Diffuse Large B-Cell Lymphoma (DLBCL)

Diffuse Large B-Cell Lymphoma (DLBCL) in brief

DLBCL is the most common subtype of non-Hodgkin lymphoma (NHL) and accounts for about 30–40 % of all NHL cases worldwide. In Germany, the number of new cases is around 4,000 to 5,000 per year. Most cases of DLBCL occur in people over 60, although younger people can also be affected. Thanks to newer treatment methods, such as antibodies, survival rates have improved significantly. The cure rate is currently 60–70 %.

DLBCL at a glance

Frequency

Most common subtype of non-Hodgkin lymphoma (about 30–40 % of cases)

New cases in Germany

About 4,000 to 5,000 per year

Typical age

Mostly over 60 years

Cure rate

Currently 60–70 %

What exactly is diffuse large B-cell lymphoma (DLBCL)?

Diffuse large B-cell lymphoma (DLBCL) is a subgroup of the non-Hodgkin lymphomas (NHL). It is considered an aggressive lymphoma that can spread quickly throughout the body. Like many other lymphoma diseases, it arises from B cells, the type of white blood cell responsible for antibody production. DLBCL is characterized by a diffuse distribution of the malignant cells in the lymphatic tissue, which means that the cancer cells are evenly distributed and not concentrated in nodes or masses. There are various subtypes of DLBCL, which can differ depending on genetic features and behavior.

Why do I have a lymphoma?

The exact cause of the development of DLBCL is still not fully understood. However, there are several factors that can increase the risk of developing DLBCL:

• Age and sex: DLBCL occurs more frequently in older adults and somewhat more often in men.
• Immune system: People with a weakened immune system, e.g. due to HIV infection, after an organ transplant, or through certain autoimmune diseases, have a higher risk.
• Viruses and infections: Certain viral infections, such as the Epstein-Barr virus (EBV) or hepatitis C, are associated with an increased risk of DLBCL.
• Genetic predisposition: There is evidence that genetic factors can play a role in the development of DLBCL.

It is important to emphasize that many people with one or more of these risk factors never develop lymphoma, and most cases of DLBCL occur without a known cause.

Symptoms of diffuse large B-cell lymphoma (DLBCL)

The symptoms of DLBCL can vary depending on the location and spread of the lymphoma cells, but common signs are:

• Swollen lymph nodes: These are often painless and appear in areas such as the neck, the armpits, or the groin.
• Fever: Often without an obvious cause.
• Night sweats: Heavy sweating during the night.
• Weight loss: Unexplained weight loss over a short period.
• Fatigue: Persistent exhaustion and weakness.
• Breathing difficulties or chest pain: Especially when the lymph nodes in the chest are enlarged.
• Abdominal pain or swelling: When the abdominal organs are affected.

If you notice these symptoms, it is important to see a doctor to determine the cause.

When is diffuse large B-cell lymphoma (DLBCL) treated?

Treatment of DLBCL should begin as early as possible, especially because this type of lymphoma is aggressive and can spread quickly. The decision to treat depends on various factors, including:

• Disease stage: How far the lymphoma has spread in the body.
• Patient's state of health: General health and accompanying illnesses.
• Prognostic factors: Certain biological markers and genetic features of the lymphoma cells.

In many cases, treatment is started immediately after diagnosis to ensure the best chances of a cure.

How is diffuse large B-cell lymphoma (DLBCL) treated?

The treatment of DLBCL is often multimodal and can involve a combination of the following approaches:

• Chemotherapy: The standard therapy for DLBCL is a combination of chemotherapy drugs, often in conjunction with the monoclonal antibody rituximab. This treatment is often referred to as R-CHOP and comprises cyclophosphamide, doxorubicin, vincristine (Oncovin), prednisone, and rituximab.
• Immunotherapy: CAR-T cell therapies, which use genetically modified T cells to specifically attack cancer cells, are a new option for patients who do not respond to conventional therapies.
• Radiation therapy: Can be used in certain cases, especially when the lymphoma is limited to one area.
• Clinical trials: For some patients, taking part in a clinical trial can be an option to gain access to new and potentially effective therapies.

The exact treatment depends on the individual case and should always be carried out in close coordination with a specialized oncologist.

How exactly have clinical trials changed the treatment landscape in DLBCL?

Clinical trials have played a decisive role in the development of new therapies for DLBCL. The introduction of rituximab into standard chemotherapy has significantly improved survival rates. New trials are investigating the effectiveness of CAR-T cell therapies, immune checkpoint inhibitors, and other targeted therapies that aim to attack specific genetic mutations in DLBCL cells. These advances have helped to expand the treatment options and improve the prognosis for many patients. Clinical trials give patients access to the latest treatment innovations while at the same time contributing to the further development of medical science.