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Diffuse Large B-Cell Lymphoma (DLBCL)

Most common aggressive non-Hodgkin lymphoma, often curable with R-CHOP immunochemotherapy and targeted regimens.

Written by: Saygı Hospital Health Guide Editorial Board
Published:

This content is for general information; please consult your physician for diagnosis and treatment.

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What is Diffuse Large B-Cell Lymphoma (DLBCL)?

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma in adults, representing 30–40% of all cases. It is an aggressive lymphoma arising from mature B cells of germinal center or activated B-cell origin, with median age at diagnosis approximately 65 years.

Molecular classification distinguishes germinal center B-cell-like (GCB) and activated B-cell-like (ABC) subtypes by gene expression profiling, with ABC carrying worse prognosis. Genomic studies identify rearrangements of MYC (alone or with BCL2/BCL6 — high-grade B-cell lymphoma or 'double/triple-hit' lymphoma), as well as mutations in EZH2, MYD88, CD79B, and TP53 with prognostic and therapeutic implications.

Standard first-line therapy is six cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) curing approximately 60–70% of patients. Polatuzumab vedotin plus R-CHP (Pola-R-CHP) improves outcomes in ABC subtype and high IPI risk groups. Refractory and relapsed disease is treated with high-dose chemotherapy and autologous stem cell transplantation, CAR T-cell therapy (axicabtagene ciloleucel, lisocabtagene maraleucel, tisagenlecleucel), or bispecific antibodies (epcoritamab, glofitamab).

Symptoms

Rapidly enlarging painless lymphadenopathy
B symptoms (fever, night sweats, weight loss > 10%)
Mediastinal mass (cough, dyspnea, SVC syndrome)
Abdominal mass, pain, early satiety
Bone marrow involvement with cytopenias
Hepatomegaly, splenomegaly
Extranodal involvement (GI, CNS, skin, testes, bone)
Pruritus
Pleural or peritoneal effusion
Compressive symptoms (cord, ureter)
Tumor lysis syndrome at presentation
CNS symptoms in primary or secondary CNS lymphoma
Skin nodules in cutaneous involvement
Bone pain
Asymptomatic incidental imaging finding

Risk Factors

Age over 60
Immunosuppression (HIV, post-transplant)
Autoimmune disease (rheumatoid arthritis, Sjögren, lupus)
Helicobacter pylori (rare association)
Hepatitis C virus
EBV reactivation in immunocompromised
Family history of lymphoma
Prior chemotherapy/radiotherapy (therapy-related)
Pesticide exposure
Hair dye, organic solvents (debated)
Obesity
Smoking
Caucasian ethnicity (slight)
Idiopathic in most
Underlying low-grade lymphoma transformation

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Rapidly enlarging lymph node
  • Persistent fever, drenching night sweats, unexplained weight loss
  • Mass on imaging or palpation
  • Symptoms of mediastinal mass (dyspnea, facial swelling)
  • Severe pruritus
  • Bone pain or pathological fracture
  • Neurological symptoms suggesting CNS involvement
  • Cytopenias on blood test
  • Recurrent infections
  • History of low-grade lymphoma with new symptoms

Treatment Methods

01
Excisional or core needle biopsy with adequate tissue for IHC, flow cytometry, FISH
02
Hans algorithm immunohistochemistry (CD10, BCL6, MUM1) to assign GCB vs non-GCB
03
FISH for MYC, BCL2, BCL6 rearrangements (double/triple-hit identification)
04
Bone marrow biopsy and PET-CT for staging (Lugano classification)
05
Lumbar puncture in high CNS risk (testicular, breast, multiple extranodal)
06
Cardiac assessment (echocardiogram or MUGA) before anthracycline
07
Hepatitis B/C, HIV testing; reactivation prophylaxis if HBsAg positive
08
IPI and NCCN-IPI for risk stratification
09
First-line R-CHOP-21 for six cycles in standard risk
10
Pola-R-CHP for IPI 2+ ABC subtype
11
Dose-adjusted EPOCH-R for high-grade B-cell lymphoma with double-hit
12
CNS prophylaxis with intrathecal methotrexate or high-dose IV methotrexate in high-risk patients
13
Interim and end-of-treatment PET-CT (Deauville criteria)
14
Autologous stem cell transplantation for chemosensitive relapse
15
CAR T-cell therapy in second-line for high-risk relapse or third-line refractory
16
Bispecific antibodies (epcoritamab, glofitamab) for relapsed/refractory disease
17
Antibody-drug conjugates (loncastuximab tesirine) for refractory disease
18
Tumor lysis prophylaxis (allopurinol or rasburicase, hydration)
19
Long-term survivorship care including cardiac, second cancer surveillance

Which Department to Visit?

You can visit our Hematoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.