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:
Lymph nodes
Spleen
Liver
Bone marrow
Gastrointestinal tract
Brain
Other organs
However, with early treatment, the 5-year survival rate is higher than 90% in the United States.
Symptoms of diffuse large B-cell lymphoma
The lymphatic system is a network of nodes, glands, and vessels that transports white blood cells through the body to fight infection.
Symptoms of DLBCL may include:
Swollen lymph nodes in the neck, underarm, groin, or abdomen
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:
Weak immune system after a bone marrow or solid organ transplant
Infection with Epstein-Barr virus or human immunodeficiency virus (HIV)
A genetic disorder, such as ataxia-telangiectasia, that increases the risk of having cancer
More common in males than females
More common in White than Black children
Diagnosis of diffuse large B-cell lymphoma
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.
Diffuse large B-cell lymphoma as seen through a microscope.
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:
Stage 1 and 2 lymphomas are limited-stage disease and are treated the same way.
Stage 3 and 4 lymphomas are advanced-stage disease. The treatment for both stages is similar, but the length of treatment may vary depending on the stage.
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.
Treatment of diffuse large B-cell lymphoma may include a stem cell (bone marrow) transplant.
Prognosis for diffuse large B-cell lymphoma
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%.
Support for patients with diffuse large B-cell lymphoma
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.
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:
Has regular checkups and screenings by a primary care provider
What are the possible side effects of each treatment?
How can my child manage their side effects?
Will my child need to be in the hospital for treatment?
Where is the treatment available? Is it close to home or will we have to travel?
What resources are available to help us cope with this illness?
What monitoring does my child need after treatment?
How can I help my child stay healthy?
What are the possible late effects of treatment?
Key points about diffuse large B-cell lymphoma
Diffuse large B-cell lymphoma (DLBCL) is a form of non-Hodgkin lymphoma that affects B lymphocytes.
Doctors diagnose this cancer using a physical exam, blood tests, imaging, and biopsy.
Treatment options may include chemotherapy, combination therapy, stem cell therapy, targeted therapy, radiation therapy, surgery, or immunotherapy.
Treatment depends on the type of DLBCL, genetic changes, stage of disease, the patient’s health, and available therapies.
The overall 5-year survival rate is higher than 90% depending on the stage at diagnosis. Every case is different. Your doctor is the best source of information about your child’s case.
