What are the clinical features of Diffuse Large B-Cell Lymphoma (DLBCL)?

From the Guidelines

The clinical features of Diffuse Large B-Cell Lymphoma (DLBCL) include fever, chills, night sweats, unexplained weight loss, painless regional or diffuse lymphadenopathy, fatigue, bone pain, and/or irritability, as well as extranodal involvement and potential oncologic emergencies. These symptoms can be associated with various sites of involvement, including abdominal tumors, intrathoracic masses, head and neck tumors, and central nervous system involvement, leading to a range of clinical presentations 1. The key features of DLBCL can be summarized as follows:

• Rapidly enlarging, painless lymph nodes, typically in the neck, armpit, or groin
• B symptoms: fever, night sweats, and unexplained weight loss
• Fatigue and loss of appetite
• Shortness of breath or cough if the chest is involved
• Abdominal pain or swelling if abdominal organs are affected
• Neurological symptoms if the central nervous system is involved DLBCL is an aggressive form of non-Hodgkin lymphoma that can affect any age group but is more common in older adults, often presenting as a rapidly growing mass in a single site or multiple sites, with B symptoms being particularly important for diagnosis and staging 1. Patients may also experience anemia, elevated lactate dehydrogenase (LDH) levels, and abnormal liver function tests, with extranodal involvement common in sites such as the gastrointestinal tract, skin, or bones 1. Diagnosis typically involves a lymph node biopsy with immunohistochemistry to confirm the presence of large B-cells, and staging procedures include PET-CT scans and bone marrow biopsy. Early recognition of these symptoms is crucial for prompt diagnosis and treatment, as DLBCL is potentially curable with timely intervention using chemotherapy regimens like R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone) 1.

From the Research

Clinical Features of Diffuse Large B-Cell Lymphoma (DLBCL)

The clinical features of DLBCL are characterized by:

• A rapidly growing tumour mass in single or multiple, nodal or extranodal sites 2
• Heterogeneous clinical presentation, genetic findings, response to therapy, and prognosis 2
• Variable clinical presentation, behaviour, and prognosis, depending mainly on the extranodal site when they arise 3
• Systemic symptoms in about one third of patients 3
• Localized presentation in approximately 20% of patients, with disseminated extranodal disease being less frequent 3

Subtypes of DLBCL

DLBCL can be subdivided into:

• Germinal centre B-cell like (GCB) and activated B-cell like (ABC) subtypes, based on cell-of-origin 2, 4
• Rare types of lymphoma composed of large B-cells, in aggregate about 15-20% of all neoplasms that are sufficiently distinctive to recognise separately 2
• Unclassifiable cases, which account for about 10-15% of all cases 2

Prognosis and Treatment

The prognosis of DLBCL is influenced by:

• The International Prognostic Index (IPI) and age adjusted IPI (aaIPI) 3
• The cell-of-origin, with GCB subtype usually having a better prognosis than ABC subtype 2
• The presence of systemic symptoms and extranodal involvement 3 The treatment of DLBCL typically involves:
• A combination of rituximab and CHOP chemotherapy, with or without radiotherapy 3
• High-dose chemotherapy supported by autologous stem cell transplant (HDC/ASCT) for young patients with high-risk disease or those who did not achieve complete remission after first-line chemotherapy 3
• Novel therapeutic approaches, including small molecules, novel monoclonal antibodies, antibody-drug conjugates (ADC), bispecific antibodies (BsAbs), and chimeric antigen receptor (CAR) T-cell therapy 5, 6