B-Cell Lymphoma

B-cell lymphoma is a type of blood cancer that develops in the lymphatic system, where abnormal white blood cells multiply to form tumors throughout the body. While some types can grow quickly, many can be successfully treated and even cured with modern therapies.

What Is B-Cell Lymphoma?
Types of B-Cell Lymphoma
How Common Is This Condition?
Signs and Symptoms
What Causes B-Cell Lymphoma?
How Doctors Diagnose B-Cell Lymphoma
Treatment Options
What to Expect
Living With B-Cell Lymphoma

What Is B-Cell Lymphoma?

B-cell lymphoma is a type of blood cancer that affects your lymphatic system (the network of organs, vessels, and tissues that helps your body fight infection and disease)^[1]. In this condition, abnormal lymphocytes (a type of white blood cell) multiply out of control to form tumors^[1].

These cancers start in B cells (also called B lymphocytes), which are white blood cells that normally make antibodies to help protect your body from infections^[2]. Because the lymphatic system is spread throughout your body, B-cell lymphoma can develop in many different places and cause various symptoms^[1].

B-cell lymphoma is a common type of non-Hodgkin lymphoma, which is one of two main categories of lymphoma^[1]. Lymphomas are divided into Hodgkin lymphoma and non-Hodgkin lymphoma, and B-cell lymphomas fall into the non-Hodgkin category^[2].

Lymph nodes
Blood
Bone marrow
Spleen
Thymus
Tonsils
Stomach
Skin
Central nervous system

Types of B-Cell Lymphoma

There are many different types of B-cell lymphoma. Doctors often describe them as either “aggressive” or “indolent” to explain how they behave^[1].

An aggressive type of B-cell lymphoma grows and spreads quickly from the lymphatic system to other organs or tissues in your body^[1]. An indolent type grows more slowly, and you can have it for months or even years before developing any symptoms^[1].

Aggressive (Fast-Growing) Types

Burkitt lymphoma is a rare, fast-growing lymphoma that may develop in your stomach and then spread to other organs^[1]. This type typically affects children and grows very quickly, but it can be highly treatable if therapy begins right away^[2].

Diffuse large B-cell lymphoma (DLBCL) is the most common type of B-cell lymphoma and the most common type of non-Hodgkin lymphoma overall^[1]. About one in three people with lymphoma have this type^[3]. DLBCL may start in your lymph nodes or in lymphoid organs like your thymus, spleen, or tonsils^[1]. Despite being aggressive, DLBCL is considered potentially curable and usually responds well to treatment^[8].

High-grade B-cell lymphoma (HGBCL) causes symptoms similar to DLBCL and Burkitt lymphoma. While treatments can put the condition into remission (a period when you don’t have symptoms and tests don’t find signs of cancer), it often comes back^[1].

Indolent (Slow-Growing) Types

Chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) are two closely related types that develop in your blood and bone marrow^[1]. These grow slowly and may not need treatment right away. They are often found while testing for other conditions^[2].

Cutaneous B-cell lymphoma is a rare type that starts in your skin^[1].

Follicular lymphoma is the second most common type of B-cell lymphoma^[1]. About one in five people with lymphoma have this type^[3]. You may develop follicular lymphoma in your lymph nodes, bone marrow, or other organs. People with follicular lymphoma often receive a diagnosis while being treated or tested for an unrelated condition^[1].

Lymphoplasmacytic lymphoma (also called Waldenstrom macroglobulinemia) is a rare type that typically grows in your bone marrow but may also develop in parts of your lymphatic system^[1].

Marginal zone lymphomas include different types that can develop in various parts of your body. Some develop in your stomach, lungs, skin, thyroid, salivary glands, and tissues around your eyes^[1].

Mantle cell lymphoma often develops in your lymph nodes, bone marrow, and spleen^[1]. This type affects about 1 in 20 people with lymphoma and is more common in older adults and men^[3].

How Common Is This Condition?

B-cell lymphoma accounts for 85% of all non-Hodgkin lymphoma cases^[1]. The American Cancer Society estimates that 80,600 people will receive a non-Hodgkin lymphoma diagnosis in 2024. By comparison, more than 2 million people will learn they have some type of cancer in 2024^[1].

