Diffuse large B-cell lymphoma (DLBCL) is a fast-growing blood cancer. Healthcare providers typically treat this condition with a combination of cancer drugs. The combined drugs often eliminate DLBCL signs and symptoms and cure the condition. Medical researchers are studying different treatments for DLBCL that don’t respond to treatment or comes back.
Diffuse large B-cell lymphoma (DLBCL) is a fast-growing blood cancer and the most common form of non-Hodgkin lymphoma. There are different forms of DLBCL that happen when several different genetic changes, or mutations, turn healthy cells into cancerous cells.
Healthcare providers treat most DLBCL types by combining several cancer drugs. This treatment often eliminates DLBCL signs and symptoms and cures the condition. The drug combination doesn’t work for all cases of diffuse large B-cell lymphoma. Medical researchers are studying different treatments for DLBCL that don’t respond to treatment or comes back.
To understand how DLBCL may affect you, it may help to know more about non-Hodgkin lymphomas. These conditions happen when white blood cells known as lymphocytes mutate or change. These cells include B -cells, T-cells and natural killer (NK) cells.
There are two categories of non-Hodgkin lymphoma — B-cell lymphoma and T-cell/NK lymphoma. Diffuse large B-cell lymphoma is a B-cell lymphoma.
B-cell lymphomas frequently affect your lymphatic system. Your lymphatic system is a network of tissues, vessels and organs that work together to move a colorless, watery fluid called lymph back into your bloodstream. Lymph contains B cells (B lymphocytes). B cells make antibodies. Antibodies are proteins that target intruders such as viruses and bacteria.
Normally, healthy B-cells die when they’re done fighting infection. B-cell lymphoma happens when healthy B-cells change into fast-growing cancer cells that don’t die the way that they should. The cancer cells duplicate, eventually overwhelming healthy cells.
In diffuse large B-cell lymphoma, cancerous B-cells may appear in your lymph nodes, but in some cases, they can appear in virtually any organ, including your gastrointestinal tract, thyroid, skin, breast, bone or brain. Diffuse large B-cell lymphoma is aggressive, meaning it may spread very quickly.
It can be, depending on your situation. One study showed a combination of cancer drugs used as front-line or initial treatment cured 90% of people with early or limited-stage lymphoma. (Early-stage cancer is cancer that hasn’t spread.) This same treatment helped up to 60% of people with a more advanced form of diffuse large B-cell lymphoma. However, the combination treatment doesn’t cure all DLBCL and it may not keep the condition from coming back (recurring).
No, it’s not, at least compared to other forms of cancer. According to the National Cancer Institute, in 2020, about 6 people in 100,000 were diagnosed with DLBCL. In comparison, that year, 19 people in 100,000 were diagnosed with some form of non-Hodgkin lymphoma, and about 500 people in 100,000 were diagnosed with cancer affecting any part of their bodies.
Diffuse large B-cell lymphoma typically affects people in their 60s. It affects more people who are white than people who are Black.
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The symptoms most people notice are swollen lymph nodes in their neck, armpits or groin. They may notice a lump or mass that doesn’t go away and seems to be getting larger. Other symptoms sometimes include:
It’s important to remember these are common symptoms related to many different conditions. Having one or all of these symptoms doesn’t mean you have diffuse large B-cell lymphoma. That said, you should contact a healthcare provider anytime you notice changes in your body that last for several weeks.
Diffuse large B-cell lymphoma happens when B-cells mutate. These are acquired genetic mutations, meaning you develop them during your lifetime instead of being born with them.
Medical researchers aren’t sure what triggers these mutations, but having a family history of DLBCL could be a risk factor. A risk factor is an activity or condition that increases your risk of developing a disease. Other risk factors may include:
Healthcare providers use several different blood tests and an imaging test to diagnose this condition. They also do genetic testing to understand whether specific mutations, or changes, are part of how a given case of diffuse large B-cell lymphoma occurred.
Tests healthcare providers may use include:
Diffuse large B-cell lymphoma happens when genes mutate, or change. In DLBCL, the mutations may affect several different genes and chromosomes to create different types of diffuse large B-cell lymphoma.
Test results help providers with cancer staging. Healthcare providers use cancer staging systems to develop treatment plans and estimate prognosis, or expected outcome. Here’s information about DLBCL stages:
Healthcare providers use cancer staging systems to plan treatment for diffuse large B-cell lymphoma.
