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.

Diagnosis

Diffuse large B-cell lymphoma diagnosis often begins with a physical exam that checks for swollen lymph nodes 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 lab testing.

Blood tests

Blood tests can sometimes show whether lymphoma cells are present. Blood tests may be used to test for viruses, including Epstein-Barr virus, HIV, hepatitis B and hepatitis C. Blood tests also measure levels of lactate dehydrogenase (LDH), which is often higher in people with lymphoma.

Imaging tests

Imaging tests make pictures of the body. They can show the location and extent of diffuse large B-cell lymphoma. Tests might include MRI, CT and positron emission tomography (PET) scan.

Biopsy

Your healthcare professional may suggest a lymph node biopsy or a biopsy of other tissue to look for cancer cells. A biopsy is a procedure to remove a sample of tissue for testing in a lab. A lymph node biopsy involves removing all or part of a lymph node. A sample may be taken from other parts of the body depending on symptoms and imaging test results. In the lab, tests may show whether you have diffuse large B-cell lymphoma.

Bone marrow aspiration and biopsy

Bone marrow aspiration and biopsy are procedures to collect cells from the bone marrow for testing. Bone marrow is the soft matter inside bones where blood cells are made. Bone marrow has a solid part and a liquid part.

In a bone marrow aspiration, a needle draws a sample of the fluid. In a bone marrow biopsy, a needle collects a small amount of the solid tissue. The samples are typically taken from the hip bone. The samples go to a lab for testing. For DLBCL, a bone marrow aspiration and biopsy may not be needed if imaging tests show bone involvement. However, they are sometimes used to help determine the cancer's extent.

Lumbar puncture

A lumbar puncture is a procedure to collect fluid from around the spinal cord. A lumbar puncture, also called a spinal tap, uses a needle. A healthcare professional inserts the needle between two bones in the lower back and draws out some of the fluid that surrounds the brain and spinal cord. This fluid is called cerebrospinal fluid. The fluid goes to a lab where it's tested for cancer cells.

For diffuse large B-cell lymphoma, a lumbar puncture may be done if you have any neurological symptoms. It also may be done if you are at higher risk of lymphoma of the central nervous system.

Testing lymphoma cells in the lab

Lymphoma cells collected from a biopsy or a bone marrow aspiration and biopsy go to a lab for testing. In the lab, specialized tests look for specific things about the cells. The healthcare team uses the results to decide on the type of lymphoma that you have.

To decide whether the cells are diffuse large B-cell lymphoma cells, the healthcare professionals in the lab look for:

• Proteins on the surface of the cancer cells. Diffuse large B-cell lymphoma cells have certain proteins on their surfaces that help identify them. These proteins are known as markers. Common markers found in diffuse large B-cell lymphoma are CD20, CD19, CD22, CD79a and CD10. These markers can help identify the type of diffuse large B-cell lymphoma.
• Changes in the cancer cell DNA. Cancer happens when cells get changes in their DNA. A cell's DNA holds the instructions that tell the cell what to do. In diffuse large B-cell lymphoma, the cells may have a gene change that changes the arrangement of their DNA. This is known as translocation. This gene change causes the cells to multiply rapidly. The genes often involved with DLBCL include BCL2, BCL6 and MYC.

Diffuse large B-cell lymphoma staging

If you're diagnosed with diffuse large B-cell lymphoma, the next step is to determine the cancer's extent, called the stage. Imaging tests, blood tests and biopsies may be used to determine the stage of diffuse large B-cell lymphoma. Your healthcare team uses the cancer stage to help create your treatment plan.

The stages of diffuse large B-cell lymphoma range from 1 to 4:

• Stage 1 diffuse large B-cell lymphoma. At this stage, only one lymph node region or one site outside of the lymph nodes is affected.
• Stage 2 diffuse large B-cell lymphoma. Stage 2 involves two or more lymph node regions on the same side of the diaphragm.
• Stage 3 diffuse large B-cell lymphoma. At stage 3, lymph node regions on both sides of the diaphragm or lymph nodes above the diaphragm and the spleen are affected.
• Stage 4 diffuse large B-cell lymphoma. At stage 4, diffuse large B-cell lymphoma has spread outside of the lymph nodes to organs including the bone marrow, liver, lungs, kidneys, digestive tract or nervous system.

Diffuse large B-cell lymphoma prognosis

The cancer prognosis tells you how likely it is that the cancer can be cured. Your personal prognosis may depend on:

• Your age.
• Your overall health.
• The cancer's stage. Lymphoma that is stage 3 or stage 4 may be harder to cure.
• Blood test results. A higher LDH level may be a sign of a poorer prognosis.
• How many sites outside of the lymph nodes are involved.

Talk with your healthcare team about your prognosis if you want to know what to expect. Your healthcare team can explain what they consider when thinking about your prognosis.

Diffuse large B-cell lymphoma survival rates

The chance of surviving diffuse large B-cell lymphoma is quite good for most people. To understand diffuse large B-cell lymphoma survival rates, experts study many people with diffuse large B-cell lymphoma to see how many are living five years after their diagnosis.