Signs and Symptoms

Some people with B-cell lymphoma don’t have any symptoms at first. For example, people with follicular lymphoma often receive a diagnosis while being treated or tested for something else^[1].

The symptoms you experience depend on where the cancer forms in your body^[3]. Common symptoms that may be related to B-cell lymphoma include^[1]:

Swollen lymph nodes in your neck, underarms, or groin that are usually painless
Drenching night sweats that soak through your clothes and bedding
Extreme tiredness or fatigue that doesn’t improve with rest
Belly pain that doesn’t go away or gets worse
Loss of appetite
Shortness of breath

What Causes B-Cell Lymphoma?

B-cell lymphoma develops when something changes the genetic code of a lymphocyte^[6]. DNA (the genetic code found in all cells) tells cells how to work. When changes occur in the DNA, the lymphocyte can no longer fight infection properly. Instead, it just grows and divides out of control^[6].

In most children and young adults with B-cell lymphoma, the cause is unknown^[6]. However, people who have DNA repair defects or immune deficiencies (problems with the immune system), or those who take immunosuppressive medications, are at higher risk for developing this type of cancer^[6].

How Doctors Diagnose B-Cell Lymphoma

Diagnosis of B-cell lymphoma often begins with a physical exam. Your doctor will check for swollen lymph nodes in your neck, underarms, and groin, and look for an enlarged spleen or liver^[9].

Blood Tests

Blood tests can sometimes show whether lymphoma cells are present. These tests may also check for viruses, including Epstein-Barr virus, HIV, and hepatitis C virus. Blood tests also measure levels of lactate dehydrogenase (LDH), which is often higher in people with lymphoma^[9].

Imaging Tests

Imaging tests create pictures of the inside of your body. They can show the location and extent of B-cell lymphoma^[9]. Tests might include^[6]:

Chest X-ray to see if there are enlarged lymph nodes in the chest
Computed tomography (CT) scan to check for lymphoma in the chest and abdomen
Positron emission tomography (PET) scan to see if the disease has spread to the liver, bones, bone marrow, or spleen
Magnetic resonance imaging (MRI) to get detailed images of soft tissues

PET scans have improved the accuracy of both staging and determining the results of treatment. Findings on a PET scan at the end of therapy are the best predictors of a good treatment outcome^[16].

Biopsy

Your doctor may suggest a biopsy, which is a procedure to remove a sample of tissue for testing in a lab^[9]. A biopsy helps your doctor confirm the diagnosis. A lymph node biopsy involves removing all or part of a lymph node. A sample may also be taken from other parts of the body depending on your symptoms and imaging test results^[9].

Doctors also take a biopsy of the affected tissue to examine it under a microscope and determine the exact type of lymphoma^[6].

Bone Marrow Tests

Bone marrow aspiration and biopsy are procedures to collect cells from the bone marrow for testing^[9]. Bone marrow is the soft matter inside bones where blood cells are made. Most often, samples are taken from the hip bone. In B-cell lymphomas, this procedure can show if the cancer has spread to the bone marrow^[9].

Treatment Options

Treatment for B-cell lymphoma depends on the specific type you have, how fast it’s growing, and how far it has spread^[2]. Many B-cell lymphomas can now be cured in more than 50% of patients^[16].

Watch and Wait

For some slow-growing types of B-cell lymphoma, doctors may recommend a “watch and wait” approach^[2]. This means you won’t start treatment right away but will have regular check-ups to monitor the cancer. Treatment begins only when symptoms appear^[3].

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. For many types of B-cell lymphoma, chemotherapy is a key part of treatment^[2].

For diffuse large B-cell lymphoma, the most widely used treatment is a combination called R-CHOP^[11]. This includes:

Rituximab (Rituxan) – a monoclonal antibody (a type of immunotherapy)
Cyclophosphamide (Cytoxan)
Doxorubicin (Adriamycin)
Vincristine (Oncovin)
Prednisone

The R-CHOP regimen is usually given in 21-day cycles (once every 21 days) for an average of 6 cycles^[11]. Since DLBCL can advance quickly, it usually requires immediate treatment^[11].

