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Being diagnosed with a type of cancer you may not have heard of can feel overwhelming — especially when you’re not sure what symptoms to watch for or what treatments might help.
Large B-cell lymphomas (LBCLs) are a group of fast-growing blood cancers that start in B lymphocytes — a type of white blood cell that helps your immune system fight infections. Each type of lymphoma behaves a little differently and may appear in different parts of the body. How people respond to treatments also depends on the LBCL type.
This article will explore how the types of blood cancer differ in symptoms, cancer treatment, and origin.
While diffuse large B-cell lymphoma (DLBCL) is the most common type of LBCL, there are several other types. These can be categorized by factors like what cancer cells look like, whether a virus is involved, where the cancer starts, and genetic features.
Primary mediastinal large B-cell lymphoma (PMBL) is a subtype of DLBCL that mainly occurs in young women, according to the American Cancer Society. It begins in the mediastinum, the area behind the breastbone, and can become quite large.
People with PMBL can have difficulty breathing if growths press on the windpipe. They may also have swelling in the arms and face if the vein that returns blood from the arms and head is pressed.
One aggressive cancer that’s difficult to diagnose is called T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL). A special characteristic of this DLBCL subtype is that, in most cases, it starts outside the lymph nodes, bean-shaped organs located throughout the body that filter fluids. Unlike other DLBCL types, THRLBCL has a high risk for bone marrow involvement.
THRLBCL makes up about 1 percent to 3 percent of all DLBCL cases and is more common in males. Most people diagnosed with THRLBCL are in their 40s, which is younger than most other DLBCL types.
This type of DLBCL looks different under the microscope from other types of DLBCL because it has very few cancerous B cells (less than 10 percent). Most of the cells in the tumor are normal immune cells.
Primary cutaneous diffuse large B-cell lymphoma (leg type) is a type of LBCL, but it’s rarer and more difficult to treat. It’s most common in females over 65, according to Cleveland Clinic, and can be recognized by rashes on the lower legs. It can also spread to other parts of the body.
High-grade B-cell lymphoma, not otherwise specified (HGBCL-NOS), is a term that doctors use to describe rare, very fast-growing types of LBCL that can’t easily be categorized.
Some cancers look very aggressive under the microscope and resemble other types of LBCL, but they don’t have the same genetic changes. This means that they don’t fit clearly into categories like DLBCL or another type of LBCL called Burkitt lymphoma. When they don’t fit into clear categories like this, these cancers are put into the HGBCL-NOS category.
To diagnose LBCL, healthcare professionals may run a variety of tests. Blood tests can be used to show where lymphoma cells are. Imaging tests (body scan to see organs/tissues) can indicate where lymphoma is in the body and how far it’s spread.
Your doctor may also perform a biopsy of lymph node tissue or bone marrow to look for cancer cells. This entails taking a small tissue sample to study under a microscope.
For some rarer types of LBCL, diagnosis can be more complex. Diagnosis of HGBCL, for example, is particularly challenging. Health experts from the World Health Organization (WHO) have recommended that HGBCL only be diagnosed when pathologists can’t confidently confirm another diagnosis.
One problem with HGBCL diagnosis is that it often relies on how cells look under a microscope. This is problematic since cells in HGBCL can look like other types of LBCL.
Diagnosis for THRLBCL can also be very difficult and requires a multifaceted approach. One study found that 82 percent of people with THRLBCL are initially diagnosed incorrectly.
Chemotherapy is often the first treatment for DLBCL and other types of LBCL. But some types require different approaches.
R-CHOP is a type of chemotherapy that uses a combination of drugs that typically involves six treatment cycles over 18 weeks.
The letters in R-CHOP refer to:
R-CHOP is effective for many people with DLBCL, curing roughly 60 percent to 70 percent of newly diagnosed cases and 30 percent to 40 percent of relapsed cases.
In some cases — like slow-growing “indolent” cancers — doctors may suggest monitoring rather than a treatment plan.
R-CHOP doesn’t work for everyone, especially for people with high-risk types. More research needs to be done to understand how other LBCL types differ biologically so that more targeted treatments can be made.
One type of treatment that has been found to improve overall survival rates of LBCL is called chimeric antigen receptor (CAR) T-cell therapy.
CAR T-cell therapy takes a person’s own T cells (a type of immune cell) and changes them so they recognize cancer cells. When CAR T cells find cancer cells, they attach to them and kill them.
Several CAR T-cell therapies are approved for people with relapsed DLBCL after they have tried other treatments:
These CAR T-cell therapies show consistent responses in clinical trials and real-world studies, even for people with high-risk DLBCL.
In the past, people with LBCL that didn’t respond to other treatments had just one possible option: a very aggressive chemotherapy followed by a stem cell transplant. Because the treatment is so demanding, most people weren’t eligible, and even among those who were, only about 1 in 4 were cured.
CAR T-cell therapy has emerged as a promising treatment that’s been effective in prolonging life for some people with LBCL. However, it may cause serious side effects and is typically used when other treatments haven’t worked.
Many factors play a role in the outlook of your cancer diagnosis, and early recognition is key.
Several aggressive types of cancer can be successfully cured if diagnosed and treated early enough. Early diagnosis is also critical for slower-progressing LBCL because these types often need multiple therapies.
Survival rates are higher for DLBCL when it’s detected early. Stage 1 DLBCL has about an 80 percent five-year survival rate. This means about 80 out of every 100 people diagnosed with stage 1 DLBCL are alive five years after their diagnosis. By stage 4, that number falls to roughly 55 percent. These numbers show why early diagnosis matters.
Knowing which factors can increase your chance of LBCL can help you and your doctor recognize your risk early.
On MyLymphomaTeam, people share their experiences with lymphoma, get advice, and find support from others who understand.
What type of LBCL do you have, and what was your path to diagnosis like? Let others know in the comments below.
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