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Non-Hodgkin lymphoma

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Diffuse large B-cell lymphoma (DLBCL)

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL). It makes up about 30–40% of all NHL cases. DLBCL is a B-cell type of lymphoma. With DLBCL, the cancer cells appear very large and scattered throughout (diffuse) all of the lymph node or tissue when looked at under a microscope.

DLBCL can occur in people of all ages, but is more common in adults in their 60s. It is slightly more common in men.

Many people with DLBCL will have rapidly enlarging lymph nodes and symptoms like fever, night sweats or weight loss (B symptoms).

Most DLBCLs start inside the lymph nodes, but DLBCL can also occur in many different locations in the body. About 30–40% of people with DLBCL will have localized, stage I or II disease when they are diagnosed. The rest will have widespread disease at the time of diagnosis. In these cases, the disease has spread to different parts of the body, such as the spleen, liver or bone marrow.

DLBCL can also appear only in organs or tissues outside the lymph nodes (primary extranodal disease). The most common locations include the:

  • bones
  • brain or spinal cord (central nervous system or CNS)
  • breasts
  • gastrointestinal tractgastrointestinal tractReferring to or having to do with the digestive organs, particularly the stomach, small intestine and large intestine., such as the intestines
  • sinuses
  • testicles
  • tonsils
  • skin

Treatment for DLBCL in these areas is tailored to the specific location involved.

Most DLBCLs express CD19 (CD19+) and CD20 (CD20+) surface markers. These are proteins found on the surface of both normal and cancerous B cells.

DLBCL is a fast-growing (aggressive) lymphoma. Generally, people with localized DLBCL have a better prognosis than those with widespread disease.

Some types of slow-growing (indolent) B-cell lymphomas can change (transform) into DLBCL. These types include follicular lymphoma, MALT lymphoma, splenic marginal zone lymphoma, small lymphocytic lymphoma or lymphoplasmacytic lymphoma.

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Subtypes of DLBCL

The subtypes of DLBCL differ in how they behave and where they occur in the body. Subtypes of DLBCL include:

  • mediastinal large B-cell lymphoma – occurs in the thymus gland or lymph nodes in the centre of the chest (mediastinummediastinumThe space in the chest between the lungs, breastbone and spine that contains the heart, great blood vessels, thymus, trachea (windpipe), esophagus and lymph nodes.)
  • primary effusion lymphoma (PEL) – a rare subtype of DLBCL that occurs in the fluid in the chest (pleuralpleuralThe thin layer of tissue that covers the lungs and lines the chest cavity. It protects and cushions the lungs and produces a fluid that acts like a lubricant so the lungs can move smoothly in the chest cavity.), abdominal (peritoneal) cavity or sometimes in the space between the layers of the pericardiumpericardiumThe double-layered sac that surrounds the heart. It protects the heart and produces a fluid that acts like a lubricant so the heart can move normally in the chest. that surrounds the heart (pericardial cavity)
  • intravascular large B-cell lymphoma – a very rare subtype of DLBCL that affects small blood vessels
  • primary DLBCL of the central nervous system (CNS) – most primary CNS lymphomas are B-cell lymphomas, most often DLBCL

DLBCL can also be associated with certain chronic inflammations.

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The main treatment for DLBCL is chemotherapy. DLBCL is very sensitive to chemotherapy. Even though DLBCL is an aggressive lymphoma, initial chemotherapy treatment is effective for between 50–60% of people with DLBCL. However, many people will relapse after initial treatment.

Treatment for DLBCL depends on the stage and other prognostic factors.


Treatment for DLBCL is usually a combination of chemotherapy drugs. Chemotherapy is used to treat all stages of DLBCL. The most commonly used combination chemotherapy for treating DLBCL initially is one called CHOP.

  • CHOP – cyclophosphamide (Cytoxan, Procytox), doxorubicin (Adriamycin), vincristine (Oncovin) and prednisone (Deltasone)

If radiation therapy is also given to treat early stage DLBCL, then the number of cycles of chemotherapy may be reduced (for example, 3–4 cycles instead of 6–8).

Biological therapy

Monoclonal antibodies are a type of biological therapy that is effective in treating certain types of NHL. Rituximab (Rituxan) is often used with chemotherapy to treat DLBCL. This combination is called CHOP-R.

Radiation therapy

External beam radiation therapy may be used after chemotherapy to treat lymph node areas in stage I or sometimes stage II DLBCL. This may be referred to as involved field radiation therapy (IFRT).

Sometimes radiation therapy is used after chemotherapy for more advanced stages of DLBCL. It is used if there is localized disease remaining or for areas containing bulky disease. Radiation therapy may be given to help control tumours.

Stem cell transplant

A stem cell transplant (SCT) may be an option for some people with DLBCL. People with DLBCL who do not have a complete response to treatment, or whose lymphoma returns or relapses after treatment, may be offered alternative treatments, such as other types of chemotherapy (salvage chemotherapy) or a SCT. A stem cell transplant may be an option, especially if the person’s lymphoma responded to chemotherapy in the past.

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For more detailed information on specific drugs, go to sources of drug information.


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