Diffuse Large B-Cell Lymphoma Symptoms, Treatment, and Hope Introduction
Know about the diffuse large B-cell lymphoma, recognising the signs, diagnosis and treatment options and more.
Written by Dr. J T Hema Pratima
Reviewed by Dr. D Bhanu Prakash MBBS, AFIH, Advanced certificate in critical care medicine, Fellowship in critical care medicine
Last updated on 16th Sep, 2025
Introduction
Hearing the words "you have lymphoma" can be overwhelming. Diffuse Large B-Cell Lymphoma, or DLBCL, might sound complex and frightening, but it's crucial to know that it is often a highly treatable form of cancer. As the most common type of non-Hodgkin lymphoma worldwide, there is a wealth of research, effective treatments, and a strong community of survivors. This guide is designed to walk you through everything you need to know about diffuse large B-cell lymphoma, from understanding what it is and recognising its symptoms to navigating diagnosis, exploring cutting-edge treatment options, and finding hope in the statistics.
What is Diffuse Large B-Cell Lymphoma (DLBCL)?
Diffuse Large B-Cell Lymphoma is an aggressive but potentially curable cancer that originates in the lymphatic system, a key part of the body's immune defense network. It is classified as a type of non-Hodgkin lymphoma (NHL).
Understanding Lymphoma and Your Immune System
Your lymphatic system includes lymph nodes, the spleen, thymus, and bone marrow. It's white blood cells, called lymphocytes, that fight infection. B-cells are a specific type of lymphocyte that produce antibodies. DLBCL starts when these B-cells undergo malignant changes, causing them to multiply uncontrollably. These cancerous B-cells are larger than normal and collect in lymph nodes or other tissues, forming tumours.
Consult an Oncologist for Personalised Advice
Why is it Called "Diffuse" and "Large B-Cell"?
The name describes what doctors see under a microscope:
1. Large B-Cell: The cancerous lymphocytes are abnormally large.
2. Diffuse: The pattern of growth is spread out or "diffuse," rather than clustered in orderly nodules. This distinguishes it from other, slower-growing lymphomas.
Recognising the Signs: Symptoms of DLBCL
The symptoms of DLBCL can appear quickly and are often what prompt someone to seek medical attention. Because it's an "aggressive" lymphoma, it grows rapidly but also typically responds well to treatment.
The Most Common Symptoms
The most frequent sign is a painless, rapid swelling of one or more lymph nodes in the neck, armpits, or groin. However, since DLBCL can appear almost anywhere in the body, symptoms can vary widely and may include:
1. Abdominal pain or swelling (if the lymphoma is in the abdomen)
2. Chest pain, coughing, or difficulty breathing (if it's in the chest)
3. Unintentional weight loss
4. Persistent fatigue
"B Symptoms" – A Key Indicator
Doctors pay special attention to a trio of systemic symptoms known as "B symptoms," which are significant for staging and prognosis:
1. Fever: Unexplained fever over 100.4°F (38°C).
2. Drenching Night Sweats: Sweats that soak through bedclothes and sheets.
3. Weight Loss: Losing more than 10% of body weight over six months without trying.
When to See a Doctor?
If you experience any persistent, unexplained symptoms—especially rapidly enlarging lymph nodes or "B symptoms"—it is essential to get evaluated. If symptoms persist beyond two weeks, consult a doctor online with Apollo24|7 for further evaluation. Early diagnosis is key to successful treatment.
How is Diffuse Large B-Cell Lymphoma Diagnosed?
A definitive diagnosis requires several steps, beginning with a biopsy.
The Crucial Biopsy
The only way to confirm DLBCL is by removing all or part of an enlarged lymph node (or other affected tissue) for examination by a pathologist. This biopsy identifies the specific type of lymphoma and its characteristics, which is critical for determining the right treatment plan.
Imaging Scans: PET/CT and CT
Once diagnosed, imaging scans determine the extent (stage) of the disease. A PET/CT scan is the gold standard. It combines detailed CT imaging with a PET scan that uses a radioactive sugar tracer to highlight metabolically active cancer cells throughout the body. This shows exactly where the lymphoma is located.
Blood Tests and Bone Marrow Aspiration
Blood tests check overall health, blood cell counts, and organ function. A bone marrow aspiration and biopsy (a procedure to remove a small sample of bone marrow) is often performed to see if the lymphoma has spread to the bone marrow. Apollo24|7 offers convenient home collection for tests like CBC and LDH, which are important initial steps, though a biopsy must be done in a hospital setting.
Frontline Treatment: The Road to Remission
The goal of initial treatment for DLBCL is cure. The standard approach is immunochemotherapy.
R-CHOP Chemotherapy: The Gold Standard
Most patients receive a regimen known as R-CHOP, which is a combination of five drugs:
1. Rituximab (a monoclonal antibody that targets CD20, a protein on B-cells)
2. Cyclophosphamide (chemotherapy)
3. Hydroxydoxorubicin (chemotherapy)
4. Oncovin (chemotherapy)
5. Prednisone (a steroid)
This combination attacks cancer cells in different ways, maximising effectiveness. Treatment is typically given in cycles, every 2-3 weeks, for 6 cycles.
How is Radiation Therapy Used?
Radiation therapy (radiotherapy) may be added after chemotherapy, especially if the lymphoma was bulky (large) or confined to one area. It uses high-energy beams to target and destroy any remaining cancer cells in a specific location.
What If the Lymphoma Returns? Understanding Relapsed/Refractory DLBCL
In about 30-40% of cases, the lymphoma may not respond to first-line treatment (refractory) or may come back after a period of remission (relapsed). There are still highly effective options.
