The diffuse B-cell lymphoma is the most common malignant neoplasms of the lymphatic system. B-cell lymphomas belong to the group of non-Hodgkin lymphomas.
What is diffuse B-cell lymphoma?
Abbreviated as DBCL on abbreviationfinder, diffuse B-cell lymphoma starts from the mature B-cells. It is a B lymphocyte tumor. B lymphocytes, also called B cells for short, belong to the group of white blood cells (leukocytes). Together with the 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 that are able to produce antibodies. According to the WHO subdivision, diffuse large B-cell lymphoma is one of the mature-cell, blastic B-cell neoplasms. These malignant cancers are considered to be very aggressive. Morphologically, it is 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 fall ill every year. The disease is rare in children. It mainly affects men around the age of 70.
Causes
Diffuse large B-cell lymphoma is based on a malignant transformation of B-lymphocytes in different stages of differentiation and maturity. The disease is based on the uninhibited division of the B cells with a simultaneous absence of programmed cell death (apoptosis). As a result, there are more and more B lymphocytes and other cells are displaced.
It has not yet been fully understood why the lymphomas develop. Genetic changes seem to play an important role in the development of lymphoma. Certain chromosome translocations are typical. This causes various cancer genes (oncogenes) to get out of control and thus help the cell to undergo malignant transformation. Although the disease is characterized by genetic changes, it cannot be inherited.
In addition to the genetic predisposition, there are risk factors that can promote the development of the disease. This includes exposure to radiation from X-rays or gamma rays. Therapy with cytostatics is also a risk factor. Such cytostatic therapies are used, for example, in the treatment of other malignant diseases.
An autoimmune disease can also promote the development of the disease. Infection with HIV can also lead to lymphoma. There are also various viruses and bacteria that promote the development of diffuse large B-cell lymphoma.
Symptoms, ailments & signs
The main symptom of diffuse large B-cell lymphoma is a rapidly increasing enlargement of the lymph nodes. The lymph nodes are enlarged but not painful. The enlargement of the lymph nodes is also known as lymphadenopathy. In addition to this swelling, it leads to decreased performance and fatigue.
So-called B symptoms may occur. These include a fever, night sweats, and weight loss. Those affected are susceptible to infection. Due to the displacement by the B lymphocytes, the other blood cells can be impaired, which can lead to changes in the blood count. When the erythrocytes are displaced by the B lymphocytes, anemia develops. This is characterized by symptoms such as hair loss, shortness of breath during exertion, paleness and fatigue.
The blood platelets can also be displaced by the degenerate B cells. This creates a lack of platelets, a so-called thrombocytopenia. The lack of platelets can cause spontaneous bleeding such as nosebleeds and bruises. Petechiae of the skin and gastrointestinal bleeding can also develop.
Diagnosis
The clinical picture provides the first indications of a diffuse large-cell B-cell lymphoma. Painless, swollen lymph nodes are always suspicious of cancer. If a lymphoma is suspected, a blood count will be done. 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 level.
The ferritin value, however, is increased. The signs of inflammation such as the rate of sedimentation, α2-globulins and fibrinogen are also increased. Antibody deficiency syndrome is often associated with B-cell lymphoma. Characteristic changes in lactate dehydrogenase and ß2-microglobulin can also be diagnosed in the blood. The diagnosis is confirmed histologically on the basis of a biopsy of an affected lymph node.
The removed tissue is assessed histomorphologically. Dyeing techniques are used for more precise classification. Further examinations must be performed to determine the exact stage of the disease. These include chest x- rays, abdominal ultrasound scans, and computed tomography of the chest, abdomen, and neck.
In most cases, a bone marrow puncture is performed to obtain a bone marrow histology and to rule out any bone marrow involvement. Precise staging and classification of the lymphoma is required for targeted therapy.
Complications
B-cell lymphoma causes the lymph nodes to enlarge. This usually progresses very quickly, but does not lead to pain at first. The patient suffers from tiredness that cannot be neutralized by getting enough sleep.
The patient’s performance is also reduced and normal tasks can no longer be carried out without further ado. Sweats and fever occur at night, and the person concerned also loses a lot of weight. The hair loss continues to occur. During exertion, those affected suffer from shortness of breath and are afraid of suffocation.
The shortness of breath can lead to a loss of consciousness. The quality of life is severely restricted and reduced by B-cell lymphoma. In most cases, B-cell lymphoma is treated with medication. However, only early treatment can achieve complete success.
