Diffuse Large B-Cell Lymphoma (DLBCL) is an aggressive (quick-growing) subtype of Non-Hodgkin Lymphoma (NHL) that affects B-lymphocytes. B-lymphocytes are white blood cells that secrete antibodies in the immune system. Despite being an aggressive lymphoma, DLBCL is considered potentially curable.
People of any age can develop lymphoma; however, it is among the most common cancer types for patients aged 15–24 years. As this type of cancer occurs within the lymphatic system, it could rapidly metastasize, or spread, to different tissues and organs all through the body. Most DLBCL patients are diagnosed in their 60’s despite cases of lymphoma being in patients of all ages.
How is DLBCL Diagnosed?
Diffuse Large B-Cell Lymphoma (DLBCL) is most diagnosed through a biopsy of the swollen lymph node. A piece is removed but, in some cases, the entire lymph node is removed, and the patient will be given a local anesthesia. Once the diagnosis is confirmed, additional tests will be performed to identify the stage of the lymphoma. Many patients do not experience symptoms in early stages, so diagnoses are usually in later stages, making treatment more complicated.
Of the nearly 80,000 new NHL diagnoses in the United States this year, more than 18,000 individuals will be identified with DLBCL. Therefore, DLBCL is the most common subtype of NHL. Around 1 in 3 people with DLBCL expertise fevers, nighttime sweats, and unexplained weight reduction. Sometimes DLBCL develops in people who have had a low-grade (slow rising) lymphoma in the past. Occasionally, a low-grade lymphoma transforms right into a quicker rising DLBCL. For some forms of lymphoma, the stage is not too insightful in figuring out a patient’s prognosis. But it is necessary to understand that survival rates can vary broadly for different types and stages of lymphoma.
What are the Stages of Diffuse Large B-Cell Lymphoma (DLBCL)?
To determine the staging of DLBCL, the common tests performed by physicians are a blood test, CT scan, bone marrow biopsy, or a PET scan to locate the extent of the affected areas within the body.
- Stage 1: Only one lymph node, structure, or extra nodal site is affected.
- Stage 2: On the same side of the diaphragm, two or more lymph node regions or structures are involved.
- Stage 3: Lymph node structures and/or regions are on both sides of the diaphragm.
- Stage 4: Spread to organs outside of the lymph nodes (Typically to bone marrow, lungs, and/or liver).
Each stage is also accompanied with an A or B. When common symptoms are present (fever, night sweats, weight loss) the stage includes a B. When none of the symptoms are being experienced, the stage has an A. Stage 1 or stage 2 DLBCL is called ‘early-stage’ lymphoma. Stage three or stage four DLBCL is known as ‘superior-stage’ lymphoma. Most individuals have advanced stage DLBCL when they are diagnosed.
While the stage is the main identifier of a patient’s overall status and progression of their cancer, another score is assigned to each patient based on the IPI (International Prognostic Index). Patients can score anywhere between 0 and 5.
The score is based on five factors that gauge the overall well-being and prognosis and cancer patients. Each factor attributes to decreasing the predicted survival rate of the patient. The five factors include:
- Cancer stage of 3 or 4
- Patient is over the age of 60
- Overall poor health (ECOG performance status of 2 or higher)
- Two or more involved extra nodal sites
- High levels of Lactate dehydrogenase (Protein that increases levels from cancer cells and damaged tissue)
The International Prognostic Index score is solely based on how many of those factors the patient has and determines the patient’s three-year survival rate. The scores of the IPI are as follows:
- Low risk: 0 or 1 of these factors
- Low to intermediate risk: 2 factors
- Intermediate to high risk: 3 factors
- High risk: 4 or 5 factors
Clinical Trials
There are many targeted drugs aimed to improve quality of life and survival rates of DLBCL patients. Your physician may counsel you to participate in a clinical trial to provide you access to a new and innovative drug.
Clinical trials have helped to develop most of the lymphoma drugs which have improved patient outcomes during the approval process by the FDA. Many clinical trials turn the most recent discoveries from the laboratory into new treatments for patients with lymphoma. For example, most individuals with early-stage DLBCL have three to four cycles of R-CHOP. This subtype of DLBCL usually develops in people over the age of 50, although it could affect young adults and children as well.
Advanced DLBCL is handled with the identical R-CHOP combination of chemotherapy and immunotherapy drugs. However, advanced DLBCL requires more rounds of the medications which might be administered every three weeks. Advanced DLBCL will often require six to eight rounds of the remedy. There are more than 30,000 active clinical trials for cancer patients. Finding the right trial has never been easier with Massive Bio’s artificial intelligence powered engine that uses more than 170 clinical algorithms to find personalized trial matches for all subtypes of lymphoma and other cancer types.
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