The information on this website is not intended for diagnosis or treatment. Please consult your physician for health concerns.

+90 850 321 50 00

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
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Hematoloji department. Book Appointment →

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.

Learn About Hematoloji Department

Let us help you

You can make an appointment with our specialists or contact us for your concerns.

Book AppointmentContact Us

Related Health Topics

Other articles from the same department you may want to explore.

Anaemia

Dahiliye (İç Hastalıkları)

Anaemia is a low haemoglobin level that reduces oxygen delivery, causing fatigue, pallor, and shortness of breath. It is not a disease itself but a sign of many underlying conditions. Most cases are correctable with appropriate diagnosis and treatment.

Iron Deficiency Anaemia

Dahiliye (İç Hastalıkları)

Iron deficiency anaemia develops when dietary intake, absorption, or losses create an iron shortfall, most often affecting women and children. Identifying the underlying cause is the core of management, alongside iron replacement.

Vitamin B12 Deficiency

Dahiliye (İç Hastalıkları)

Vitamin B12 deficiency can cause megaloblastic anaemia, neurological symptoms, and cognitive impairment. Early treatment with intramuscular or oral B12 largely prevents irreversible complications.

Hypertension (High Blood Pressure) Management

Dahiliye (İç Hastalıkları)

Hypertension is often called the silent killer because it progresses symptom-free for years and can damage the heart, brain, kidneys, and eyes. Regular monitoring, lifestyle change, and evidence-based drug therapy dramatically reduce cardiovascular risk.

Chronic Kidney Disease

Dahiliye (İç Hastalıkları)

Chronic kidney disease is one of the most common complications of chronic conditions such as diabetes and hypertension, and can be silent in its early stages.

Hepatitis B (HBV)

Dahiliye (İç Hastalıkları)

Hepatitis B is a DNA virus infection causing acute and chronic hepatitis with risk of cirrhosis and hepatocellular carcinoma; diagnosis integrates HBsAg, HBeAg, anti-HBc, and HBV DNA with management based on disease phase using nucleos(t)ide analogues (entecavir, tenofovir) and universal infant vaccination.

Hepatitis C (HCV)

Dahiliye (İç Hastalıkları)

Hepatitis C is an RNA virus causing chronic hepatitis that may progress to cirrhosis and hepatocellular carcinoma; modern direct-acting antiviral (DAA) pangenotypic regimens (sofosbuvir/velpatasvir, glecaprevir/pibrentasvir) achieve sustained virologic response over 95% in 8–12 weeks with universal adult screening and cure for nearly all patients.

Fatty Liver Disease

Dahiliye (İç Hastalıkları)

Non-alcoholic fatty liver disease (NAFLD) is closely related to obesity and metabolic syndrome and is largely reversible with early treatment.

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.