Diffuse B-cell lymphoma is one of the most common malignant neoplasms of the lymphatic system. B-cell lymphomas belong to the non-Hodgkin lymphoma group.
What is diffuse B-cell lymphoma?
Diffuse large B-cell lymphoma (DLCBL) originates from mature B cells. It is a tumor of B lymphocytes. B lymphocytes, also called B cells for short, belong to the white blood cells (leukocytes). Together with T lymphocytes, they form a crucial part of the adaptive immune system. B cells are the carriers of the humoral immune response. They are the only cells in the body capable of producing antibodies. According to the WHO subdivision, diffuse large B-cell lymphoma belongs to the mature blastic B-cell neoplasms. These malignant cancers are considered to be very aggressive. Morphologically, they are divided into centroblastic lymphoma, immunoblastic lymphoma, and anaplastic lymphoma. Diffuse large B-cell lymphoma is one of the most common neoplasms of the lymphatic system. Eight out of 100,000 people develop the disease annually. In children, the disease occurs rather rarely. Mainly men aged about 70 years are affected.
Causes
Diffuse large B-cell lymphoma is based on malignant transformation of B lymphocytes at different stages of differentiation and maturation. The disease is based on the uninhibited division of B cells with a concomitant failure of programmed cell death (apoptosis). As a result, more and more B lymphocytes exist and other cells are displaced. Why lymphomas develop has not yet been fully elucidated. Genetic alterations seem to play a significant role in the development of lymphoma. Certain chromosome translocations are typical. As a result, various cancer genes (oncogenes) get out of control and thus help the cell to undergo malignant transformation. Although the disease is characterized by genetic alterations, it cannot be inherited. In addition to genetic predisposition, there are risk factors that can promote the development of the disease. These include exposure to radiation from X-rays or gamma radiation. Therapy with cytostatics is also a risk factor. Such cytostatic drug therapies are used, for example, in the treatment of other malignant diseases. An autoimmune disease can also promote the development of the disease. Furthermore, an infection with HIV can lead to lymphoma. There are also various viruses and bacteria that favor diffuse large B-cell lymphoma in its development.
Symptoms, complaints, and signs
The main symptom of diffuse large B-cell lymphoma is a rapidly progressive enlargement of the lymph nodes. The lymph nodes are enlarged but not painful. The lymph node enlargement is also called lymphadenopathy. In addition to this swelling, there is decreased performance and fatigue. So-called B symptoms may occur. These include fever, night sweats and weight loss. Those affected are susceptible to infections. Due to the displacement by the B lymphocytes, the other blood cells may be impaired, so that changes in the blood count may occur. When the erythrocytes are displaced by the B lymphocytes, anemia develops. This is characterized by symptoms such as hair loss, shortness of breath on exertion, pallor and fatigue. Platelets can also be displaced by the degenerate B cells. This results in a deficiency of platelets, called thrombocytopenia. The lack of platelets can cause spontaneous bleeding, such as nosebleeds and bruises. Petechiae of the skin and gastrointestinal bleeding can also occur.
Diagnosis
The first clues to diffuse large B-cell lymphoma are provided by the clinical picture. Painless swollen lymph nodes are always suspicious for cancer. If lymphoma is suspected, a blood count is obtained. Depending on the extent of the disease, this shows anemia, an increase or decrease in white blood cells (leukocytosis or leukopenia) and a decreased iron value. The ferritin value, on the other hand, is elevated. Inflammatory signs such as erythrocyte sedimentation rate, α2-globulins, and fibrinogen are also elevated. Antibody deficiency syndrome is often seen in association with B-cell lymphoma. Characteristic changes in lactate dehydrogenase and ß2-microglobulin may also be diagnosed in the blood.The diagnosis is confirmed histologically by biopsy of an affected lymph node. In this process, the removed tissue is assessed histomorphologically. Staining techniques are used for more precise classification. Further examinations must be performed to determine the exact stage of the disease. These include X-ray examinations of the chest, ultrasound examinations of the abdomen, and computed tomography of the chest, abdomen, and neck. A bone marrow aspiration is performed in most cases to obtain a bone marrow histology and to exclude bone marrow involvement. Accurate staging and classification of lymphoma is needed for targeted therapy.
Complications
B-cell lymphoma causes enlargement of the lymph nodes. This usually progresses very rapidly but does not initially cause pain. The patient suffers from fatigue that cannot be neutralized by sufficient sleep. Likewise, the patient’s performance decreases and ordinary tasks can no longer be performed easily. At night there are sweating and fever, furthermore the affected person loses a lot of weight. Furthermore, hair loss occurs. During exertion, the affected person suffers from shortness of breath and is afraid of suffocating. Due to the shortness of breath, loss of consciousness may occur. The quality of life is severely limited and reduced by the B-cell lymphoma. In most cases, treatment of B-cell lymphoma takes place with the help of medication. However, only early treatment can achieve complete success. In many cases, the patient dies if treatment is initiated late. Likewise, those affected suffer from increased susceptibility to infections and other diseases. Life expectancy is reduced by the disease. The patient must be prepared for a long hospital stay in this case.
