Key takeaways

  • Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin’s lymphoma. It develops when abnormal B cells rapidly accumulate in lymph nodes, causing painless swelling often in the neck, armpit, or groin.
  • Treatment typically involves R-CHOP chemotherapy given in 3 to 6 cycles spaced 3 weeks apart. Around 90% of people with early stage DLBCL achieve long-term management with this treatment.
  • Common symptoms include painless lymph node swelling, severe night sweats, unexplained fever, sudden weight loss, and overwhelming fatigue. A person should speak with a doctor if they experience these symptoms.

Diffuse large B-cell lymphoma (DLBCL) 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).

DLBCL affects B cells, which help protect the body against infections by producing antibodies that attach to bacteria and viruses. These antibodies signal the immune system to destroy pathogens.

Abnormalities in B cells mean the cells no longer develop and function as they should. These irregular cells rapidly accumulate in the lymph nodes, causing them to swell and leading to complications.

DLBCL is a type of non-Hodgkin’s lymphoma (NHL). It is the most common NHL, accounting for up to 3 in 10 cases.

This article discusses DLBCL, including the different subtypes. It also outlines its symptoms, causes, and stages, along with treatment options.

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People with DLBCL often 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 neck, armpit, and groin areas.

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.

Experts do not yet know the cause of DLBCL, according to the American Cancer Society. However, researchers have identified certain risk factors for DLBCL, including:

  • being ages 60 years and older
  • being assigned male at birth
  • having a relative with DLBCL
  • having low grade NHL
  • having certain prior infections, such as:

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.

DLBCL 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 DLBCL of the central nervous system: Refers to DLBCL originating in the brain or the eye.
  • Primary cutaneous DLBCL: 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
    • buttocks
    • arms
    • 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 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 DLBCL: A form of DLBCL that usually occurs in people ages 50 years or older and test positive for EBV.
  • DLBCL not otherwise specified (NOS): DLBCL that does not fall into one of the above subtypes. In Western countries, 25% to 30% of NHLs in adults are DLBCL-NOS. This percentage is higher in developing countries.

Healthcare professionals typically use a variety of tests to diagnose DLBCL and monitor its progression.

The first point of contact is typically a primary care doctor, who can perform a physical examination to assess symptoms and may also order blood tests.

If the doctor believes symptoms warrant further investigation, they can refer a person to a medical specialist, such as:

  • an ear, nose, and throat (ENT) doctor
  • a hematologist
  • an oncologist

The most accurate medical test for diagnosing DLBCL and other lymphomas is a lymph node biopsy, in which a doctor removes a part of the lymph node (incision) or the entire lymph node (excision) for assessment in a lab.

Other tests may include:

Healthcare professionals may also use these tests to help stage DLBCL.

Find a medical specialist in your area today

Your healthcare team may comprise several people who can provide support.

Sometimes, a medical specialist will be required to help diagnose, manage, or treat a healthcare condition.

You can find the following medical specialists in your area today:

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.

Treatment for DLBCL depends on where the cancer originated and the extent of its spread. DLBCL is an aggressive cancer, so doctors typically recommend chemotherapy treatment in cycles spaced 3 weeks apart.

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

Most people with DLBCL following the R-CHOP protocol need between 3 and 6 treatment cycles. The goal of the treatment is to remove as many cancerous lymphocytes as possible.

Around 9 in 10 people who receive R-CHOP treatment during stages 1 and 2 achieve long-term DLBCL management. This figure drops to around 6 in 10 people for those with more advanced DLBCL.

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

Following successful treatment, there is a risk that DLBCL will return. A doctor will explain the different options for follow-up treatment on a case-by-case basis.

Medical professionals classify NHLs according to the speed at which they grow. Fast-growing cancers are “aggressive,” while slower ones are “indolent.” DLBCL 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 DLBCL have no further signs of the disease afterward.

The outlook for this form of cancer depends on:

  • the type of DLBCL a person has
  • the stage that it has progressed to
  • whether a person receives treatment for it

The relative 5-year survival rate for people with DLBCL is 65%.

Researchers have not identified the exact cause of DLBCL. However, factors such as genetics, ages 60 years and older, or a history of infections may increase the risk of developing DLBCL.

Healthcare professionals often recommend 3 to 6 rounds of treatment for DLBCL, but the exact amount will vary for each individual.

DLBCL is a type of non-Hodgkin’s lymphoma that affects B-cell lymphocytes. It can originate in any part of the body and generally causes a painless swelling in one or more lymph nodes.

While DLBCL is an aggressive cancer that grows and proliferates rapidly, it 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 during the earlier stages of the disease. Therefore, people who experience symptoms of DLBCL should contact a doctor as soon as possible for a diagnosis and appropriate treatment.