Diffuse Large B-Cell Lymphoma (DLBCL): Information on Causes, Diagnosis & Treatments

Diffuse large B-cell lymphoma (DLBCL) is a form of non-Hodgkin lymphoma cancer that involves lymphocytes, which are special white blood cells. The cancerous lymphocytes tend to grow in lymph nodes in the armpits, groin, neck or anywhere in the immune system. The condition develops when the special white blood cells begin dividing uncontrollably.

While lymphoma can develop from T lymphocytes, the condition tends to develop primarily in B lymphocytes cells. The lymphoma is divided into two categories – Hodgkin lymphoma and non-Hodgkin lymphoma – where both types require different treatments. Diffuse large B-cell lymphoma is a common form of fast-growing non-Hodgkin cancer that develops unique characteristics that include:

• The abnormal lymphocytes tend to grow much larger than regular healthy B cells


• than normal


• The cancerous lymphocytes spread diffusely in the tumor causing considerable damage to the lymph node (gland) structure

Some individuals who suffer from severe immune system issues including HIV (human immunodeficiency virus) experience a rare form of diffuse large B-cell lymphoma that can only be identified through testing and under a microscope. However, this condition is often treated identically to the more common form of DLBCL.

• Who Is at Risk for Diffuse Large B-Cell Lymphoma?
• Common Symptoms
• Diagnosing Diffuse Large B-Cell Lymphoma
• Treating the Condition

Who Is at Risk for Diffuse Large B-Cell Lymphoma?

While any individual at any age can develop DLBCL, including children, the risk of developing the condition tends to increase with age. Most individuals who are diagnosed with diffuse large B-cell lymphoma on average are over 64 years of age. Men are at greater risk of developing the condition than women. African-American and Asian Americans are less likely to develop DLBCL compared all other ethnicities in the United States. This cancerous disease is not contagious, inherited nor passed on to others.

However, medical science has found the correlation between diffuse large B-cell lymphoma and other disorders that affect the body's immune system including:

• Organ transplantation


• Immune system problems like HIV


• Autoimmune disorders including systemic lupus erythematosus and rheumatoid arthritis

Common Symptoms

Diffuse large B-cell lymphoma can develop in lymph nodes anywhere in the body, including in areas that cannot be touched through the skin. However, some people experience DLBCL in parts of the body outside the lymph node system (extra nodal sites), while others develop "bulky disease" with the formation of large lumps.

Generally, diffuse large B-cell lymphoma will initially present itself as a fast-growing mass appearing in in large lymph nodes in the abdomen, armpit, groin or neck area. Less common areas where DLBCL can developing include the salivary gland, testes, lungs, liver, nasal sinuses, eyeballs, brain, and/or skin. While the growth is usually not painful, the individual may experience:

• Unexpected weight loss


• Night sweats


• Abdominal distention


• Intense pain in the abdomen


• Central nervous system symptoms


• Bone pain


• High fevers


• Fatigue


• Coughing


• Tiredness


• Shortness of breath


• Chest pain


• Stomach pain


• Skin itching


• Pallor that might indicate anemia


• Petechiae, purpura, or ecchymoses which might indicate thrombocytopenia


• Mass in the thyroid


• Abdominal mass


• Cutaneous lesions


• Pharyngeal involvement


• Testicular mass

If the condition develops in the stomach, it can cause significant abdominal pain and discomfort followed by bleeding and diarrhea. If the condition develops in the chest area, it can lead to breathlessness or excessive coughing. The initial symptoms of the condition tend to grow quickly and often develop within just a few weeks.

Diagnosing Diffuse Large B-Cell Lymphoma

The condition is most often diagnosed through a tissue sample (biopsy) that is examined under a microscope in a laboratory setting by an experienced pathologist. The doctor will usually remove a tissue sample from an enlarged lymph node or other areas in the body that might be suspected of harboring lymphoma. Sometimes, an entire tumor or lymph nodes removed during a biopsy procedure. In some instances, a second biopsy is required if the initial biopsy tissue could not conclusively rule out or verify the presence of lymphoma.

More than likely, the doctor will recommend numerous tests that can identify many subtypes of diffuse large B-cell lymphoma that include:

• GCB subtype (germinal center B cell) lymphoma


• Non-GCB subtypes


• Tests to identify the areas of the body with the lymphoma is likely growing

However, nearly all forms of diffuse large B-cell lymphoma are treated the same way. Once an accurate diagnosis has been verified, the doctor will likely stage the condition after performing a CT or PET scan and associated blood tests and bone marrow tests to determine if the lymphoma cells of metastasized (spread) to other areas of the body.

Staging

Staging the disease is important to determine the most effective solution for treating the condition to ensure the patient has the most successful outcome involving the lymphoma. Staging is essential for the doctor to develop a plan to cure the disease. However, the outlook will depend on the patient's general help and the state of the disease. The four main stages of diffuse large B-cell lymphoma include:

• Stage I – At this initial stage, only the local lymph nodes are affected


• Stage II – As the disease progresses, more than one lymph node is now affected and appear below or above the diaphragm


• Stage III – At this advancing stage, the lymph nodes above and below the diaphragm are now affected


• Stage IV – At the most advanced age, lymphoma can be detected in bone marrow, organs and areas outside the lymphatic system


• Stage X – The stage indicates large "bulky" lumps of lymphoma

The doctor might also stage the condition as 1A or 2A meaning the cancer is in its early stage. However, most cases of diffuse large B-cell lymphoma are diagnosed in their advanced stages.

Treating the Condition

Doctors typically recommend short-term chemotherapy and chemo immunotherapy treatments during the initial stages of diffuse large B-cell lymphoma followed by radiation treatments. The medication is usually administered in cycles that provide ample time for the body to recover prior to the next course of treatment. These medications are given intravenously through a vein.

Treating DLBCL in its advanced stages is more complicated where intensive chemotherapy regimens (up to eight cycles of treatment) are usually given. The doctor will use chemical medications like rituximab and ifosfamide followed by dose adjusted steroids including prednisone or etoposide before antibiotic treatments begin that could include doxorubicin or cyclophosphamide.

In its most advanced stages, the individual may not be well enough to undergo strong chemotherapy treatments. Others will be suffering from significant health issues including heart problems were a traditional treatment for advanced age DLBCL is not possible. However, the doctor can develop a regimen for specialized cases that eliminate the use of some medications or radiotherapy, or use new or medications available only through clinical trials.

However, there are serious side effects to many of the treatments available for diffuse large B-cell lymphoma due to exposure to radiation and chemotherapy chemicals. Some of the medications can affect fertility or produce late effects where symptoms from the treatment develop long after the patient has healed from their condition.

Recurrence of DLBCL is possible if the treatment only reduces the symptoms of the disease and did not completely clear away the cancer cells or if the lymphoma never got better after treatment.

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Sources:

https://consultqd.clevelandclinic.org/2016/04/targeted-treatments-take-aim-diffuse-large-b-cell-lymphoma/

http://www.mayoclinic.org/diseases-conditions/non-hodgkins-lymphoma/basics/definition/con-20027792

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2593154/ https://my.clevelandclinic.org/childrens-hospital/sitecore/content/Sites/ClevelandClinic/Home/health/diseases_conditions/hic_Adult_Non-Hodgkins_Lymphoma/can_overview

https://www.cancer.org/cancer/non-hodgkin-lymphoma/treating/b-cell-lymphoma.html

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