After successful treatment for diffuse large B-cell lymphoma (DLBCL), you’ll enter complete remission and be cancer-free. Although almost two-thirds of people are initially cured, from 30 percent to 40 percent will experience their cancer returning (relapsing) 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’ve already 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 happens because the body makes abnormal white blood cells called B lymphocytes, or B cells. Normally, these cells make antibodies that help your body fight infection. In most types of lymphoma, B cells develop mutations (changes) and become cancerous.

Cancer cells can build up in your lymph nodes and other organs. These small structures belong to your lymphatic system, which contains other immune system 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 if you notice other signs of DLBCL coming back.

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 abdomen (stomach) — commonly in the lower right side, but it can spread out onto other areas as well. 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 symptoms are very similar to those of appendicitis — 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 moves to the lower right side of your body, becoming more severe over time. If you move around a lot, it tends to make appendicitis symptoms worse.

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 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.

It can be scary and overwhelming if you experience B symptoms after you’ve entered remission. You may be worried that your DLBCL has returned, but many other conditions and medications can cause these symptoms.

Night sweats 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 oncology team 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 doctor may order a biopsy, imaging tests, and blood tests.

If you’re 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 T-cell therapy (CAR T-cell therapy) like tisagenlecleucel (Kymriah) or axicabtagene ciloleucel (Yescarta)
• Autologous or allogeneic bone marrow transplant
• Bispecific antibodies like epcoritamab-bysp (Epkinly) and glofitamab-gxbm (Columvi) for those with specific subtypes of DLBCL
• Clinical trials for new types of immunotherapy

Make sure to keep your scheduled follow-up appointments to stay on track with blood cancer survivor care. Your health care team will help you understand your prognosis and what you can do to live as long and as well as possible with DLBCL.

Talk With Others Who Understand

MyLymphomaTeam is the social network for people with lymphoma and their loved ones. More than 17,000 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.