B-Cell Lymphoma

What is B-cell lymphoma?

B-cell lymphoma is a type of blood cancer in your lymphatic system. In B-cell lymphoma, abnormal lymphocytes (a type of white blood cell) multiply to form tumors. Your lymphatic system is a large network of organs, vessels and tissues, so B-cell lymphoma can develop in many places in your body and cause different symptoms.

B-cell lymphoma is a common type of non-Hodgkin lymphoma. There are many B-cell lymphoma types, but most cause the same symptoms: swollen lymph nodes, fatigue and drenching night sweats.

Often, treatment cures some types of B-cell lymphoma. And there are treatments that put the conditions into remission so you don’t have symptoms and tests don’t find signs of cancer. But the conditions can come back (recur).

Types of B-cell lymphoma

When your provider talks about your condition, they may use terms like “aggressive” or “indolent” to describe it:

• An aggressive type of B-cell lymphoma is one that can quickly spread (metastasize) from your lymphatic system to other organs or tissues in your body.
• An indolent type of the condition grows more slowly.

Aggressive (fast-growing) B-cell lymphoma

Aggressive B-cell lymphomas can develop in several areas of your body. Examples include:

• Burkitt lymphoma: This rare, fast-growing lymphoma may develop in your stomach and then spread to other organs.
• Diffuse large B-cell lymphoma (DLBCL): There are different forms of diffuse large B-cell lymphoma. It’s the most common type of non-Hodgkin lymphoma. DLBCL may start in your lymph nodes or a lymphoid organ like your thymus, spleen or tonsils.
• High-grade B-cell lymphoma (HGBCL): This type of B-cell lymphoma causes the same symptoms as DLBCL and Burkitt lymphoma. There are treatments that put the condition into remission, but it often comes back.

Indolent (slow-growing) B-cell lymphoma

You can have a type of indolent B-cell lymphoma for months and years before you develop symptoms. Common types include:

• Chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL): This type develops in your blood and bone marrow.
• Cutaneous B-cell lymphoma: This rare type starts in your skin.
• Follicular lymphoma: This is the second most common type of B-cell lymphoma. You may develop follicular lymphoma in your lymph nodes, bone marrow and other organs.
• Lymphoplasmacytic lymphoma (Waldenstrom macroglobulinemia): This is a rare type of lymphoma that typically grows in your bone marrow, but may also develop in parts of your lymphatic system.
• Marginal zone lymphomas: There are different types of marginal zone lymphomas. Some develop in your stomach, lungs, skin, thyroid, salivary glands and tissues around your eyes.
• Mantle cell lymphoma: This B-cell lymphoma type often develops in your lymph nodes, bone marrow and spleen.

How common is B-cell lymphoma?

B-cell lymphoma accounts for 85% of all non-Hodgkin lymphoma. The American Cancer Society estimates 80,600 people will receive a non-Hodgkin lymphoma diagnosis in 2024. By comparison, in 2024, more than 2 million people will learn they have some type of cancer.

What are the symptoms of B-cell lymphoma?

You can have a type of B-cell lymphoma without having symptoms. For example, people with follicular lymphoma often receive a diagnosis while receiving treatment or tests for an unrelated condition. Symptoms that may be related to B-cell lymphoma include:

• Abdominal (belly) pain: Some types start in your belly, causing pain that doesn’t go away or gets worse.
• Drenching night sweats: This is sweating so much that your pajamas, sheets and blankets are soaking wet.
• Swollen lymph nodes: Painless lumps in your neck, armpit or groin are very common symptoms.
• Enlarged spleen or liver: B-cell lymphoma in your spleen or liver can make them get larger.
• Loss of appetite: Cancer in your spleen may make it press on your stomach, so you feel full even when you don’t eat very much.
• Persistent fatigue: Abnormal B cells in your bone marrow can affect red blood cell production and cause anemia (low red blood cell levels). Anemia can make you feel exhausted no matter how much rest you get.
• Pruritus (itchy skin): B-cell lymphoma in your liver may cause liver damage symptoms, including itchy skin.
• Rashes or skin lumps: Cutaneous B-cell lymphoma causes rashes, lumps and bumps on your skin. MALT lymphoma, a rare type of B-cell lymphoma, can cause skin changes, including lumps.
• Unexplained fever: A fever that stays above 100.4 degrees Fahrenheit (38.0 degrees Celsius) lasting more than two days or that comes back may be a B-cell lymphoma symptom.
• Unexplained weight loss: This is losing weight without trying to change what you eat and exercising.

B-cell lymphoma may cause symptoms that look and feel a lot like less serious medical issues. For example, swollen lymph nodes are a common B-cell lymphoma symptom. But they’re also a common symptom of colds and flu.

Having one or more of these symptoms doesn’t mean you have a type of B-cell lymphoma. But you should talk to a healthcare provider if you have symptoms that don’t go away or get worse.

What causes B-cell lymphoma?

Your B cells protect your body from invaders like bacteria, viruses and cancerous cells. Normally, your body produces new B cells as needed and the cells die once they’ve done their job.

In B-cell lymphoma, normal B cells change (mutate), turning into abnormal cells that multiply uncontrollably, don’t die and can spread from where they started to other areas of your body.

The condition typically happens because there are accidental (sporadic) changes in your B cells as they replicate themselves. Research suggests that sometimes, there’s a connection between B-cell lymphomas and the following issues:

• Autoimmune diseases, like rheumatoid arthritis, inflammatory bowel disease, Sjörgren’s syndrome and other related conditions.
• Being exposed to certain viruses, including HIV (human immunodeficiency virus), Epstein-Barr (mononucleosis) and Kaposi sarcoma human immunodeficiency virus.
• Having a family history of Hodgkin lymphoma.
• Having obesity.

