Diffuse Large Cell Lymphoma: Diagnosis and Staging

Diffuse Large B-Cell Lymphoma (DLBCL) is an aggressive Non-Hodgkin’s Lymphoma (NHL) that occurs in B-cells.

This disease accounts for 2 out of 5 cases of NHL. It often involves the lymph nodes, spleen, liver, and bone marrow, though this differs from patient to patient. In rare cases, the central nervous system (brain and spinal cord) are involved.

DLCL occurs in many age groups, including both adults and children, though it affects men more often than women.

Types of DLCL:

Morphologic Variants

• Centroblastic
• Immunoblastic
• Anaplastic Large B-Cell
• Plasmablastic
• Anaplastic lymphoma kinase-positive

Subtypes

• Mediastinal (thymic) large B-cell lymphoma
• Intravascular large B-cell lymphoma
• T-cell/histiocyte-rich large B-cell lymphoma
• Lymphomatoid granulomatosis-type large B-cell lymphoma
• Primary effusion lymphoma

Diagnosis and Staging

Symptoms of DLBCL include painless swelling of the lymph nodes, fatigue, and loss of appetite, as well as other symptoms common to lymphomas (night sweats and fevers).

Primary diagnosis is made by examining tissue through a biopsy. Follow-up tests including X-rays, PET scans, CT scans, ultrasounds, and bone marrow biopsies may be used to stage the disease.

Staging is based on the spread of the disease:

• Stage I: Only one group of lymph nodes is involved.
• Stage II: Two groups of lymph nodes are involved, but they are on the same side of the diaphragm.
• Stage III: Lymph nodes on both sides of the diaphragm are involved. The spleen is considered a lymph node in this staging system, so its involvement marks stage III.
• Stage IV: The bone marrow, liver, or other organs are involved.

Treatment

There are many different types of treatment for DCLC. They are:

CombinationChemotherapy and Immunotherapy: The R-CHOP protocol is the favored treatment. Rituxan, an immunotherapy agent, works in combination with the CHOP (cytoxan, adriamycin, oncovin, prednisone) chemo regimen for optimal results.

Chemotherapy: Chemotherapy using adriamycin and cytoxan is typically used. In cases where the lymphoma relapses, the ICE, ESHAP, or DHAP chemo regimens may be used instead.

Radiation: Radiation therapy works well for Stage I or II disease, and can be used in combination with other therapies for more advanced disease.

Stem Cell Transplant: In the case of advanced disease, aggressive chemotherapy may be used. Stem cell transplantation will be needed for the patient to recover their immune system after such treatments.

Immunotherapy Using Monoclonal Antibodies:
If the R-CHOP combination protocol is not used, different monoclonal antibodies, such as Zevalin and Bexxar, may be substituted for Rituxan.

Clinical trials: Clinical trials are available if a patient desires to participate in one. They use newer treatment options in order to test their effectiveness.