In many cases, if treatment is started late, the patient dies. Those affected also suffer from an increased susceptibility to infections and other diseases. Life expectancy is reduced by the disease. The patient has to be prepared for a long hospital stay.
When should you go to the doctor?
If the lymph nodes enlarge rapidly, a doctor should be seen. Fever, night sweats and other typical signs of diffuse B-cell lymphoma are also best clarified immediately. In the event of breathlessness and loss of consciousness as a result, the person affected 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 hospitalized and closely monitored by a medical professional.
Regular follow-up visits are indicated after therapy in order to rule out complications and to monitor the healing process. Immediate clarification of the symptoms is recommended, especially in the case of an existing autoimmune disease or HIV infection.
Even after repeated exposure to radiation, such as X-rays or gamma rays, the risk of diffuse B-cell lymphoma may increase. If these risk factors apply to you, ideally contact your family doctor directly. Other contact persons are the lymphologist or a specialist in internal medicine. The emergency medical service can also be called in in an emergency.
Treatment & Therapy
Diffuse large B-cell lymphoma can in principle be cured. However, the disease is quickly fatal, so treatment should start as early as possible. B-cell lymphomas are usually treated chemotherapy using the CHOP protocol. The drug rituximab is also used. It is a biotechnologically produced chimeric monoclonal antibody.
Depending on the stage and form of the lymphoma, radiation therapy can be used in addition or as an alternative. Therapy also depends on the Ann Arbor stage. The Ann Arbor classification can be used to determine the extent to which the lymphoma has spread. The prognosis varies greatly depending on the type and extent at which the diagnosis is made. Sometimes there is a good chance of recovery, sometimes the prognosis is hopeless.
In hopeless cases, palliative care is provided. Often times, patients have to spend a long time in the hospital. In particular, bone marrow insufficiency with bleeding, anemia and increased susceptibility to infection cause major problems in treatment.
Outlook & forecast
If there is no treatment for this disease, in most cases the affected person dies from the symptoms and the consequences of this disease. Self-healing does not occur, so that in any case the disease progresses poorly without treatment.
Those affected suffer from severe fatigue and exhaustion, with the patient’s lymph nodes also being significantly enlarged and those affected suffering from weight loss and shortness of breath. It can also lead to a loss of consciousness or anemia.
Symptoms in the stomach and intestines also occur and reduce the quality of life of those affected enormously. The tumor can 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 symptoms, although they will not completely heal. 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 only be prevented to a limited extent. The disease is partly genetically caused, so that prevention is not possible. Nevertheless, risk factors such as cytostatics or ionizing radiation should be avoided.
Aftercare
In most cases, there are no special follow-up measures available to those affected with this disease. First and foremost, a comprehensive diagnosis and subsequent treatment must be carried out so that there are no further complications and other complaints. The earlier the B-cell lymphoma is detected and treated, the better the further course of the disease will usually be.
For this reason, the focus is on the early diagnosis of B-cell lymphoma, whereby a doctor should be consulted as soon as the first signs and symptoms appear. The treatment usually takes the form of a surgical procedure. The patient should rest and take care of his body.
Exertion or other stressful activities should be avoided so that the body can recover. In general, those affected with B-cell lymphoma are also dependent on care and support from friends and family, with psychological support also taking place. Since the disease also increases the susceptibility to infections, it is advisable to be particularly careful with your health and to take appropriate hygiene measures.
You can do that yourself
Diffuse large B-cell lymphoma (DLCBL) is a B-lymphocyte tumor that, if left untreated, can quickly lead to death. There is usually only a chance of a complete cure if the disease is discovered at a very early stage and treated appropriately. The most important self-help measure is therefore to correctly interpret the symptoms and to consult a doctor immediately.
The DLCBL is characterized by rapidly enlarging lymph nodes, although the swelling is not associated with pain. The patient also suffers from constant fatigue and a reduced physical capacity. As the disease progresses, there are often additional fevers, sweats and weight loss.
Often there is also an increased susceptibility to infection. Anyone who observes such symptoms should by no means dismiss this as a dragged-out cold or otherwise trivialize it. Such symptoms must always be taken seriously and promptly clarified by a doctor.
The patient can only contribute indirectly to the treatment of the disease by following the behavioral instructions of the attending physician. The frequently ordered chemotherapy must not be canceled without authorization, even in spite of severe side effects. If the disease is accompanied by thrombocytopenia, i.e. a lack of blood platelets, the person affected should be careful not to injure himself, as even small bleeding can no longer be easily stopped by the body in this case.
