Diffuse large B cell lymphoma (patient information)

Diffuse large B-cell lymphoma (DLBCL or DLBL) is a cancer of B cells, a type of white blood cell responsible for producing antibodies. Diffuse large B cell lymphoma is the most common type of non-Hodgkin lymphoma among adults, with an annual incidence of 78 cases per 100,000 people per year. This cancer occurs primarily in older individuals, with a median age of diagnosis at approximately 70 years of age, though it can also occur in children and young adults in rare cases.

The most common symptoms of diffuse large B cell lymphoma include a rapidly enlarging, non-painful lumps/masses that may be located in neck, groin, or abdomen. The less common symptoms of diffuse large B cell lymphoma include fever, weight loss, and drenching night sweats also known as ”B symptoms“. Other symptoms might depend on the organ of Involvement for example DLBCL in Chest can lead to shortness of breath or cough while DLBCL involving gut or Stomach can cause Abdominal Pain/ Diarrhea/ Bleeding etc. Involvement of Brain can lead to Headaches, vision or personality changes, seizures etc.

According to the American Cancer Society, There are several Factors including Old Age, Male Gender, White Ethnicity, Geography, exposure to Certain Drugs and Chemicals, Radiation exposure, and weak Immune System that can increase the chances of getting Non Hodgkin Lymphoma(NHL) among which Diffuse Large B cell Lymphoma is the Most common sub-type. Some Other Risk Factors include hepatitis C virus (HCV) seropositivity, high body mass as a young adult, HIV, and Family History of Lymphoma

There are no definitive known causes of DLBCL but preventing risk factors like Immunodeffeciency, radiation exposure, avoiding associated drugs and chemicals can decrease the chances of getting a cancer.

Diagnostic Work up for Diffuse Large B cell Lymphoma include Laboratory tests including Complete Blood count (CBC), Comprehensive Metabolic Panel, LDH and Uric acid Levels, Genetic testing, molecular diagnostic assays and immunophenotyping. Screening tests for Hepatitis B, Hepatitis C and HIV are usually recommended after diagnosis. Excisional Lymph node or tissue biopsy is diagnostic of diffuse large B cell lymphoma.

As per American Cancer Society, Symptoms of Lymphoma can vary. It can present early or may not cause any symptoms till late. Below are some of the symptoms that should be concerning and need urgent evaluation by a healthcare professional

• Lumps under the skin ( Sides of Neck, Groin, Underarms, Above the Collar Bone)
• Weight loss
• Fever
• Sweating and Chills
• Fatigue
• Swollen Belly
• Chest Pain/ Pressure
• Shortness of Breath/ Cough

Main treatment of Choice for DLBCL. Chemotherapy is administered intravenously and people receiving chemotherapy commonly have a (peripherally inserted central catheter) in their arm near the elbow or a surgically implanted medical port. It is most effective when it is administered multiple times over a period of months (e.g. every 3 weeks, over 6 to 8 cycles). Different regimens of Chemotherapy with different durations/Cycles are used depending on the stage of disease, age of patient and prognsotic index. In general

• Patients with limited stage disease receive 3 cycles of therapy
• Patients with extensive disease 6 or 8 cycles of chemotherapy. In the United States, 6 cycles is the preferred approach rather than 8 cycles.

Radiation is often added in the treatment. It is used commonly after completing 3 cycles of treatment in limited stage disease. In extensive disease, after 6-8 cycles of chemotherapy, radiation can be used at the end of the treatment to areas of bulky involvement. Radiation therapy alone is not an effective treatment for this disease

High dose Chemotherapy coupled with stem cell transplantation is sometimes used to treat patients whose disease is refractory or relapsed following initial chemotherapy. Most common is Autologous stem cell transplant in which patients receive their own stem cells. Other option is Allogenic stem cell transplant in which patient will receive stem cells from a donor

The prognosis of diffuse large B cell lymphoma depends on the stage of the disease And International Prognostic Index is widely used to calculate estimated survival. Overall survival for older adults at five years is around 58%^[1] while for children with diffuse large B-cell lymphomas, most studies have found 5-year survival rates ranging from about 70% to more than 90%^[2]. The Germinal-center sub-type has the best prognosis, with 66.6% of treated patients surviving more than five years.

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