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Diffuse large B-cell lymphoma (DLBCL) is a type of non-Hodgkin lymphoma. This disease starts in the B lymphocytes of the immune system. Normally, these cells fight infection and disease. But genetic changes in these cells can lead to cancer.
The abnormal lymphocytes grow larger and more quickly than normal cells. This disease can start in the lymph nodes or somewhere else in the body (known as an extranodal disease).
DLBCL grows fast and spreads quickly. The abnormal cells may travel through the lymphatic system. Because of this, DLBCL may develop in the:
However, with early treatment, the 5-year survival rate is higher than 90% in the United States.
Symptoms of DLBCL may include:
Risk factors may increase your child’s chances of getting a disease. Little is known about the risk factors for DLBCL in children. For lymphoma, the risk factors we know so far are:
A cancer diagnosis requires tests and procedures. The doctor will give your child a physical exam, ask about their medical history, and order tests such as:
If the pathologist finds lymphoma cells in the biopsy sample, the lab will do more lab tests on the sample, such as flow cytometry, immunophenotyping, and cytogenetic analysis, if they are available.
There are several types of DLBCL:
Your care team may order tests to find out which type of DLBCL your child has.
The care team plans treatment based on the cancer stage. Some tumors grow rapidly. So, the doctor must stage the lymphoma as quickly as possible.
To find out the stage of disease, doctors may order more tests such as:
The stage will tell how much cancer is present and if it has spread to other parts of the body.
The International Pediatric Non-Hodgkin Lymphoma Staging System divides the disease into 4 stages:
Treatment of DLBCL depends on:
Treatments may include:
Higher-stage, advanced disease is often treated with chemotherapy and immunotherapy. This is known as combination therapy. The most commonly used treatment in North America is the Lymphome Malin de Burkitt (LMB) treatment. It includes chemotherapy with or without the targeted therapy rituximab.
Treatment can sometimes cause side effects. One that may occur early in treatment is tumor lysis syndrome. This happens when cancer cells quickly die and break apart. The care team will watch your child closely for possible side effects. Ask the care team if you have questions.
A common chemotherapy plan for relapsed disease is RICE (rituximab, ifosfamide, carboplatin, and etoposide) followed by a stem cell transplant. New targeted therapies are being studied. Some patients may be able to take part in clinical trials to test new treatments.
The prognosis depends on several factors, including the stage of the disease.
In the United States, the 5-year survival rate for limited-stage (stage 1 and 2) diffuse large B-cell lymphomas is higher than 95%. The survival rate for advanced-stage (stage 3 and 4) DLBCL is higher than 90%.
Coping with a cancer diagnosis and treatment can be stressful for the patient and the family. Talking to a social worker, psychologist, or another mental health specialist may help.
Learn how to talk to your child about cancer.
After treatment, your care team may use imaging tests and exams to watch for recurrence.
Childhood cancer survivors should get follow-up care throughout their lives. Some treatments can cause late effects. These are health problems that happen months or years after treatment ends.
After completing treatment, it is important that your child:
Reviewed: June 2023