Salvage Chemotherapy and Stem Cell Transplant
The traditional approach involves stronger chemotherapy regimens (salvage therapy) to push the lymphoma back into remission, followed by a stem cell transplant. This transplant allows for very high doses of chemo by rescuing the bone marrow with the patient's own or a donor's healthy stem cells.
Breakthrough CAR T-Cell Therapy
This is a revolutionary form of immunotherapy. A patient's T-cells (another immune cell) are collected and genetically engineered in a lab to recognise and attack lymphoma cells. These "supercharged" CAR T-cells are then infused back into the patient. Therapies like Axicabtagene ciloleucel (Yescarta) and Tisagenlecleucel (Kymriah) have shown remarkable success in patients who have not responded to other treatments.
Prognosis and Survival Rates for DLBCL
The outlook for DLBCL is generally positive. The overall 5-year relative survival rate is around 64%, but this number varies significantly based on individual factors.
The Importance of the International Prognostic Index (IPI)
Doctors use the IPI, a scoring system, to estimate prognosis. It considers:
1. Age
2. Stage of lymphoma
3. Whether the lymphoma has spread to organs outside the lymph system
4. Performance status (how well you can perform daily activities)
5. Level of LDH (a blood enzyme that can be elevated with lymphoma)
6. A lower IPI score indicates a more favourable prognosis.
Conclusion
A diagnosis of diffuse large B-cell lymphoma is a life-changing event, but it is not a journey anyone has to take alone. Modern medicine has transformed DLBCL from a once devastating diagnosis to one with a strong potential for cure. Understanding the disease, its symptoms, and the array of treatment options from established regimens like R-CHOP to innovative therapies like CAR T is your first step toward empowerment. Remember, statistics are guides, not destinies. Your individual journey is unique. Work closely with your healthcare team, ask questions, seek support, and hold onto the well-founded hope that effective treatment exists.
Consult an Oncologist for Personalised Advice
Consult an Oncologist for Personalised Advice
Dr Sunita Samleti
Oncologist
18 Years • M.D. (Pathology)- TN Medical College, Mumbai University, Mumbai, Mar 2005 M.B.B.S. Grant Medical College, Mumbai University, Mumbai, Oct 1999
Chinagadila
Apollo Hospitals Health City Unit, Chinagadila
Dr Gowshikk Rajkumar
Oncologist
10 Years • MBBS, DMRT, DNB in Radiation oncology
Bengaluru
Apollo Clinic, JP nagar, Bengaluru
Dr. Sanchayan Mandal
Oncologist
17 Years • MBBS, DNB Raditherapy, DrNB Medical Oncology
East Midnapore
VIVEKANANDA SEBA SADAN, East Midnapore
Dr.sanchayan Mandal
Oncologist
17 Years • MBBS, DrNB( MEDICAL ONCOLOGY), DNB (RADIOTHERAPY),ECMO. PDCR. ASCO
Kolkata
Dr. Sanchayan Mandal Oncology Clinic, Kolkata
Dr. Ruquaya Ahmad Mir
Surgical Oncologist
20 Years • MBBS, DNB
Delhi
Apollo Hospitals Indraprastha, Delhi
(25+ Patients)
Consult an Oncologist for Personalised Advice
Dr Sunita Samleti
Oncologist
18 Years • M.D. (Pathology)- TN Medical College, Mumbai University, Mumbai, Mar 2005 M.B.B.S. Grant Medical College, Mumbai University, Mumbai, Oct 1999
Chinagadila
Apollo Hospitals Health City Unit, Chinagadila
Dr Gowshikk Rajkumar
Oncologist
10 Years • MBBS, DMRT, DNB in Radiation oncology
Bengaluru
Apollo Clinic, JP nagar, Bengaluru
Dr. Sanchayan Mandal
Oncologist
17 Years • MBBS, DNB Raditherapy, DrNB Medical Oncology
East Midnapore
VIVEKANANDA SEBA SADAN, East Midnapore
Dr.sanchayan Mandal
Oncologist
17 Years • MBBS, DrNB( MEDICAL ONCOLOGY), DNB (RADIOTHERAPY),ECMO. PDCR. ASCO
Kolkata
Dr. Sanchayan Mandal Oncology Clinic, Kolkata
Dr. Ruquaya Ahmad Mir
Surgical Oncologist
20 Years • MBBS, DNB
Delhi
Apollo Hospitals Indraprastha, Delhi
(25+ Patients)
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Frequently Asked Questions
1. Is diffuse large B-cell lymphoma curable?
Yes, DLBCL is considered potentially curable, even in advanced stages. With standard R-CHOP therapy, approximately 60-70% of patients will be cured, meaning the cancer does not return.
2. What is the life expectancy for someone with stage 4 DLBCL?
Life expectancy is measured by survival rates. The 5-year survival rate for stage 4 DLBCL is lower than for earlier stages but still significant, often cited between 55-65%. The International Prognostic Index (IPI) provides a more personalised estimate than stage alone.
3. What are the first signs of DLBCL?
The most common first sign is the rapid enlargement of one or more lymph nodes in the neck, armpit, or groin, which are typically painless. Many people also first notice systemic 'B symptoms' like drenching night sweats, unexplained fevers, or significant weight loss.
4. How fast does DLBCL spread?
As an aggressive lymphoma, DLBCL can grow and spread quickly, often over weeks or a few months. This rapid growth also makes it more sensitive to chemotherapy, which is why it often responds well to treatment.
5. What is the main cause of diffuse large B-cell lymphoma?
In most cases, the exact cause is unknown. It occurs due to random genetic mutations in a B-cell that cause it to multiply uncontrollably. Certain risk factors, like a compromised immune system, autoimmune diseases, or previous exposure to specific chemicals, can increase susceptibility.