For stage 1 diffuse large B-cell lymphoma, the chance of surviving at least five years is 80%. As the cancer spreads, the chances get lower. For stage 4 diffuse large B-cell lymphoma, the chance of surviving at least five years is about 55%.

Keep in mind that survival statistics take five years to collect. The most recent survival rates include people who had diffuse large B-cell lymphoma treatment more than five years ago. These people may not have had access to the latest treatments. Over the last few decades, diffuse large B-cell lymphoma death rates have been falling and survival rates have been increasing.

Treatment

Diffuse large B-cell lymphoma treatments may include immunotherapy, chemotherapy, radiation therapy, targeted therapy, CAR-T cell therapy and bone marrow transplant, also called bone marrow stem cell transplant. Which treatment is best for you depends on the extent of your cancer, called the stage. Your healthcare team also considers how quickly the cancer is growing, your overall health and what you prefer.

Immunotherapy

Immunotherapy for cancer is a treatment with medicine that helps the body's immune system kill cancer cells. 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 find and kill the cancer cells.

Immunotherapy may be used as a first line treatment for diffuse large B-cell lymphoma. It is usually combined with chemotherapy. Immunotherapy also may be combined with other medicines in people with advanced cancer or cancer that has come back after treatment, known as relapsed diffuse large B-cell lymphoma.

Chemotherapy

Chemotherapy treats cancer with strong medicines. There are many chemotherapy medicines. Most chemotherapy medicines are given through a vein. Some come in pill form.

Chemotherapy may be used as a first line treatment for diffuse large B-cell lymphoma. It is usually combined with immunotherapy. Chemotherapy may be combined with other medicines in people with advanced cancer or cancer that has come back after treatment, known as relapsed diffuse large B-cell lymphoma. High doses of chemotherapy may be used to treat DLBCL of the nervous system.

Radiation therapy

Radiation therapy for cancer is a treatment that uses powerful energy beams to kill cancer cells. 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.

Radiation therapy is often combined with chemotherapy and may be used for people with early-stage diffuse large B-cell lymphoma. Radiation therapy also may be used to relieve symptoms and improve quality of life for people with DLBCL that has come back after treatment.

Targeted therapy

Targeted therapy for cancer is a treatment that uses medicines that attack specific chemicals in cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die.

For diffuse large B-cell lymphoma, targeted therapy may be used as a first line treatment. It also may be used when cancer comes back after treatment, known as relapsed diffuse large B-cell lymphoma. Targeted therapy also may be an option when other treatments haven't worked. This is known as refractory diffuse large B-cell lymphoma.

CAR-T cell therapy

Chimeric antigen receptor (CAR)-T cell therapy trains the immune system cells to fight diffuse large B-cell lymphoma. This treatment begins with removing some white blood cells, including 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. They find and destroy the DLBCL cells.

CAR-T cell therapy might be an option for advanced DLBCL that has not responded to other treatments, called refractory diffuse large B-cell lymphoma. It also may be an option for DLBCL that has come back after treatment, called relapsed diffuse large B-cell lymphoma.

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. Stem cells can come from your own body, called an autologous transplant.

For some diffuse large B-cell lymphomas, a bone marrow transplant can be used for cancer that has come back after treatment, called relapsed diffuse large B-cell lymphoma.

A bone marrow transplant is only an option for some people who are younger and in good health. Chemotherapy is typically done before the transplant to suppress the immune system and bone marrow.

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:

Learn enough about diffuse large B-cell lymphoma to make decisions about your care

Ask your healthcare team about your cancer, including your test results, treatment options and, if you want, your prognosis. As you learn more about diffuse large B-cell lymphoma, you may become more confident in making treatment decisions.

Keep friends and family close

Keeping your close relationships strong can help you deal with diffuse large B-cell lymphoma. Friends and family can provide the practical support you may need, such as helping take care of your home if you're in the hospital. And they can serve as emotional support when you feel overwhelmed by having cancer.

Find someone to talk with

Find someone who is willing to listen to you talk about your hopes and worries. This person may be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful.

Ask your healthcare team about support groups in your area. Other sources of information include the National Cancer Institute, the American Cancer Society, the Leukemia & Lymphoma Society and the Lymphoma Research Foundation.

Preparing for an 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 diffuse large B-cell lymphoma, 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.

Your time with your healthcare team is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For diffuse large B-cell lymphoma, some basic questions to ask include:

• Do I have diffuse large B-cell lymphoma?
• What is the stage of my diffuse large B-cell lymphoma?
• Has my diffuse large B-cell lymphoma 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?
• 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 material 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 symptoms better?
• What, if anything, seems to worsen your symptoms?
• Have you had any fevers, night sweats or weight loss?
• Have you noticed any lumps, swelling or pain anywhere in your body?
• Have you had any chest pain, coughing or trouble breathing?
• Have you had any recent infections?
• Do you have any other health conditions, such as diabetes, heart disease or kidney disease?
• What are your biggest worries about your diagnosis or treatment?