Diffuse large B cell lymphoma (DLBCL)

• What is Diffuse large B cell lymphoma (DLBCL)
• Statistics on Diffuse large B cell lymphoma (DLBCL)
• Risk Factors for Diffuse large B cell lymphoma (DLBCL)
• Progression of Diffuse large B cell lymphoma (DLBCL)
• Symptoms of Diffuse large B cell lymphoma (DLBCL)
• Clinical Examination of Diffuse large B cell lymphoma (DLBCL)
• How is Diffuse large B cell lymphoma (DLBCL) Diagnosed?
• Prognosis of Diffuse large B cell lymphoma (DLBCL)
• How is Diffuse large B cell lymphoma (DLBCL) Treated?
• Diffuse large B cell lymphoma (DLBCL) References

What is Diffuse large B cell lymphoma (DLBCL)

Lymphoma is cancer of the lymphatic system, which can be further divided into Hodgkin’s lymphoma and non-Hodgkin’s lymphoma. Diffuse large B cell lymphoma (DLBCL) is a type of non-Hodgkin’s lymphoma.
The lymphatic system is part of the body’s immune system and helps us fight infection. It is made up of various lymph organs, such as thymus, spleen, bone marrow, and lymph nodes.
Lymph is a colourless fluid that circulates in the lymphatic system. It contains lymphocytes which are white blood cells that fight infection. There are two types of lymphocytes: T cells and B cells. T cells grow in the bone marrow but mature in the thymus (behind the breast bone). B cells grow and continue to develop in the bone marrow. They both play an essential role in our immune system.
When the lymphatic system fails to function in the normal manner, lymphoma may result. DLBCL is a type of lymphoma that involves B cells.

Statistics on Diffuse large B cell lymphoma (DLBCL)

Diffuse large B cell lymphoma is relatively common, making up about 30-40% of all lymphomas. It is slightly more common in men than women.
It can affect any age group but occurs mostly in older people.
The average age is in the mid-sixties.

Risk Factors for Diffuse large B cell lymphoma (DLBCL)

The exact cause of diffuse large B cell lymphoma is not known.
Genetic changes play a role. Part of the genetic material in cells undergoes a process called translocation (transfer to a different position).
The environment (such as long-term exposure to chemicals and radiation) may also contribute to the development of the disease.

Progression of Diffuse large B cell lymphoma (DLBCL)

This is a lymphoma that grows very quickly, it therefore has to be treated promptly. At the start of the disease, it is often confined (restricted to an area) and at this stage it may be curable.
For some Diffuse large B cell lymphoma patients, when they first come to the doctor, the disease is restricted to either a single lymph node or a group of lymph nodes.
There is another group of patients with the disease starting from a site outside the lymph nodes, e.g. in the chest. This type tends to spread to other parts of the body such as the brain, kidneys, ovaries, and adrenal glands (glands situated above the kidneys).

How is Diffuse large B cell lymphoma (DLBCL) Diagnosed?

 

• Blood tests to look at the number and nature of blood cells under the microscope.
• Some other blood tests to check calcium level, uric acid level, liver function, protein in the blood, and level of a substance of beta2-microglobulin.
• Blood will be drawn into tubes and sent to the laboratory.
  

  Prognosis of Diffuse large B cell lymphoma (DLBCL)

  Diffuse large B cell lymphoma has a fairly good outcome. About half of these lymphoma patients are cured with therapy.
  About 30% of these lymphomas are confined to one part of the body (localized). When it is localized, it is generally more possible to be cured than when it has spread to other parts of the body.
  Diffuse large B cell lymphoma is staged using a system called the Ann Arbor staging system, from Stage I to IV:
   

• Diffuse large B cell lymphoma Stage I: involvement of a single lymph node or one single site outside the lymphatic system
• Diffuse large B cell lymphoma Stage II: involvement on the same side of the diaphragm, confined to either above or below the diaphragm
• Diffuse large B cell lymphoma Stage III: involvement on both sides of the diaphragm
• Diffuse large B cell lymphoma Stage IV is widespread involvement of 1 or more sites outside the lymphatic systemRisk factors that point to a poorer outcome are older age (>60 years), high level of a substance in the body (an enzyme called LDH), stage III/IV, involvement of 2-4 sites outside the lymph nodes.
  

  How is Diffuse large B cell lymphoma (DLBCL) Treated?

  The main treatment used in diffuse large B cell lymphoma is chemotherapy.
  The 2 main drugs used are doxorubicin and cyclophosphamide. They are combined with other anti-cancer drugs. The most common combination used now is the CHOP regimen. This can be carried out as an outpatient for 4-6 months. Chemotherapy can often cure the disease in a large number of patients, or at least keep it under control for a few years.
  Chemotherapy at a high dose with bone marrow infusion (introduction of bone marrow into the body) may be used in patients whose lymphoma have come back. Some types of intensive chemotherapy cannot be used in patients over 65 of age.
  For diseases which are more confined, radiotherapy may be used in addition to chemotherapy.
  Steroids are often given to reduce sick feelings from chemotherapy.
  Another form of treatment called monoclonal antibodies (e.g. rituximab which are often used together with chemotherapy) can recognise, target and stick to specific proteins on the surface of the cancer cells.
  

  Diffuse large B cell lymphoma (DLBCL) References

  [1] Diffuse large B-cell lymphoma [online]. 2004 [cited 2005 August 12]. Available from: URL: http://www.cancerbacup.org.uk/Cancertype/Lymphomanon-Hodgkins/TypesofNHL/DiffuselargeB-cell
  [2] Kasper D et al. Harrison’s principles of internal medicine. 16th ed. New York; McGraw-Hill; 2005.
  [3] Souhaimi et al, editors. Oxford Textbook of Oncology. 2nd ed. Oxford ; New York : Oxford University Press; 2002.