosed with DLBCL, I think is to, first of all, make sure that the diagnosis is right. Secondly, if it is, if that is right, is this one of those scenarios where R-CHOP might not be enough or might not be the appropriate treatment? And there are a number of sort of exceptions, the scenarios where we would look at that,
00:00:33:02 - 00:01:03:24
Dr. Fenske
but it can be helpful to, to get another opinion to make sure everything's on the right track.
Heather
Is it something that is difficult to diagnose? You mentioned the importance of getting a second opinion for the DLBCL.
Dr. Fenske
The lymphoma can really mimic a lot of other conditions. It's essentially a cancer of the immune system. So when people get lymphoma, the symptoms can often mimic other conditions like inflammatory conditions or autoimmune conditions.
00:01:03:24 - 00:01:35:06
Dr. Fenske
It can be tricky sometimes to get that diagnosis sorted out. Other times it's very straightforward. Somebody notices that they have a lump one day, they see their doctor, they get referred to have a biopsy and, boom, they have a diagnosis. Sometimes, it's a very winding road, you know, where they saw they had rashes and they had itching and they had, you know, just a whole constellation of different symptoms that really made it hard for people to, to pin it down.
00:01:35:06 - 00:02:01:21
Dr. Fenske
And finally, months into the process, you know, somebody got a CAT scan or something that finally got people on the right track.
Heather
Can you talk a little bit about the typical process of treating people with diffuse large B-cell lymphoma?
Dr. Fenske
So most patients with diffuse large B-cell lymphoma will get a regimen called R-CHOP R, C, H, O, P. It’s a five-drug regimen.
00:02:01:23 - 00:02:38:02
Dr. Fenske
The P stands for prednisone, which is given as a pill, usually five days, every three weeks. And then the R is an immune type therapy. The rest of the drugs are given IV. And so, the R is Rituxan, which is an immune therapy. It's not really a chemotherapy technically. And then the other three drugs, C, H, O. That's Cytoxan, Adriamycin, and Vincristine. Those are IV conventional standard chemotherapy drugs that have been around for decades and are used in many different types of cancer, also besides lymphoma,
00:02:38:04 - 00:03:09:10
Dr. Fenske
but altogether, that five-drug regimen we refer to as R-CHOP. And that, for the most patients with DLBCL, that is what we refer to, the abbreviation for diffuse large B-cell lymphoma. So most patients will get that regimen on an outpatient basis every three weeks. It's the most, it takes most of the day to infuse these drugs, usually through a Mediport or a PICC line, although it is possible in some select cases to give it through regular IV
00:03:09:12 - 00:03:38:06
Dr. Fenske
if people have really great veins, which some people do, but most of us don't. So every three weeks usually for six cycles, there's a lot of exceptions to that, but that's sort of the more, kind of, typical course. You give DLBCL patients R-CHOP. You'll get about 80 percent of them in remission. And the majority of those patients will actually stay in remission and never have their lymphoma come back.
00:03:38:06 - 00:03:52:17
Dr. Fenske
So those patients are cured in the way that we're thinking of a cure, you know, one-and-done treatment never comes back.
Your immune cells work around the clock to protect you from infections. But what happens when these cells turn cancerous? Diffuse large B-cell lymphoma (DLBCL) is a blood cancer that affects certain white blood cells. This fast-growing and aggressive cancer typically responds well to treatment.
This article provides an overview of DLBCL, including its causes and symptoms. We’ll also cover how doctors diagnose and treat this type of cancer.
DLBCL forms in specialized immune cells known as B cells. Also called B lymphocytes, healthy B cells make antibodies. These proteins fight infections from bacteria and viruses. B cells come from the bone marrow — the spongy tissue inside your bones. The cells move into immune system structures (lymph nodes) to mature. Your lymphatic system carries immune cells throughout your body and filters your blood.
Normally, B cells die after they finish fighting off an infection. DLBCL develops when cancerous B cells grow and divide more than they should. The cancer cells outnumber the healthy B cells and build up in your organs.
DLBCL is a type of non-Hodgkin lymphoma (NHL). These blood cancers affect your lymphatic system. NHL develops in immune cells like B and T cells.
Researchers classify DLBCL using different criteria. DLBCL usually develops in the lymph nodes. Lymph nodes are small, bean-shaped structures located throughout the body that filter lymph fluid and house immune cells to help fight infections and disease. When DLBCL develops anywhere outside the lymph nodes, it’s known as extranodal disease. DLBCL may grow in organs including the:
DLBCL is also divided into groups based on the characteristics of the cancer cells. For example, your lymphoma cells may have a certain genetic mutation (change). Other subtypes are related to specific viral infections — like Epstein-Barr virus (EBV).
Most people with DLBCL have DLBCL, not otherwise specified (DLBCL-NOS). This means that their cancer doesn’t have any notable characteristics. Overall, about one-quarter of NHL cases in adults in Western countries are DLBCL-NOS.
Anyone can develop DLBCL, but certain factors put you at a higher risk. DLBCL usually affects middle-aged people and older adults. While DLBCL is most commonly seen in middle-aged and older adults, the average age at diagnosis is 64 years. Men may be more likely to develop DLBCL compared to women, according to Wolters Kluwer UpToDate, a clinical decision-support resource.
Yale Medicine identifies the following risk factors that may increase your chances of developing DLBCL:
The most common symptom of DLBCL is swollen lymph nodes. You may feel a new mass or lump under your skin. Lymph node swelling is usually found underneath the armpits, along the neck, or in the groin.
DLBCL can also cause “B symptoms.” This is a specific set of symptoms associated with NHL. Around 1 in 3 people with DLBCL experience B symptoms like:
Depending on which organs your DLBCL affects, it’s possible to have other symptoms. DLBCL in the stomach or intestines may lead to diarrhea or abdominal (stomach) pain.