When should one go to the doctor?
If the lymph nodes enlarge rapidly, a doctor should be consulted. Fever, night sweats and other typical signs of diffuse B-cell lymphoma are also best clarified immediately. If respiratory distress occurs, resulting in loss of consciousness, the affected person must be taken to the nearest hospital. There, the symptoms can be examined and, if necessary, treatment can be initiated. A diagnosed lymphoma must be treated as an inpatient and closely monitored by a medical professional. After therapy, regular follow-up visits are indicated to rule out complications and monitor the healing process. Immediate clarification of symptoms is recommended, especially in the case of an existing autoimmune disease or HIV infection. The risk of diffuse B-cell lymphoma may also be increased after repeated exposure to radiation, such as X-rays or gamma radiation. Anyone to whom these risk factors apply should ideally contact their primary care physician directly. Other contacts are the lymphologist or a specialist in internal medicine. In an emergency, the emergency medical service can also be called in.
Treatment and therapy
Diffuse large B-cell lymphoma can, in principle, be cured. However, the disease is rapidly fatal, so treatment should begin as early as possible. B-cell lymphomas are usually treated with chemotherapy according to the CHOP protocol. In addition, the drug rituximab is used. This is a biotechnologically produced chimeric monoclonal antibody. Depending on the stage and form of the lymphoma, radiation therapy may be used as a supplement or alternative. Therapy is also based on the Ann Arbor stage. With the help of the Ann Arbor classification, the degree of spread of the lymphoma can be determined. The prognosis varies greatly depending on the type and extent at diagnosis. In some cases there is a good chance of cure, in others the prognosis is hopeless. In hopeless cases, palliative care is given. Patients often have to spend a long time in hospital. In particular, bone marrow insufficiencies with bleeding, anemia, and increased susceptibility to infection cause major problems in treatment.
Outlook and prognosis
If treatment for this disease does not occur, the affected person will die in most cases from the symptoms and consequences of this disease. Self-cure does not occur in this case, so in any case there is a bad course of the disease without treatment.Affected individuals suffer from severe fatigue and lassitude, and the patient’s lymph nodes are also significantly enlarged, and they experience weight loss and shortness of breath. Furthermore, loss of consciousness or anemia may also occur as a result. Complaints in the area of the stomach and intestines also occur and reduce the quality of life of the affected person enormously. The tumor can also spread to other regions of the body and cause damage there. For this reason, the further course of the disease also depends very much on the time of diagnosis. Chemotherapy or radiation therapy can alleviate some of the symptoms, but there is no complete cure. Those affected therefore also suffer from a reduced life expectancy. Only in rare cases and with a very early diagnosis can the disease be completely cured.
Prevention
Diffuse large B-cell lymphoma can be prevented only to a limited extent. The disease is partly caused genetically, so no prevention is possible. However, risk factors such as cytostatics or ionizing radiation should still be avoided.
Follow-up care
In most cases, no special measures of aftercare are available to the person affected by this disease. First and foremost, a comprehensive diagnosis with subsequent treatment must be carried out to prevent further complications and other ailments. The earlier the B-cell lymphoma is detected and treated, the better the further course of the disease usually is. For this reason, the focus is on early diagnosis of B-cell lymphoma, whereby a doctor should be consulted at the first signs and symptoms. The treatment is usually carried out by a surgical intervention. The patient should rest and take it easy on his body. Efforts or other stressful activities should be refrained from, so that the body can recover. In general, those affected by B-cell lymphoma are also dependent on care and support from friends and family, and psychological support should also be provided. Since the disease also results in a significantly increased susceptibility to infections, it is recommended to be especially mindful of one’s health and adhere to appropriate hygiene measures.
This is what you can do yourself
Diffuse large B-cell lymphoma (DLCBL) is a tumor of B lymphocytes that can quickly lead to death if left untreated. Chances of a complete cure usually only exist if the disease is detected at a very early stage and adequately treated. The most important self-help measure is therefore to interpret the symptoms correctly and to consult a physician immediately. DLCBL is characterized by rapidly enlarging lymph nodes, but the swelling is not accompanied by pain. The patient also suffers from constant fatigue and decreased exercise tolerance. As the disease progresses, fever, sweating, and weight loss often occur as well. Often there is also an increased susceptibility to infections. Who observes such symptoms at itself should not dismiss this under any circumstances as a protracted cold or otherwise trivialize. Such symptoms must always be taken seriously and promptly clarified by a doctor. The patient can only indirectly contribute to the therapy of the disease by following the behavioral instructions of the attending physician. The frequently ordered chemotherapy must not be discontinued arbitrarily, even in spite of severe side effects. If the disease is accompanied by thrombocytopenia, i.e. a lack of blood platelets, the affected person should take care not to injure himself, as even minor bleeding can no longer be stopped by the body without further ado in this case.
