• Between 30 percent and 40 percent of people with diffuse large B-cell lymphoma (DLBCL) who have a complete response to treatment will have a relapse within the first two years.
• Many symptoms of DLBCL relapse are similar to ones you may have experienced before your initial diagnosis.
• If you begin to notice new swollen lymph nodes, abdominal pain, or classic B symptoms associated with DLBCL, reach out to your doctor or oncologist.

When treatment for diffuse large B cell lymphoma is successful, you’ll enter complete remission and be cancer-free. While almost two-thirds of people are initially cured, 30 percent to 40 percent will experience their cancer relapsing (returning) within two years of finishing treatment. Knowing the signs of a potential DLBCL relapse can help you seek treatment sooner rather than later.

Research shows that most people experience telltale symptoms during a DLBCL relapse. One study found that 67 percent of participants were experiencing symptoms when they were diagnosed with a relapse.

Most relapse symptoms are similar to the ones you experienced — if you had any — before your initial diagnosis. Some are general symptoms that may be associated with other conditions or illnesses. In this article, we’ll cover the most common symptoms of DLBCL relapse and when you should reach out to your oncologist for further testing.

1. Swollen Lymph Nodes

DLBCL is the most common form of non-Hodgkin lymphoma (NHL). It’s caused by the production of abnormal white blood cells known as B lymphocytes or B cells. Normally, these cells make antibodies that help your body fight infection.

However, in DLBCL, abnormal B cells build up in your lymph nodes and other organs. These small structures belong to your lymphatic system, which contains other immune cells. Lymph nodes can be found all over your body, but most people are familiar with the ones found in the neck, groin, and armpits.

One sign of a DLBCL relapse is having swollen or enlarged lymph nodes — lumps that can be felt underneath your skin and are often painless. You may want to see your oncologist or primary care physician if your lymph nodes are swollen for several weeks, continue to grow, or are accompanied by other signs of relapsed DLBCL.

You may also develop tender, swollen lymph nodes when you’re sick with a bacterial or viral infection. If you also have a runny nose, cough, or sore throat, you likely have the common cold or another upper respiratory infection. If you have a more serious infection or an undiagnosed autoimmune disorder, you may experience bodywide lymph node swelling.

2. Abdominal Pain

Swelling can also occur in the nodes deeper within your body, not just underneath your skin. Mesenteric lymphadenitis refers to swollen, inflamed lymph nodes that can cause pain in the lower right side of your abdomen (tummy). This condition can affect people with lymphoma and may be a sign that DLBCL has relapsed.

Abdominal pain is a common complaint related to several conditions outside of a DLBCL relapse. Depending on where your pain is, you may have a stomach virus, constipation, or another intestinal issue.

Mesenteric lymphadenitis is very similar to appendicitis (inflamation of your appendix) — both conditions cause abdominal pain, nausea, vomiting or diarrhea, and fever. However, appendicitis pain tends to start in the middle of your abdomen and gradually move to the lower right side of your body, becoming more severe over time. Movement tends to worsen appendicitis symptoms.

3. Loss of Appetite

DLBCL relapse can also cause organ swelling, particularly in the spleen and liver. Your spleen is part of your lymphatic system, and it helps store immune cells and filter your blood. Abnormal B cells can build up in your spleen, causing it to swell and press on nearby organs.

You may start to lose your appetite more easily or feel full even after eating just a small amount of food. If you begin experiencing abdominal pain or changes in your appetite, you may want to schedule a visit with your oncologist.

Losing your appetite early in a meal can also be caused by gastroparesis, in which your stomach empties digested food into your intestines much more slowly. The food sits in your stomach longer, making you feel fuller sooner when eating. Other symptoms that accompany gastroparesis include acid reflux (heartburn), bloating, and vomiting undigested food soon after eating.

4. B Symptoms

DLBCL and NHL are associated with a specific set of symptoms known as B symptoms, or the combination of drenching night sweats, fever, and unexplained weight loss of at least 10 percent of your body weight over six months. You may have experienced one or more B symptoms before your first DLBCL diagnosis — if they return, it may be a sign of a relapse.

Experiencing B symptoms again after you’ve entered remission can be scary and overwhelming. Although you may understandably be worried that your DLBCL has returned, it’s important to know many other conditions and medications can cause these symptoms.

Night sweats, for example, may be caused by:

• Hormone therapy
• Antidepressants
• Menopause
• Sleep apnea and other sleep disorders

Fevers can also point to a viral or bacterial infection — your other symptoms can help you narrow down the possible cause. Rapid weight loss without trying is reason for concern, but it may not necessarily be due to a DLBCL relapse. Diabetes, thyroid problems, and certain medications can also lead to an unexpected drop in weight.

Taking the Next Steps

If you begin noticing new symptoms that could be associated with a DLBCL relapse, it’s best to reach out to your oncologist sooner rather than later. You may need additional testing to check that your symptoms aren’t due to a relapse or other serious condition. Your oncologist may order a biopsy, imaging tests, and blood tests.

If you are diagnosed with relapsing DLBCL, your oncologist may recommend one of several treatment options. You may be treated with:

• Second-line chemotherapy with drugs such as bendamustine (Treanda) or gemcitabine, which may be combined with rituximab (Rituxan)
• Chimeric antigen receptor (CAR) T-cell therapy
• Allogeneic bone marrow transplant, where bone marrow comes from a donor
• Immunotherapy for people with a type of DLBCL known as primary mediastinal large B-cell lymphoma

Be sure to also keep your scheduled follow-up appointments to stay on track with your cancer survivor care. Your health care team is there to help you along every step of your journey with DLBCL.

Talk With Others Who Understand

MyLymphomaTeam is the social network for people with lymphoma and their loved ones. More than 14,000 members understand what it’s like to face lymphoma and can provide support and answers.

Are you or a loved one living with DLBCL? Do you worry about relapse symptoms? Share your experience or post a comment on your Activities page to start a conversation.