Diffuse Large B-Cell Lymphoma (DLBCL)


What is Diffuse Large B-Cell Lymphoma (DLBCL)?

Diffuse large B-cell lymphoma (DLBCL) is an aggressive cancer that causes the development of abnormally large B-cells in the lymphatic system. The lymphatic system is a vital part of the immune system that protects the body from bacterial, viral, and fungal infections, as well as other foreign invaders.1 

What Are Common Symptoms of DLBCL?

The primary symptom of DLBCL involves swelling in the neck, armpit, or groin due to enlarged lymph nodes. It is usually painless, but the swelling may cause varying pain levels due to its size or rate of growth. Three other symptoms of DLBCL, called B symptoms, include drenching night sweats, unexplained high fever, and the loss of at least 10% of a patient’s body weight in 6 months.1,2 

If the cancer affects sites outside of the lymphatic system, other symptoms may appear, including those affecting the stomach and intestines.1

Generalized symptoms of DLBCL include fatigue, loss of appetite, chest discomfort, shortness of breath, and swelling in the feet.1,2

Read more about DLBCL signs and symptoms

Treatment for Diffuse Large B-Cell Lymphoma

Depending on the type of DLBCL and the affected sites, treatment for DLBCL may involve combined chemotherapy and immunotherapy, chemotherapy injected close to the spinal cord (intrathecal chemotherapy) if the brain and spinal cord are involved, steroids, radiation, stem cell transplants, or chimeric antigen receptor (CAR) T-cell therapy.1

Read more about DLBCL treatment

Side Effects of DLBCL Treatment

Treatment for DLBCL may cause ancillary adverse effects. Every patient’s reaction is different, and patients are unlikely to encounter all possible side effects. Monitoring for reactions is important, as therapies can be managed and treatment may require modification.7

Symptomatic Side Effects

Chemotherapy may cause unwanted side effects, such as hair loss, nausea, vomiting, diarrhea, constipation, loss of appetite, body aches, and fatigue.7

Laboratory Abnormalities and Associated Risk

Chemotherapy may lower the number of white blood cells, platelets, and red blood cells in the bloodstream.3 Lower white blood cell levels increase the risk of infections, especially respiratory infections like pneumonia. These infections may be fatal.3,4 Lower platelet levels result in thrombocytopenia, increasing the risk of bruising and bleeding, even after minimal trauma.3 Lower red blood cell levels may lead to anemia, causing fatigue, weakness, and decreased tolerance to activity. If levels of red blood cells or platelets get very low, a blood transfusion may be necessary.3 Possible complications of blood transfusions include the transmission of bloodborne infections, transfusion-associated graft-versus-host disease in which the patient’s body rejects non-native blood from the transfusion, changes in the immune system, and problems with the lungs and heart in response to transfusion (pulmonary decompensation).5

Read more about DLBCL complications

Reproductive Side Effects

Chemotherapy with or without radiation, especially to the pelvic lymph nodes, may cause irreversible infertility in both men and women of reproductive age. Women may experience irregular menstrual cycles and sexual dysfunction, while men may experience decreased sperm counts or sterility.3,6 

It is important for patients to have a discussion with their doctor about the steps for preserving fertility following chemotherapy. These steps may include egg retrieval and freezing, sperm collection/banking and freezing, in vitro fertilization and embryo freezing, and other techniques that allow the possibility of having children after chemotherapy for DLBCL.1,6 

It is important that women of reproductive age with DLBCL who are undergoing chemotherapy take steps to avoid pregnancy, as the medications used in chemotherapy are harmful to a fetus.3 

Read more about R-CHOP

Lifestyle Changes

Maintaining regular activity, eating a well-balanced and healthy diet, quitting smoking, reducing the risk of infections, getting plenty of sleep, and modifying activities to manage fatigue may help with recovery after treatment for DLBCL.1,8

Balanced, Active Lifestyle

Staying regularly active improves energy levels, boosts the immune system, and improves emotional wellbeing. It is important to balance rest and exercise with activity modification to avoid excessive fatigue.8