Some people who have cancer may be confused and intimidated by a system that describes their illness with a formula of letters and numbers or risk factors that place them in one category or another. They may even feel as if their condition’s stage or category defines who they are.
If this is your situation, talk to your provider. They’ll understand why you may feel this way and will be glad to answer your questions about cancer staging systems.
The standard treatment is R-CHOP. It combines the monoclonal antibody drug rituximab with three chemotherapy drugs and a drug that helps kill lymphoma cells.
This treatment is safe and effective but doesn’t always work or keep DLBCL from coming back. (Studies show relapses or recurring disease affect an estimated 10% to 35% of people who receive R-CHOP.) If that happens, healthcare providers may recommend the following treatments:
A risk factor is an activity or condition that increases your risk of developing a condition. There are DLBCL risk factors you can’t control, like having an autoimmune disease or immunodeficiency. And there are risk factors you may be able to avoid, like developing certain infections.
Avoiding risk factors may help, but there’s no guarantee you won’t develop DLBCL. That’s because this condition happens when certain genes mutate and create cancerous cells. These are acquired genetic mutations, meaning you develop them during your lifetime instead of being born with them. Medical researchers aren’t sure why these mutations happen or the specific role that risk factors may play.Additional risk factors for diffuse large B-cell lymphoma include:
That depends on your situation. Like many kinds of cancer, healthcare providers have more success treating early-stage DLBCL than advanced or later-stage cancer that’s spread. In general, people who are cancer-free two years after their diagnosis can expect to live as long as most people in their age group.
However, diffuse large B-cell lymphoma can come back. And there are different forms of DLBCL that are more difficult to treat. If you have this condition, your healthcare provider is your best source of information about what you can expect.
Many times, front-line or initial treatment cures people with early-stage diffuse large B-cell lymphoma. (In this case, “cure” means that treatment eliminated all signs and symptoms of cancer.) Front-line or initial treatment cures about 60% of people who have advanced or later-stage DLBCL.
According to the National Cancer Institute, 64.6% of people with DLBCL are alive five years after diagnosis. (Relative survival rates are estimates based on large groups of people.)
Like many kinds of cancer, survival rates increase for people with early-stage cancer. In this case, 79.5% of people with Stage I DLBCL are alive five years after diagnosis. Often, people have advanced-stage cancer by the time they receive a diagnosis. In that case, 54.7% of people with Stage IV DLBCL are alive five years after diagnosis.
It’s important to remember survival rates are estimates. They’re based on the experiences of large groups of people who have with different forms of DLBCL, at different times in their lives and different overall health.
Survival rate estimates may be helpful, but your healthcare provider is your best resource if you have questions about what you may expect.
Like most forms of cancer, it can be stressful and exhausting to live with diffuse large B-cell lymphoma. It’s important that you do what you can to take care of yourself throughout your treatment for diffuse large B-cell lymphoma. Here are some suggestions:
You’ll see your healthcare provider throughout your treatment. They’ll monitor your overall health. They’ll assess how you’re reacting to treatment and whether the treatment is working. You may see your provider every three to four months for the first two years and then less frequently for the next three years. That’s because diffuse large B-cell lymphoma may come back. Contact your healthcare provider if you notice changes in your body that may mean your condition has come back.
Cancer treatment may have strong side effects. Your healthcare provider may have given you medication to help manage your side effects. You should go to the emergency room if you have:
Diffuse large B-cell lymphoma is a rare disease. If you have this condition, you may want to ask your healthcare provider some of the following questions:
A note from Cleveland Clinic
Diffuse large B-cell lymphoma (DLBCL) is a fast-growing blood cancer and the most common form of non-Hodgkin lymphoma. Most of the time, healthcare providers can cure this condition, using a combination of cancer drugs as initial or front-line therapy. (In this case, “cure” means that treatment eliminated cancer signs and symptoms.)
Unfortunately, there are situations when initial therapy doesn’t work. Diffuse large B-cell lymphoma can come back after treatment. When that happens, healthcare providers have different treatments that may be successful.
At the same time, medical researchers are testing many treatments that may do more to help people with DLBCL. If you have this condition and want information about newer treatments, ask your healthcare provider about participating in a clinical trial.
Last reviewed by a Cleveland Clinic medical professional on 10/31/2022.
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