Diffuse large B-cell lymphoma
Diffuse large B-cell lymphoma (DLBCL) is a cancer of B cells, a type of white blood cell that makes antibodies. It is the most common non-Hodgkin lymphoma in adults and can start almost anywhere in the body. DL B-cell lymphoma grows quickly, so it is usually treated as an aggressive disease.
Who it affects and how it presents
- Most often diagnosed in older adults, with about the median age around 70. It can occur in younger adults and rarely in children.
- People often notice a rapidly enlarging lump or swelling. Some also have “B symptoms” such as fever, night sweats, and weight loss.
- The disease can stay in lymph nodes or involve other organs (extranodal disease). Signs depend on where the lymphoma grows.
Causes and risk factors
- The exact cause isn’t clear. It usually develops from normal B cells that acquire genetic changes over time.
- A weaker immune system increases risk. Certain infections (for example, EBV, HIV, HHV-8, or Helicobacter pylori in some subtypes) are linked to some forms of DLBCL.
- Most cases are driven by multiple genetic changes that let the cancer grow and evade normal controls.
How it’s diagnosed
- Diagnosis is by biopsy: a sample of the tumor is examined under a microscope by a hematopathologist.
- Many subtypes exist, differing in appearance, how fast they grow, and how they respond to treatment. The most common is called DLBCL, not otherwise specified (DLBCL, NOS).
Key features and prognosis
- Most DLBCL cells express CD20, a target for antibody therapy.
- The outlook varies a lot depending on the subtype and individual factors, but modern treatment has improved outcomes for many people.
- Overall, many patients can be cured or achieve long remissions, though older patients may have a lower cure rate than younger patients.
Treatment overview
- First-line treatment for most patients is R-CHOP: rituximab plus four chemotherapy drugs (cyclophosphamide, doxorubicin, vincristine, and a steroid such as prednisone).
- R-CHOP cures a substantial proportion of patients, but relapse or treatment failure happens in some. For these cases, doctors may use different chemotherapy combinations (such as DA-R-EPOCH) or other strategies.
- For relapsed or refractory cases, newer approaches show promise:
- CAR-T cell therapy (engineered T cells that target CD19 on B cells) can induce meaningful remissions in some patients.
- Additional targeted therapies and antibody-based drugs are being studied and, in some settings, approved.
- Autologous stem cell transplant may be used in certain relapsed cases; allogeneic transplant is considered for others.
- Prophylaxis and special approaches:
- In some high-risk cases or those prone to spread to the brain, doctors may add drugs like methotrexate to help prevent central nervous system involvement.
- Most patients receive treatments through the healthcare team’s plans, sometimes within clinical trials.
Subtypes (a quick note)
- There are many subtypes beyond DLBCL, NOS, each with its own behavior and prognosis. Some subtypes resemble other lymphomas or are linked to specific sites or infections. The choice of treatment can vary by subtype, but many are managed using similar strategies to DLBCL, NOS, with adjustments as needed.
What to know if you or someone you know is affected
- DLBCL is a serious disease, but many people respond well to treatment and can be cured or live for many years after diagnosis.
- Early diagnosis and starting appropriate therapy improve outcomes.
- Work with an oncology team that specializes in lymphomas to discuss the best treatment plan, including the potential role of newer therapies and clinical trials.
This page was last edited on 2 February 2026, at 08:08 (CET).