Diffuse large B-cell lymphoma is a type of blood cancer that affects the white cells called lymphocytes. These cells help fight infections. When they become cancerous (malignant), they grow and divide more rapidly than normal cells and produce more lymphocytes. This leads to a build up of abnormal lymphocytes in the blood and causes symptoms such as swollen glands (lymph nodes) or lumps under the skin, tiredness, fever and weight loss.
There are about 5,500 cases of DLBCL diagnosed each year in adults in western countries. There are a number of different sub types but they are all treated in the same way.
The first step in diagnosing DLBCL is to ask the person about their symptoms and carry out a physical examination. A sample of tissue from a swollen lymph node or tumour is then taken by doctors using a biopsy. This may be done under local anaesthetic and might involve the use of a core or fine needle biopsy. Occasionally doctors might need to do a bone marrow biopsy too, to check for signs of the disease in the bone marrow where new stem cells are produced.
After the biopsy, doctors will work out if the lymphoma is low or high grade and what stage it is. This is important as this will influence what treatments are available. Staging is also important because it tells doctors how much of the body is affected by the lymphoma.
For people with DLBCL, the most common treatment is a combination of chemotherapy drugs and radiotherapy. This is usually given in cycles of 21 days. This is called chemo-immunotherapy. Some patients will have radiotherapy before or after chemo-immunotherapy to reduce the side effects of this treatment.
In some cases, DLBCL can be a rarer subtype that is only found in people who have HIV. In these cases the diagnosis is made by looking at a sample of the lymphoma under a microscope and using specialist laboratory tests. The subtypes are named Epstein-Barr virus (EBV) positive DLBCL of the elderly and DLBCL not otherwise specified (NOS). These subtypes tend to be more difficult to treat than the most common forms of DLBCL but can still be successfully treated with similar combinations of medicines.
Doctors are working hard to develop new treatment options for DLBCL, including identifying which patients are most likely to benefit from specific drugs based on the molecular profile of their lymphoma cells. They are also trying to find out more about why some treatments fail, so that they can improve the care of patients in future.
Some patients with DLBCL may be offered a treatment called CAR T cell therapy (axicabtagne ciloleucel). This involves collecting your own immune cells and genetically modifying them in the lab so that they can recognise and kill lymphoma cells. This treatment is currently only available at a few specialised centres. It is often used in patients whose lymphoma does not respond to other treatments or comes back after they have been treated.