The symptoms of DLBCL can look like other diseases — including autoimmune disorders. Be sure to visit your doctor if you notice any new or worsening symptoms. Just because you notice one or two B symptoms doesn’t necessarily mean you have DLBCL.
If you’re experiencing diffuse large B-cell lymphoma symptoms, your doctor will likely perform a series of tests to confirm the diagnosis. The process typically begins with a review of your medical history and a physical exam. Let your doctor know if you have a personal or family history of cancer or any DLBCL risk factors. During the physical exam, they’ll check for enlarged lymph nodes, which may indicate the need for further testing.
Your doctor may also recommend a biopsy if you have swollen lymph nodes. This test involves removing part or all of the affected lymph nodes with surgery. The tissue is sent to a lab where a pathologist looks for cancer cells under a microscope. A lymph node biopsy confirms whether or not you have DLBCL. A bone marrow biopsy also checks for lymphoma cells in your bone marrow.
Blood tests are a key part of diagnosing DLBCL. Your doctor may order:
Imaging studies allow doctors to assess the extent and location of the cancer. Common imaging tests include:
Thanks to new research, people with DLBCL now have more treatment options than ever. Your doctor will create your cancer treatment plan based on your specific case. Researchers are also studying new treatments in large studies known as clinical trials.
Most people with DLBCL receive a treatment known as R-CHOP. It combines three chemotherapy drugs with a steroid and immunotherapy. They are:
In 2023, the U.S. Food and Drug Administration (FDA) approved a new treatment combination for DLBCL known as Pola-R-CHP. It uses polatuzumab vedotin (Polivy) — an antibody-drug conjugate that delivers chemotherapy directly to lymphoma cells. Pola-R-CHP is a combination of:
Radiation therapy uses intense X-rays to damage cancer cells beyond repair. The cells stop growing and eventually die. Doctors recommend radiation therapy after R-CHOP or other DLBCL treatments. You may need radiation if your DLBCL is only found in one or two areas close to each other. People who don't respond well to chemotherapy may also have radiation therapy.
If your DLBCL relapses or returns after treatment, you may be eligible for a bone marrow transplant.
B cells form in your bone marrow, so for some people, replacing abnormal bone marrow with healthy tissue may help treat DLBCL. Doctors start by collecting healthy cells from your bone marrow. You’re then treated with intensive chemotherapy to destroy the remaining tissue. The healthy cells are given back to you to form new bone marrow tissue. The hope is that the transplant lets you make healthy immune cells again.
Chimeric antigen receptor (CAR) T-cell therapy is a type of immunotherapy that helps your immune system fight cancer. A provider collects your T cells and sends them to a lab. The cells are engineered to recognize proteins on lymphoma cells. When the CAR T cells are injected into your bloodstream, they find and destroy the cancer.
FDA-approved CAR T-cell therapies include:
Bispecific antibody therapy is a newer type of immunotherapy that also harnesses the body’s immune system to fight cancer. Bispecific antibodies are engineered to bind to two different targets simultaneously — one on cancer cells and one on immune cells — bringing the two together to trigger an immune response. This approach enables T cells to directly attack and destroy cancer cells.
FDA-approved bispecific antibody therapies for DLBCL include:
Studies show that up to 70 percent of people with DLBCL who complete their R-CHOP treatment have a complete response. This means they don’t have any signs of remaining cancer. Unfortunately, around one-third of those who respond will relapse (have cancer regrowth) within two years.
The prognosis (expected outlook) with DLBCL is fairly good. The National Cancer Institute notes that the five-year relative survival rate is 64.7 percent. This means that someone with DLBCL has a 64.7 percent chance of being alive after five years compared to someone from the general population.
Notably, survival rates are generally higher when DLBCL is diagnosed and treated at an earlier stage. For example, the five-year survival rate for those with stage 1 DLBCL is 79.2 percent. For stage 2, it’s 75.5 percent. Advanced-stage DLBCL often requires more intensive treatments, which can affect prognosis. This highlights the importance of prompt diagnosis and intervention.
Diffuse large B-cell lymphoma is a challenging but increasingly treatable disease, thanks to advancements in medical research. Early diagnosis and prompt treatment remain critical, as survival rates are higher when DLBCL is detected in its early stages.
If you or someone you know is experiencing symptoms or has been diagnosed with DLBCL, speak with a health care provider to explore treatment options tailored to your unique needs. Additionally, consider asking about clinical trials, as these studies may provide access to promising new therapies. With the right care plan and support, people with DLBCL can continue to benefit from advancements that are transforming outcomes for this aggressive form of cancer.
MyLymphomaTeam is the social network for people with lymphoma and their caregivers. On MyLymphomaTeam, more than 20,000 members come together to ask questions, give advice, and share their experiences with others who understand life with different forms of lymphoma.
Are you living with diffuse large B-cell lymphoma? Share your experience in the comments below, or start a conversation by posting on your Activities page.
Fatima Sharif, MBBS, FCPS
graduated from Aga Khan University, Pakistan, in 2017 after completing medical school.
Learn more about her here.
Emily Wagner, M.S.
holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology.
Learn more about her here.
Get updates directly to your inbox.
My First Older Oncologist , Said It’s Not Curable But Manageable. My New One Says That’s Not True I Am In Remission Almost Two Years
How Can I Improve My Appetite?
Become a member to get even more:
Your Privacy Choices
A MyLymphomaTeam Subscriber
Breyanzi has many side effects CRS, neuro toxicity- researchers pls work on
Mitigating the side effects
We'd love to hear from you! Please share your name and email to post and read comments.
You'll also get the latest articles directly to your inbox.