Diffuse large B cell lymphoma (diffuse LBCL or DLBCL) is a cancer that affects white blood cells called B cell lymphocytes. Ordinarily, these cells help to protect against infection and disease.

In DLBCL, abnormalities within the B cell lymphocytes mean the cells no longer develop and function as they should. These abnormal cells quickly proliferate in the lymphatic system, causing complications.

This article describes what DLBCL is, including the different subtypes. We also outline the symptoms, causes, and stages of DLBCL, and provide information on the treatment options available.

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Diffuse LBCL is a type of cancer that affects white blood cells called lymphocytes. There are two main types of lymphocytes: B cell lymphocytes (B cells) and T cell lymphocytes (T cells). Diffuse LBCL affects B cells.

B cells produce proteins called antibodies, which stick to bacteria and viruses. These antibodies signal to the immune system to destroy and eliminate pathogens.

Diffuse LBCL accelerates the reproduction rate of B cells to such an extent that the cells no longer develop or function as they should. Compared with healthy B cells, these faulty B cells are larger and accumulate in the lymph nodes, causing the lymph nodes to swell.

Diffuse LBCL is a type of non-Hodgkin lymphoma (NHL). It is the most common NHL, accounting for 85% of these lymphomas.

Medical professionals classify NHLs according to the speed at which they grow. Fast-growing cancers are “aggressive”, while slower ones are “indolent”. Diffuse LBCL is an aggressive form of cancer but one that responds well to treatment.

According to the American Cancer Society, 3 in 4 people who receive treatment for diffuse LBCL have no further signs of the disease afterward.

The outlook for this form of cancer depends on the type of diffuse LBCL a person has, the stage that it has progressed to, and whether or not a person receives treatment for it.

Diffuse LBCL can originate inside the lymph nodes or in an organ outside the lymph nodes. Medical professionals refer to different subtypes of DLBCL according to where or how they originated.

  • Primary diffuse LBCL of the central nervous system: Refers to DLBCLs that originate in the brain or the eye.
  • Primary cutaneous diffuse LBCL: Refers to DLBCLs that typically appear as red or bluish-red tumors on the skin. They may develop anywhere on the body, including:
    • the torso
    • the buttocks
    • the arms
    • the legs
  • Primary mediastinal B-cell lymphoma: A DLBCL that originates in the mediastinum. This is the area in the center of the chest, which contains the following structures:
    • the heart
    • the thymus gland
    • sections of the windpipe and esophagus
  • T-cell/histiocyte-rich B-cell lymphoma: A form of DLBCL that has the following characteristics when viewed under a microscope:
    • a few scattered large and atypical B cells
    • numerous normal T cells
    • numerous histiocytes, which are another type of immune cell
  • Epstein-Barr virus (EBV)-positive diffuse LBCL: A form of DLBCL that usually occurs in people who are 50 years of age or older and test positive for EBV.
  • Diffuse LBCL not otherwise specified (NOS): Diffuse LBCL that does not fall into one of the above subtypes. In Western countries, 25–30% of NHLs in adults are DLBCL-NOS. This percentage is higher in developing countries.

Cancer staging is a process that determines how far a cancer has spread. In DLBCL, there are four stages:

  • Stage 1: The cancer affects only one area — either a single organ or a single cluster of lymph nodes.
  • Stage 2: The cancer affects two or more areas on the same side of the diaphragm.
  • Stage 3: The cancer affects areas on both sides of the diaphragm.
  • Stage 4: The DLBCL has spread to organs outside the lymphatic system, such as the lungs or bones.

Doctors may also use the following letters to further describe the stages of DLBCL:

  • A: The person has DLBCL but is not experiencing any symptoms of the disease.
  • B: The person has DLBCL and has one or more “B symptoms.”
  • E: The DLBCL has spread beyond the lymphatic system.
  • S: The DLBCL is present in the spleen.

The treatment for DLBCL depends on where in the body the cancer originated and the extent to which it has spread. DLBCL is an aggressive cancer, so doctors typically recommend chemotherapy treatment in cycles spaced 3 weeks apart.

The most common treatment protocol for DLBCL is R-CHOP, which features the following combination of drugs:

  • Rituximab: A monoclonal antibody, which helps to reduce the number of B cells in circulation.
  • Chemotherapy drugs: These three drugs help slow or stop the growth of cancer cells:
    • cyclophosphamide
    • doxorubicin
    • vincristine
  • Prednisone: A steroid medication that helps to increase the effectiveness of chemotherapy while reducing some of its side effects.

Most people with DLBCL who are following the R-CHOP protocol need between three and six treatment cycles. The goal of the treatment is to remove as many cancerous lymphocytes as possible.

Around 90% of people who receive R-CHOP treatment during disease stages 1 and 2 achieve long-term control of the disease. This figure drops to around 60% for people with more advanced disease.

People who do not achieve the desired outcome to the initial treatment may receive further chemotherapy cycles using different drug combinations.

There is a risk that DLBCL will come back following successful treatment. A doctor will explain the different options for follow-up treatment on a case-by-case basis.

Experts do not yet know the cause of DLBCL. However, researchers have identified certain risk factors for the disease. These include:

  • Older age: DLBCLs are more common in older people.
  • Being male: Males are slightly more susceptible to DLBCL than females.
  • Genetics: A person who has a close relative with DLBCL may be at increased risk of developing the disease themselves.
  • Prior infections: Certain infections can increase the risk of developing DLBCL, including:
  • Having a low-grade NHL: Rarely, a low-grade lymphoma can transform into a high-grade lymphoma, such as DLBCL.

It is important to remember that having one or more risk factors for DLBCL does not mean a person will develop the disease. Equally, people without any risk factors can still develop DLBCL.

People with DLBCL typically experience inexplicable but painless swelling in one or more lymph nodes. These swellings can appear in any part of the body but are more common in the following areas:

  • the neck
  • the armpit
  • the groin

People may experience additional symptoms, known as B symptoms. Examples include:

A person who experiences symptoms of DLBCL should consult a doctor as soon as possible.

Diffuse large B cell lymphoma is a type of non-Hodgkin lymphoma that affects B cell lymphocytes. The disease can originate in any part of the body and generally causes a painless swelling in one or more lymph nodes.

Diffuse LBCL is an aggressive cancer that grows and proliferates rapidly. However, this type of cancer responds well to treatment. The typical treatment protocol for DLBCL is R-CHOP, which combines different drugs to help slow or stop the growth of cancerous lymphocytes.

Treatment for DLBCL is typically more successful if a person receives treatment in the earlier stages of the disease. For this reason, a person who experiences symptoms of DLBCL should see their doctor as soon as possible for a diagnosis and appropriate treatment.