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Epidemiology

Diffuse large B-cell lymphoma (DLBCL) is a type of cancer that originates in and affects the lymphatic system.¹ It is the most common type of non-Hodgkin lymphoma (NHL), accounting for approximately 31% of NHL cases in Western countries and around 37% of B-cell tumors globally.²

Incidence Rate of DLBCL

Between 1970 and 1995, the incidence of new NHL cases increased. Between 2007 and 2016, new cases declined by approximately 0.9% per year, and mortality from NHL decreased by 2.2% per year.³ Non-Hodgkin lymphoma is the seventh most common type of cancer in the United States, accounting for 4.3% of all newly diagnosed cancers.^1,3

As of 2021, the incidence rate of NHL in the United States was estimated at 19.6 cases per 100,000 per year. In 2020, an estimated 73,652 new NHL cases were reported in the United States.¹ For DLBCL specifically, the estimated incidence rate is 4.68 cases per 100,000 per year in the United States.³ Between 2020 and 2025, the incidence of DLBCL is projected to increase in the United States and Western Europe.¹

Globally, the incidence of DLBCL is higher in developed countries, particularly the United States, France, Germany, Italy, Spain, and the United Kingdom.^1,3 In 2020, an estimated 72,035 new NHL cases were reported in Western Europe.¹ The incidence rates of DLBCL have increased by 50% or more in 20 countries since the late 20^th century.³

Incidence rates of specific subtypes of DLBCL vary according to geographic location, often displaying endemic qualities with higher incidence in certain regions.³

Prevalence of DLBCL

The projected 10-year prevalence of DLBCL is calculated from the estimated incidence and survival rates of individuals diagnosed with the disease. Due to increasing incidence rates, projected 10-year prevalence rates have increased more in the United States than in Western Europe (12% vs 7%, respectively). Similarly, the projected 20-year prevalence rates have increased, with total rates of increase of 14% in the United States and 11% in Western Europe.¹

Impact of Sex on DLBCL Incidence Rates

Sources provide conflicting information regarding sex-based epidemiology for DLBCL.

One source reported a slightly higher incidence of DLBCL in men than in women (6.7 vs 4.6 cases per 100,000 per year) using statistics from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program.² Another study that examined the incidence and survival rates of all lymphoid neoplasm subtypes from 1998 to 2012 in Singapore reported that men demonstrated higher incidence rates than women across all lymphoid neoplasm types, including DLBCL.⁴

In contrast, another source suggests that DLBCL occurs more frequently in women.³

While conflicting evidence exists on the impact of sex on DLBCL incidence rates, sex impacts survival rates according to other studies. Elderly male patients with DLBCL treated with rituximab demonstrated lower survival rates than female patients treated with rituximab due to slower rituximab clearance in female patients.^4,5

Impact of Age on DLBCL Incidence Rates

While DLBCL can occur at any age, initial onset typically occurs in middle-aged and older adults, and it is commonly diagnosed during the seventh or eighth decade of life.³ The median age at initial diagnosis is estimated to be between 63 and 66 years of age.^2,3

The risk of DLBCL increases with age. In men, the risk of DLBCL increases from 0.13% before the age of 39 years to 1.77% after 70 years of age, while in women, the risk of DLBCL increases from 0.09% before age 39 to 1.4% after age 70.²

The 5-year survival rates of patients with DLBCL decline with age, with a 78% 5-year survival rate in patients under the age of 55 years to around 54% for those aged 65 years and above.²

Impact of Race on DLBCL Incidence Rates

According to one study, White patients and those of Hispanic descent demonstrated an increased incidence of DLBCL compared to Black patients or those of Asian/Pacific Islander descent.⁶ When stratified by race and sex, DLBCL occurred most frequently in non-Hispanic White men and least frequently in Black women.⁶

In another study, Asian/Pacific Islander women demonstrated a 12% higher incidence of DLBCL than White women.⁷

Black patients with DLBCL demonstrated the highest rate of extranodal involvement as well as the worst survival rates at stage I of the disease. At stage IV of DLBCL, patients with Asian or Pacific Islander heritage demonstrated the worst survival rates.⁶

According to another study that examined data from the Southern United States between 1981 and 2010, Black patients were more likely to present with higher lactate dehydrogenase levels, B-symptoms, and a performance status ≥2; have lower survival rates; and obtain a DLBCL diagnosis at a younger age (median, 50 vs 57 years) than White Americans.⁸

Certain DLBCL subtypes, such as Epstein-Barr virus (EBV)-associated lymphoma (Burkitt lymphoma) and human T-cell leukemia virus (HTLV) type 1-associated lymphoma/leukemia, occur more frequently in patients with specific ancestries living in specific geographic locations, indicating more endemic properties.^3,7

References

Kanas G, Ge W, Quek RGW, Keeven K, Nersesyan K, Arnason JE. Epidemiology of diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL) in the United States and Western Europe: population-level projections for 2020–2025. Leuk Lymphoma. 2022;63(1):54-63. doi:10.1080/10428194.2021.1975188
Umukoro C, Khan S. Epidemiology, pathology, and clinical features of DLBCL. Lymphoma Hub. February 11, 2021. Accessed August 4, 2022.
Gandhi S. Diffuse large B-cell lymphoma (DLBCL): epidemiology. Medscape. Updated May 6, 2021. Accessed August 4, 2022.
Lim RBT, Loy EY, Lim GH, Zheng H, Chow KY, Lim ST. Gender and ethnic differences in incidence and survival of lymphoid neoplasm subtypes in an Asian population: secular trends of a population-based cancer registry from 1998 to 2012. Int J Cancer. 2015;137(11):2674-2687. doi:10.1002/ijc.29635
Pfreundschuh M, Müller C, Zeynalova S, et al. Suboptimal dosing of rituximab in male and female patients with DLBCL. Blood. 2014;123(5):640-646. doi:10.1182/blood-2013-07-517037
Li Y, Wang Y, Wang Z, Yi D, Ma S. Racial differences in three major NHL subtypes: descriptive epidemiology. Cancer Epidemiol. 2015;39(1):8-13. doi:10.1016/j.canep.2014.12.001
Wu XC, Andrews P, Chen VW, Groves FD. Incidence of extranodal non-Hodgkin lymphomas among whites, blacks, and Asians/Pacific Islanders in the United States: anatomic site and histology differences. Cancer Epidemiol. 2009;33(5):337-346. doi:10.1016/j.canep.2009.09.006
Flowers CR, Shenoy PJ, Borate U, et al. Examining racial differences in diffuse large B-cell lymphoma presentation and survival. Leuk Lymphoma. 2013;54(2):268-276. doi:10.3109/10428194.2012.708751

Reviewed by Kyle Habet, MD, on 9/18/2022.

Maria Arini Lopez, PT, DPT, CSCS, CMTPT, CIMT

Maria Arini Lopez, PT, DPT, CSCS, CMTPT, CIMT is a freelance medical writer and Doctor of Physical Therapy from Maryland. She has expertise in the therapeutic areas of orthopedics, neurology, chronic pain, gastrointestinal dysfunctions, and rare diseases especially Ehlers Danlos Syndrome.

Diffuse Large B-Cell Lymphoma (DLBCL)