Healthy Diet

Maintaining a healthy diet affects both the body and the mind, allowing for faster recovery and healing after treatment due to proper nutritional support. Consulting with a registered dietitian or nutritionist may be needed to come up with a structured meal plan to combat loss of appetite and weight loss caused by chemotherapy treatments or DLBCL itself.8 

Read more about DLBCL diet and nutrition

Smoke-Free Habit

Smoking increases the risk of complications during medical procedures and slows the ability of the body’s tissues to heal.8

Minimized Risk of Infection

Chemotherapy weakens the immune system, making a person with DLBCL more likely to develop infections. Patients with DLBCL who are undergoing chemotherapy or who have completed chemotherapy must regularly and thoroughly wash their hands, as this is the single most effective way to reduce the chances of infection. Other tips for preventing infection include carrying hand sanitizer, avoiding crowds (especially during cold and flu seasons), getting annual flu and pneumonia vaccines, regularly cleaning and disinfecting frequently touched surfaces, and avoiding touching the eyes, nose, and mouth after touching surfaces or other people.8

Read more about DLBCL prognosis

Emotional Support

After being diagnosed with DLBCL, it is important that patients reach out to family, friends, and other people in the community for emotional support. Additionally, social workers, psychiatrists, and psychologists can provide professional emotional support for patients and their caregivers.8

Support groups for DLBCL can connect patients to other people with the same cancer diagnosis. These groups can provide a place to exchange information, tips, and emotional support, and they can also provide advice to caregivers and information on the latest research and developments regarding DLBCL treatments. These support groups include the American Cancer Society, Leukemia & Lymphoma Society, Cancer Support Community, Lymphoma Research Foundation, Cancer Research Institute, and DLBCL Support Source.8-13

Read more about DLBCL care team

References

  1. Diffuse large B-cell lymphoma (DLBCL). Macmillan Cancer Support. Accessed August 22, 2022.
  2. Gandhi S. Diffuse large B-cell lymphoma (DLBCL) clinical presentation. Medscape. Updated May 6, 2021. Accessed August 22, 2022.
  3. Gandhi S. Diffuse large B-cell lymphoma (DLBCL) patient education. Medscape. Updated May 6, 2021. Accessed August 22, 2022.
  4. Wang J, Liu F, Tang X. Incidence and risk factors of pneumonia in diffuse large B-cell lymphoma patients receiving first line R-CHOP/R-CHOP-like immunochemotherapy: a retrospective study of 287 patients in single center. Ann Palliat Med. 2021;10(11):11931-11938. doi:10.21037/apm-21-3280
  5. Federici AB, Vanelli C, Arrigoni L. Transfusion issues in cancer patients. Thromb Res. 2012;129(Supplement 1):S60-S65. doi:10.1016/S0049-3848(12)70018-X
  6. Viviani S, Caccavari V, Gerardi C, et al. Male and female fertility: prevention and monitoring Hodgkin’ lymphoma and diffuse large B-cell lymphoma adult survivors. A systematic review by the Fondazione Italiana Linfomi. Cancers (Basel). 2021;13(12):2881. doi:10.3390/cancers13122881
  7. Diffuse large B-cell lymphoma (DLBCL) treatment and side effects. Blood Cancer UK. Accessed August 22, 2022.
  8. Lifestyle changes to manage non-Hodgkin lymphoma. Beth Israel Lahey Health Winchester Hospital. Accessed August 22, 2022.
  9. American Cancer Society homepage. American Cancer Society. Accessed August 22, 2022.
  10. Leukemia & Lymphoma Society homepage. Leukemia & Lymphoma Society. Accessed August 22, 2022.
  11. Cancer Support Community homepage. Cancer Support Community. Accessed August 22, 2022.
  12. Lymphoma Research Foundation homepage. Lymphoma Research Foundation. Accessed August 22, 2022.
  13. Cancer Research Institute homepage. Cancer Research Institute. Accessed August 22, 2022.
  14. DLBCL Support Source homepage. DLBCL Support Source. Accessed August 22, 2022.

Reviewed by Kyle Habet, MD, on 8/27/2022.

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