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Diffuse Large B-Cell Lymphoma (Detailed)

Most common aggressive non-Hodgkin lymphoma in adults, curable with R-CHOP-based therapy in many cases.

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 (Detailed)?

DLBCL accounts for 25-30% of non-Hodgkin lymphomas and arises from mature germinal center or post-germinal center B cells. Median age at diagnosis is 65 years. The 2017 WHO classification recognizes biological subgroups based on cell of origin (germinal center B-cell-like vs activated B-cell-like) and double-hit/triple-hit lymphomas with MYC plus BCL2 and/or BCL6 rearrangements.

Pathologically, the tumor is composed of large B cells with diffuse architectural effacement of involved tissue. Common immunohistochemical markers include CD20, CD19, CD22, and PAX5. Molecular features include mutations in BCL6, MYD88 (especially L265P in CNS lymphomas), CD79B, and CARD11. The IPI (International Prognostic Index) and revised R-IPI use age, stage, LDH, performance status, and extranodal disease to estimate prognosis.

First-line therapy is R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) for 6 cycles, achieving cure in 60-70%. Polatuzumab-R-CHP, dose-adjusted EPOCH-R for double-hit lymphomas, and CNS prophylaxis for high-risk disease are increasingly used. Relapsed/refractory disease may be treated with second-line chemotherapy followed by autologous stem cell transplantation, CAR-T cell therapy (axicabtagene ciloleucel, lisocabtagene maraleucel, tisagenlecleucel), bispecific antibodies (epcoritamab, glofitamab), or targeted agents (polatuzumab, loncastuximab, tafasitamab).

Symptoms

Rapidly enlarging lymphadenopathy
Extranodal involvement (gastrointestinal, CNS, bone, skin, testis)
B symptoms: fever, night sweats, unexplained weight loss
Cytopenias due to bone marrow involvement
Hepatosplenomegaly
Compressive syndromes (superior vena cava, spinal cord)
CNS symptoms in primary CNS lymphoma
Fatigue, dyspnea, recurrent infections

Risk Factors

Older age (median 65 years)
Immunosuppression (HIV, post-transplant)
Autoimmune disease (Sjogren, rheumatoid arthritis)
Hepatitis C, EBV-related transformations
Family history of lymphoma
Prior chemotherapy or radiotherapy
Indolent lymphoma transformation (Richter syndrome)
Genetic predisposition (limited)

When to See a Doctor?

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

  • Rapidly enlarging lymph node
  • Unexplained fever, night sweats, weight loss
  • New extranodal mass (GI, CNS, bone, skin)
  • Cytopenia with constitutional symptoms
  • Compressive syndromes (SVC, cord compression)
  • Indolent lymphoma with new aggressive symptoms

Treatment Methods

01
First-line: R-CHOP × 6 cycles for most patients
02
Polatuzumab-R-CHP for selected patients
03
Dose-adjusted EPOCH-R for double-hit/triple-hit lymphomas
04
CNS prophylaxis (intrathecal or high-dose methotrexate) for high CNS-IPI
05
Relapsed/refractory: salvage chemotherapy + autologous stem cell transplant
06
CAR-T cell therapy: axicabtagene ciloleucel, lisocabtagene maraleucel, tisagenlecleucel
07
Bispecific antibodies: epcoritamab, glofitamab
08
Targeted agents: polatuzumab, loncastuximab, tafasitamab + lenalidomide

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.