How are B-cell lymphomas diagnosed?

A healthcare provider will ask about your symptoms and your medical history. They’ll do a physical examination that may focus on your lymph nodes, liver and spleen. They may refer you to a hematologist-oncologist, a provider who specializes in diagnosing and treating blood cancer. Your specialist may order blood tests, imaging tests and biopsies to diagnose your condition.

Blood tests

Blood tests for cancer give your healthcare provider a view of your overall health. Specific tests may include:

• Complete blood count (CBC) with differential: This test measures and counts your blood cells and platelets, including your B cells.
• Comprehensive metabolic panel (CMP): Your provider may order this test to check on substances in your blood that may be signs of B-cell lymphoma.
• Lactate dehydrogenase (LDH) levels: This test measures LDH levels. High LDH levels may be a sign of lymphoma or other diseases.

Imaging tests

Your provider may order the following imaging tests to look for signs of lymphoma in your lymph nodes, liver or spleen:

• CT scans.
• PET scans.
• Ultrasound.

Biopsy

A biopsy to obtain lymph node tissue is the only way your provider can confirm you have B-cell lymphoma. A medical pathologist will examine lymph node tissue samples to identify the lymphoma type. Biopsies may include:

• Excisional or incisional biopsy: In these procedures, a surgeon makes cuts in your body to remove lymph nodes for examination.
• Fine-needle aspiration (FNA): This procedure involves using a fine needle and a syringe to pull out cells for examination.
• Bone marrow biopsy: Providers use a special biopsy needle to remove a small piece of bone marrow for examination. Bone marrow biopsies are common tests to diagnose blood cancers like B-cell lymphoma.

How are B-cell lymphomas treated?

There’s no single treatment for B-cell lymphoma. If you have this condition, your treatment will depend on factors like the type, your overall health and if tests detect the condition before it spreads.

Your hematologist oncologist will recommend treatments that do the most to eliminate cancerous tumors while causing the fewest side effects. You may receive one or more of the following treatments:

• Chemotherapy.
• Immunotherapy.
• Radiation therapy.
• Targeted therapy. These include treatments such as monoclonal antibody therapy.
• Watchful waiting/active surveillance. If you have a type of slow-growing B-cell lymphoma and don’t have symptoms, your provider may do watchful waiting or active surveillance. Providers carefully monitor your overall health so they’re ready to start treatment as soon as you have symptoms.

Common treatment side effects

Each treatment may cause different side effects. And people often react differently to any given treatment. Your healthcare provider will select treatments that do the most to eliminate cancerous cells with the fewest side effects. Although cancer treatments are different, they do have some common side effects. Common side effects may include:

• Diarrhea.
• Fatigue.
• Nausea and vomiting.

Talk to your healthcare provider about each treatment option and potential side effects. Understanding how your treatment might affect you can help you feel more confident about managing side effects.

Regardless of the kind of treatment that you receive, also ask your provider about palliative care. Palliative care is a specialized treatment to help you manage B-cell lymphoma symptoms and treatment side effects.

What can I expect if I have a type of B-cell lymphoma?

There are many different types of B-cell lymphoma, so what you can expect depends on your situation and factors like the type of lymphoma, how well your body responded to treatment and your overall health. Your provider is your best resource for information on what to expect.

B-cell lymphoma survival rates

Survival rates vary widely depending on the type of lymphoma. For example, according to data from the National Cancer Institute (U.S.), 64.6% of people with diffuse large B-cell lymphoma are alive five years after diagnosis. On the other hand, data show 90% of people with follicular lymphoma are alive five years after diagnosis.

If you’re receiving treatment for a type of B-cell lymphoma, ask your provider to explain survival rate information for your situation, including whether a survival rate can predict how long you’ll live. And try to keep in mind that any survival rate is an estimate based on the experiences of other people. What was true for them may not be true for you.

How do I take care of myself?

B-cell lymphoma can be a life-changing diagnosis. You may feel overwhelmed as you try to take in information about your condition and treatment while trying to keep up with your daily life. Here are some suggestions that may help you:

• Have a plan for living with B-cell lymphoma. That plan might be lining up support during treatment, whether that’s arranging for special meals, transportation to appointments or someone to keep you company during treatment.
• Eat well. Treatment may affect your appetite. Consider working with a nutritionist so you fill your plate with food that you enjoy.
• Get your rest. Treatment can be exhausting. Plan to rest as much as possible, meaning rest when you need to, not just when you think you have time.
• Consider mental health support. Having cancer may make you feel anxious, angry, overwhelmed or depressed. Working with a mental health provider may help you understand and manage all those emotions.
• Find ways to relieve stress. Cancer is stressful. Consider activities such as meditation, relaxation exercises or deep breathing exercises.
• Reach out for support. Your healthcare provider can direct you to support groups and programs where you can express your feelings and concerns with people who understand what you’re going through.

When should I see my healthcare provider?

You’ll see your hematologist-oncologist and other care team members throughout your treatment. They’ll manage your treatment and monitor your overall health. When you finish treatment, your provider may recommend a schedule of regular follow-up appointments so they can watch for signs that B-cell lymphoma is coming back.

When should I go to the emergency room?

Many cancer treatments affect your immune system, increasing the chance you’ll develop infections that can cause high fevers. Go to the emergency room if you have a fever that stays above 100.4 degrees Fahrenheit (38 degrees Celsius).

You may also have unusually strong side effects from your cancer treatment. While your healthcare provider likely gave you medication to help manage side effects, you should go to the emergency room if they continue despite medication.