Lymphoma is a type of blood cancer that begins in the lymphatic system. The two main types are Hodgkin lymphoma and non-Hodgkin lymphoma (NHL), which is more common. Large cell lymphoma is a type of NHL.

The two most common types of large cell lymphoma are diffuse large B-cell lymphoma (DLBCL) and anaplastic large cell lymphoma (ALCL).

This article will focus on the types, causes, and symptoms of large cell lymphoma. It will also cover the risks, diagnosis, and treatment options.

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A histological slide of a tissue sample. Close microscopic view. Large cell lymphoma in the colonic mucosa.

Large cell lymphoma is an aggressive form of NHL. It is a type of blood cancer that occurs in white blood cells called lymphocytes, which are part of the immune system. Cancers can originate in the T cells or B cells, which are the two main types of lymphocytes. These cells are essential components of the immune system.

The two main types of large cell lymphoma are DLBCL and ALCL.

Diffuse large B-cell lymphoma

DLBCL is the most common type of NHL and large cell lymphoma. It is a fast-growing cancer that can spread to several areas of the body. Although DLBCL usually occurs in adults and older people, it can sometimes develop in children.

Localized DLBCL, known as stage 1 or 2 DLBCL, occurs in one part of the body. Advanced, or stage 3 or 4, DLBCL has spread to several areas of the body.

DLBCL typically begins as a rapidly growing mass in a lymph node deep within the body, such as in the chest or abdomen. However, it may also originate in lymph nodes just below the skin that a person may be able to feel, including those in the neck and armpit.

The disease may also develop in other organs and parts of the body, including the gastrointestinal tract, testes, thyroid, skin, breast, bone, brain, and spinal cord.

Learn more about diffuse large B-cell lymphoma.

Anaplastic large cell lymphoma

ALCL is a rare form of NHL that involves the T cells. In comparison with other T-cell lymphomas, it tends to have better outcomes. ALCL can occur in the skin, lymph nodes, or organs. Doctors classify it as either cutaneous or systemic.

ALCL that originates in the skin is called primary cutaneous ALCL. Usually, primary cutaneous ALCL is less aggressive and does not travel to organs or lymph nodes.

Systemic ALCL begins in lymph tissue in the neck, chest, abdomen, lungs, skin, or bone. It is more aggressive and widespread than primary cutaneous ALCL. The two types of systemic ALCL are ALK-negative ALCL and ALK-positive ALCL.

Learn more about ALCL and other T-cell lymphomas.

The exact causes of DLBCL and ALCL are not always clear, although certain groups of people are more at risk. For example, people with family members who have had lymphoma may carry an increased risk, as might people who have the hepatitis C virus.

In rare cases, there may be a link to other conditions affecting the immune system, such as:

The symptoms of large cell lymphoma can vary based on the cancer type and location.

Symptoms of diffuse large B-cell lymphoma

The symptoms of DLBCL include:

  • painless, swollen lymph nodes
  • digestive discomfort
  • cough
  • breathlessness
  • fatigue
  • decreased appetite
  • fever
  • night sweats
  • unintentional weight loss
  • severe itching

Symptoms of anaplastic large cell lymphoma

The symptoms of ALCL include:

  • raised, discolored skin lesions that may ulcerate and itch and do not heal
  • rash
  • swollen lymph nodes
  • fever
  • night sweats
  • unexplained weight loss
  • bloating
  • diarrhea
  • vomiting
  • shortness of breath
  • cough
  • pain or pressure in the chest
  • anemia
  • thrombocytopenia

DLBCL has various associated risk factors, including:

  • chronic inflammation
  • autoimmune conditions, such as rheumatoid arthritis and systemic lupus erythematosus
  • HIV
  • organ transplantation

Children and young adults are more likely to have ALK-positive ALCL, whereas older people have a higher chance of developing ALK-negative ALCL. Both types are more common in males than in females. In rare cases, ALCL is linked to breast implants.

The diagnostic procedure for ALCL and DLBCL involves taking a biopsy and viewing the cells under a microscope.

Doctors may also order additional tests that provide more detailed information. These may include a:

The stage of large cell lymphoma and the areas of the body that it affects will determine the suitable treatment options. The options include:

  • surgery
  • chemotherapy
  • radiation therapy
  • certain immunotherapy drugs
  • certain targeted therapy drugs

Treatment for diffuse large B-cell lymphoma

The standard treatment for DLBCL is a chemotherapy called R-CHOP, which consists of rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisolone. Some people also undergo radiation therapy alongside R-CHOP. Many people respond well to this DLBCL treatment. However, individuals whose lymphoma either recurs after treatment or does not go into remission will require further intervention.

Researchers are developing new treatments, such as immunotherapy with adoptive T-cell therapy, for people in high risk groups who do not respond well to R-CHOP.

Treatment for anaplastic large cell lymphoma

The treatment for ALCL usually involves chemotherapy with CHOP, which consists of cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisolone. Sometimes, it includes etoposide. Additional treatment options include radiation therapy, targeted therapies, and immunotherapies.

People may also have the opportunity to participate in a clinical trial that tests new, targeted drugs.

Many people with large cell lymphoma make a full recovery, especially if they receive a diagnosis in the early stages, begin treatment right away, and respond well to it.

Factors that can affect treatment success include age, overall health, and disease progression. Individual responses to treatments can also vary.

Large cell lymphoma is an aggressive form of NHL, which is a type of blood cancer that begins in the lymphatic system.

The two main types of large cell lymphoma are DLBCL and ALCL.

These aggressive blood cancers respond well to treatment, especially if doctors detect and treat them early. People should talk with a doctor as soon as possible if they notice any symptoms that could indicate cancer.