Diffuse Large B-Cell Lymphoma Stage I

Diffuse large B-cell lymphoma (DLBCL) stage I is a fast-growing but often curable blood cancer that affects only one group of lymph nodes in a single area of the body. Although aggressive, early-stage DLBCL responds well to treatment, with many people achieving complete remission.

Table of contents

• What is diffuse large B-cell lymphoma?
• Understanding Stage I DLBCL
• Symptoms
• Diagnosis
• Treatment
• Outlook and Survival

What is diffuse large B-cell lymphoma?

Diffuse large B-cell lymphoma, or DLBCL, is a blood cancer that involves changes in your B cells, a particular type of white blood cell (also called lymphocytes)^[1]. It is the most common form of aggressive non-Hodgkin lymphoma and the most common type of B-cell lymphoma^[1][2].

DLBCL affects your lymphatic system, which is a network of tissues, vessels and organs that help fight infection in your body^[1]. Normal B cells are part of that infection-fighting network. But with DLBCL, healthy B cells change into fast-growing cancer cells that overtake healthy ones. They are no longer able to fight off infection-causing invaders, like viruses and bacteria^[1].

The name “diffuse large B-cell lymphoma” describes the appearance of the cancer cells. When healthcare professionals look at the cells with a microscope, the cancer cells are larger than healthy cells, and they spread out in the tissue in a scattered (diffuse) pattern rather than being grouped together^[2][3].

With diffuse large B-cell lymphoma, cancerous B cells may appear in your lymph nodes. But they may also appear in virtually any organ, including your gastrointestinal tract, thyroid, skin, breast, bone or brain^[1][2].

According to the National Cancer Institute, in 2020, about 6 people in 100,000 received a DLBCL diagnosis^[1]. Each year about 5,000 people are diagnosed with DLBCL in the UK, making up more than 40 out of 100 cases (40%) of non-Hodgkin lymphoma in adults^[3]. DLBCL is more common in males than females^[3].

Understanding Stage I DLBCL

The stage of the lymphoma describes where the lymphoma is in your body. Doctors need to know the stage to plan the best treatment for you^[6].

Stage I means that only one lymph node or group of lymph nodes is affected, in one place in your body^[6]. This is considered early-stage disease.

Sometimes you might see this number written as Roman numeral I. Your doctor may also add letters to describe the lymphoma in more detail. The letter “B” means you have certain symptoms including fever, night sweats, or weight loss. If you don’t have these symptoms, doctors may note this with the letter “A”^[6].

Stage I DLBCL is classified as early or limited-stage disease, which generally has a better outlook compared to more advanced stages^[6].

Symptoms

The symptoms most people notice with diffuse large B-cell lymphoma are swollen lymph nodes in their neck, armpits or groin^[1]. These swellings can grow very quickly^[3]. They usually appear as a lump that doesn’t go away and seems to be getting larger. The lump isn’t usually painful, but it can be^[1][3].

About 30% of people with DLBCL have “B symptoms,” which include^[1]:

• A fever above 103 degrees Fahrenheit (39.5 degrees Celsius) that lasts longer than two days or comes and goes
• Unexplained weight loss that involves losing more than 10% of your body weight over six months
• Heavy night sweats (so intense that it drenches your sheets)

Some people may also have unexplained itching^[3]. Other symptoms depend on where the DLBCL grows. For example, DLBCL growing in your stomach or bowel might cause pain, diarrhea or bleeding. DLBCL in your chest might cause breathlessness or a cough^[3].

Having these symptoms doesn’t necessarily mean you have diffuse large B-cell lymphoma. That said, you should contact a healthcare provider anytime you notice changes in your body that last for several weeks^[1]. Symptoms can start or get worse in just a few weeks^[3].

Diagnosis

Diffuse large B-cell lymphoma diagnosis often begins with a physical exam that checks for swollen lymph nodes in the neck, underarms and groin and an enlarged spleen or liver^[9].

The main test to diagnose lymphoma is a lymph node biopsy^[3]. A biopsy is a procedure to remove a sample of tissue for testing in a lab. A doctor removes part or all of the swollen lymph node and sends it to the laboratory for a specialist to look at it under a microscope^[3][9].

You might also have some blood tests. Blood tests can sometimes show whether lymphoma cells are present. Blood tests may be used to test for viruses, including Epstein-Barr virus, HIV, hepatitis B and hepatitis C. Blood tests also measure levels of lactate dehydrogenase (LDH), which is often higher in people with lymphoma^[9].

If your doctor diagnoses lymphoma, you might have further tests to determine the stage. These might include^[3][9]:

• Imaging tests such as PET-CT scan, MRI scan, or CT scan to show the location and extent of the lymphoma
• A bone marrow test to check if you have lymphoma cells in your bone marrow
• An MRI scan to look at your head or spine
• A lumbar puncture to check for lymphoma cells in the fluid around your brain and spinal cord

The stage is determined based on which parts of your body are affected, the symptoms you have, and how large any swollen lymph nodes are^[6].

Treatment

Although DLBCL is aggressive, it is often treatable and curable, especially with early diagnosis and treatment^[1]. Since DLBCL can advance quickly, it usually requires immediate treatment^[8].

The main treatment for newly diagnosed DLBCL is chemoimmunotherapy. This gets most people with DLBCL into remission, meaning there are no lymphoma cells left^[10].

The most widely used treatment for DLBCL is the combination known as R-CHOP, which stands for rituximab (Rituxan), cyclophosphamide (Cytoxan), doxorubicin (Adriamycin), vincristine (Oncovin), and prednisone^[8][10]. This combination of chemotherapy and the targeted drug rituximab is the standard treatment^[3].

The R-CHOP regimen is usually given in 21-day cycles (once every 21 days). Your doctor or nurse will tell you how many cycles of treatment you will need. Typically, people have 6 cycles of chemoimmunotherapy, given every 3 weeks^[8][10]. However, for limited stage disease (Stage I or II), 3-4 cycles may be used followed by radiation therapy^[8][13].

Another treatment option is polatuzumab vedotin-piiq (Polivy) in combination with rituximab, cyclophosphamide, doxorubicin, and prednisone (pola-R-CHP)^[8][10].

In some cases, treatment may involve radiation therapy. Treatment is usually given on an outpatient basis^[8][13].

Outlook and Survival

DLBCL is considered potentially curable^[7]. Between 50% and 60% of all patients are cured with rituximab-based chemoimmunotherapy in the first-line setting^[11]. Based on studies between 2014 and 2020, 65 percent of people with DLBCL live for at least five years after diagnosis^[17].

Younger adults tend to have a better outlook compared with older adults. According to the National Cancer Institute^[17]:

• About 80 percent of those under age 55 will live for five years or more
• About 70 percent of people between 55 and 64 will live at least five years
• About 55 percent of those 65 or older will live five years or more

Stage I DLBCL is classified as early-stage disease, which generally has a better prognosis than advanced-stage disease. Your outlook is also affected by your overall health and how well you can complete daily activities (called performance status)^[17].

About 75% of patients treated initially for this type of cancer respond well to standard chemotherapy-based therapy, and many people are cured of the condition^[14]. Newer therapies are available to patients who don’t respond to initial treatment^[14].

When there is no sign of the lymphoma left after treatment, you will usually have follow-up appointments for 2 to 3 years^[10].