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Diffuse Large B-Cell Lymphoma (DLBCL)

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Clinical Features

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL), comprising approximately 35% to 40% of all cases.1

Diffuse large B-cell lymphoma can be diagnosed at any age. However, onset typically occurs in older adults and often presents in a patient’s seventh or eighth decade of life. Although the incidence of DLBCL increases with age, race and sex have no impact on the development of DLBCL. It can develop in almost any organ. DLBCL is believed to be a heterogeneous group of aggressive B-cell lymphomas due to the variety in its clinical characteristics, morphology, genetics, and molecular presentations.2 

Read more about DLBCL epidemiology

The disease may manifest in the lymph nodes or in extranodal sites including the gastrointestinal tract, central nervous system, bones, testes, thyroid gland, skin, breast, or virtually any organ in the body. DLBCL can be localized or generalized as it spreads. Although DLBCL is an aggressive lymphoma, it is potentially curable.3 

Lymphadenopathy

Similar to other types of NHL, the most frequent clinical symptom of DLBCL is lymphadenopathy. Enlarged lymph nodes are initially painless, but they can become painful when the lymphomatous tumor masses rapidly enlarge. The disease has a rapid growth rate and can cause symptoms when enlarged lymph nodes or tumor masses invade tissues or impede organs. The majority (75%) of individuals have more advanced disease (bulky stage II or stage III–IV), and 25% of patients experience anatomically limited stage disease (clinical stage I or II). As nearly any organ can be impacted by DLBCL and extranodal disease is extremely common in this condition, symptoms may resemble those of several other illnesses. Various clinical signs and symptoms of DLBCL can occur, often depending on the location of disease.1,4 

The most common sites of lymphadenopathy are the cervical, axillary, and inguinal lymph nodes. These lymph nodes are present just beneath the skin, and they are therefore noticed easily when enlarged.5 However, affected lymph nodes may also be located deeper in the body. The location of the enlarged lymph nodes and the organs they are pushing against will determine the symptoms experienced. These signs may include chest discomfort, abdominal pain, bone pain, skin lumps, cough, or shortness of breath.5 

Read more about DLBCL diagnosis

B Symptoms

Constitutional (“B”) symptoms are present in a large number of patients. These symptoms are taken into consideration by the physician for treatment purposes. B symptoms include drenching night sweats that soak clothes and bedding, fever (>38 ºC), and unexplained weight loss in the last 6 months (10% of previous body weight or more).1,5

Read more about DLBCL signs and symptoms

Organ-Specific Clinical Features

Local symptoms can vary widely depending on which organs or tissues are affected. DLBCL affecting the gastrointestinal system can result in abdominal pain or discomfort, nausea, diarrhea, and bleeding. The bowel is affected in about 1 in 4 patients with DLBCL. Cough or shortness of breath can be signs of DLBCL in the chest. Less than 1 in 10 patients with DLBCL have disease that affects the lungs.6 Clinical features associated with central nervous system involvement include confusion, memory changes, weakness, numbness, and seizures. When DLBCL affects the bone marrow, patients present with a low blood count, which can cause  unusual bleeding or bruising, shortness of breath, and persistent infections.7 The salivary glands, nasal sinuses, skin, and eyes can also be affected depending on the amount of pressure the lymphoma is applying to these structures.8 

Read more about DLBCL complications

Other Clinical Features

The clinical presentation of DLBCL can also include anorexia, fatigue, low-grade fever, generalized pruritus, chest discomfort or shortness of breath (due to mediastinal lymphadenopathy), splenomegaly, and pedal edema (due to massive pelvic lymphadenopathy).4,9 

A comprehensive medical history is crucial, with particular focus on the frequency, duration, and severity of B symptoms and any neurological or gastrointestinal symptoms. Exposure to specific viruses and a history of environmental or infectious diseases (such as human immunodeficiency virus [HIV] or hepatitis B or C viruses) may impact the choice of treatment and its effectiveness.4

Read more about DLBCL treatment

References

  1. Sweetenham JW, Wotherspoon A, Rosenwald A, Ott G. Diffuse large B-cell lymphoma. In: Marcus R, Sweetenham JW, Williams ME, eds. Lymphoma: Pathology, Diagnosis and Treatment. Cambridge, UK: Cambridge University Press; 2007:168-181. doi:10.1017/CBO9780511663369.013
  2. Shi Y, Han Y, Yang J, et al. Clinical features and outcomes of diffuse large B-cell lymphoma based on nodal or extranodal primary sites of origin: analysis of 1,085 WHO classified cases in a single institution in China. Chin J Cancer Res. 2019;31(1):152-161. doi:10.21147/j.issn.1000-9604.2019.01.10 
  3. Diffuse large B-cell lymphoma. Lymphoma Research Foundation. Accessed August 19, 2022.
  4. ​​Gandhi S. Diffuse large B-cell lymphoma (DLBCL) clinical presentation. Medscape. Updated May 6, 2021. Accessed August 19, 2022.
  5. Diffuse large B-cell lymphoma (DLBCL) symptoms. Blood Cancer UK. Accessed August 19, 2022.
  6. Diffuse large B-cell lymphoma. Lymphoma Action. Accessed August 19, 2022.
  7. Diffuse large B cell lymphoma (DLBCL). Lymphoma Australia. Accessed August 19, 2022.
  8. Diffuse large B-cell lymphoma. Leukaemia Foundation. Updated June 20, 2020. Accessed August 19, 2022.
  9. Gandhi S. Diffuse large B-cell lymphoma (DLBCL). Medscape. Updated May 6, 2021. Accessed August 19, 2022.

Reviewed by Kyle Habet, MD, on 8/30/2022.

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