In one study, patients who received rituximab plus CHOP chemotherapy as initial treatment for DLBCL spent an average of 2.9 years without their cancer advancing, compared with an average of 1.1 years for patients who received CHOP chemotherapy alone. Adding rituximab to CHOP chemotherapy reduced the risk of death by 32% compared to receiving CHOP alone^[15].

Immunotherapy

Immunotherapy helps your immune system fight the cancer. Rituximab is an immunotherapy drug that targets a protein called CD20 found on B cells^[2]. However, some subtypes of B-cell lymphoma, such as plasmablastic lymphoma, typically lack CD20 and do not benefit from treatment with rituximab^[16].

Radiation Therapy

Radiation therapy uses high-energy rays to kill cancer cells^[2]. It may be used alone or combined with chemotherapy. Early-stage indolent B-cell lymphomas can often be treated with radiation alone, with long-term success^[7].

Targeted Therapy

Targeted therapy uses drugs that target specific features of cancer cells^[2]. A great deal of current research focuses on using precision medicine to select customized treatments based on the specific subtype of lymphoma^[11].

CAR-T Cell Therapy

Chimeric antigen receptor (CAR)-T cell therapy is a newer treatment that takes your own immune cells, changes them in a lab to help them fight cancer better, and puts them back into your body^[2].

Bone Marrow or Stem Cell Transplant

A bone marrow transplant (also called a stem cell transplant) may be used for some types of B-cell lymphoma, especially if the cancer comes back after initial treatment^[2].

Clinical Trials

Clinical trials are research studies that test new treatments. They may be an option if standard treatments aren’t working or if you want to try a newer therapy^[2].

What to Expect

The outlook for B-cell lymphoma depends on the specific type and how early it’s caught^[1]. Often, treatment can cure some types of B-cell lymphoma or put them into long-term remission^[1].

In general, with modern treatment, more than 60% of patients with non-Hodgkin lymphoma survive at least 5 years. More than 70% of patients with aggressive types can be cured^[12]. Early-stage aggressive disease treated with chemotherapy and often radiation has a 70-90% cure rate^[7].

Indolent lymphomas have a relatively good prognosis, with survival as long as 20 years in some cases^[12]. However, these slow-growing types are usually not curable in advanced stages. Instead, they respond to treatment and are kept under control with long-term survival of many years^[7].

Most relapses occur in the first 2 years after therapy^[12]. The condition can come back even after successful treatment^[1].

Living With B-Cell Lymphoma

Getting a cancer diagnosis can be scary and stressful. The days after receiving a diagnosis are typically the most anxiety-provoking time^[21]. However, there are things you can do to help yourself adjust and feel more in control.

Build a Care Team You Trust

Find a medical team you feel comfortable with and that cares for you. You will spend a great deal of time with your doctors and deserve to feel fully heard and understood by them^[21]. Always feel comfortable asking questions or getting a second opinion^[21].

Keep a journal so you can write down questions as they come to you and take notes on what your care team tells you. If you can come prepared with questions, that can help address your concerns^[21].

Get Support

Lean on family and friends to get the emotional backing you need. It’s important to have a support network you trust^[3]. Give some thought to what would be most helpful to you when others ask what they can do. Perhaps a meal train or help with laundry would be useful^[21].

Make a Plan

A cancer diagnosis can impact many parts of your life, including employment, finances, family life, and your daily routine. It’s important to make a plan, even if it’s simple to start with. Focus on what you can control^[21]. Consider:

Who will drive you to and from appointments
Work accommodations like remote work or short-term disability
Childcare arrangements for days you’ll be at treatment

Take Care of Yourself

A healthy lifestyle has lots of benefits, both physically and emotionally. It can help prepare you for treatment, reduce the risk of side effects, and lower the likelihood of developing other illnesses in the future^[18].

Eating well and living a healthy lifestyle is important for anyone with lymphoma, whether you’re in remission or facing a relapse^[20]. Nutrition guidelines for people with lymphoma are similar to general healthy eating practices. Try to eat plenty of fruits, vegetables, whole grains, and lean proteins^[20].

Although it takes time and can involve making some changes to your everyday life, most people adjust well to life after a diagnosis of lymphoma and find a ‘new normal’^[18].