Diffuse Large B-cell Lymphoma (DLBCL)
Characteristics
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma (NHL) in adults. DLBCL is an aggressive (fast-growing) NHL that affects B-lymphocytes, a type of white blood cells that produces antibodies to target viruses, bacteria, cancer cells, and other foreign substances.
DLBCL can develop at any age, but most commonly affects older people. In fact, the majority of patients with DLBCL is older than 65 years. In addition to this, DLBCL is slightly more common in men than in women. In 2021, about 400 patients were diagnosed with DLBCL in Belgium.
In most cases, the cause of DLBCL is unclear. However, there is an established association between the development of DLBCL and conditions that affect the immune system, such as auto-immune disorders, HIV, or the use of immunosuppressive therapy after an organ transplantation.
Symptoms
The most common symptom of DLBCL is a painless swelling of lymph nodes. These swollen lymph nodes can develop in any area of the body, but most commonly occur in the neck, armpit, groin, or in the testicles. In most cases, the swollen lymph nodes are hard, painless and grow quickly, over just a few weeks. Sometimes, DLBCL can develop in lymph nodes deep inside your body where they can’t be felt from the outside.
The exact symptoms that patients with DLBCL experience depend on the disease location. For example, patients with DLBCL affecting nodes in the stomach, or bowel may suffer from abdominal, discomfort, nausea, or diarrhea. In contrast, if the DLBCL affects nodes in the chest area, patients may experience a cough or suffer from breathlessness.
About a third of DLBCL patients also encounters so-called ‘B-symptoms’, consisting of heavy sweating during the night, fever, and an unexplained weight loss over short period of time. Finally, DLBCL is often associated with fatigue and a loss of appetite.
Diagnostic tests
The diagnosis of DLBCL is made on a lymph node biopsy. This is a simple procedure during which all, or part of a lymph node is removed from the body and sent to the laboratory for a microscopic evaluation. If this analysis is indicative for DLBCL, additional tests can be performed to assess how far the cancer has spread. This includes blood tests, a bone marrow biopsy and imaging tests to look for signs of DLBCL in other areas of your body (X-ray, CT, PET, MRI, ultrasound). In addition to this, a lumbar puncture can be performed in patients with a high-risk disease to check whether the lymphoma has spread to the spinal cord. To better characterize the exact DLBCL subtype, genetic and/or molecular assays can be performed.
Treatments
DLBCL can re-emerge after an initial remission (relapse). For patients with relapsed/refractory DLBCL, the current standard of care consists of a stem cell transplantation, or CAR-T cell therapy.
For patients with a second relapse, several immunotherapeutic options are available, these include monoclonal antibodies (e.g., tafasitamab) bispecific antibodies, and antibody-drug conjugates (e.g., polatuzumab vedotin). In addition to this, participation in clinical trials may offer the opportunity to be treated with alternative therapies
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