What are the B symptoms for lymphoma?

B Symptoms of Lymphoma

B symptoms in lymphoma are defined as unexplained fever >38°C, drenching night sweats that require changing clothes or bedding, and unexplained weight loss >10% of body weight within 6 months. 1, 2, 3

Classic B Symptoms

• Fever: Temperature >38°C (>101°F) without other explanation 2
• Night sweats: Drenching sweats that require changing clothes or bedding 2, 3
• Weight loss: Unexplained loss of >10% body weight over a 6-month period 1, 2, 3

Clinical Significance of B Symptoms

• B symptoms indicate systemic involvement and are important for staging and prognosis 1
• The presence of B symptoms is denoted by adding the letter "B" to the stage (e.g., Stage IIB), while absence is denoted by "A" (e.g., Stage IIA) 2
• B symptoms often correlate with more advanced disease and may indicate the need for treatment initiation 1
• In follicular lymphoma, therapy should be initiated upon development of B symptoms, as they indicate active disease requiring intervention 1

Other Common Symptoms (Not B Symptoms)

• Painless lymphadenopathy: Most common presenting sign, occurring in over 60% of patients, particularly in the cervical region 2, 3
• Fatigue: Persistent tiredness not relieved by rest 2, 3
• Pruritus: Generalized or localized itching without rash 2, 3
• Alcohol-induced pain: Pain in lymph node regions after consuming alcohol (particularly in Hodgkin lymphoma) 1, 3

Site-Specific Symptoms

• Abdominal involvement: Abdominal pain, swelling, early satiety, constipation, nausea 3
• Thoracic involvement: Cough, dyspnea, chest pain, reduced physical endurance 3
• Head and neck involvement: Swelling in neck or jaw, difficulty swallowing 3
• CNS involvement: Headaches, bladder or bowel dysfunction 3

Clinical Pearls

• B symptoms are important criteria for treatment initiation in follicular lymphoma, even in the absence of other high tumor burden criteria 1
• Hodgkin lymphoma more commonly presents with B symptoms compared to many non-Hodgkin lymphoma subtypes 2, 3
• In early-stage asymptomatic patients, the presence of B symptoms may change management approach from "watch and wait" to active treatment 1
• B symptoms may spontaneously resolve in 10-20% of follicular lymphoma cases 1
• Diagnostic workup should include thorough documentation of B symptoms as they impact staging and treatment decisions 1

High Tumor Burden Criteria

B symptoms are included among the high tumor burden criteria in follicular lymphoma, along with:

• Bulky disease (>7 cm) or 3 lymph nodes in distinct areas >3 cm 1
• Symptomatic splenic enlargement 1
• Organ compression, pleural or peritoneal effusion 1
• Elevated LDH or β2-microglobulin 1
• Cytopenias (neutrophils <1×10⁹/L, platelets <100×10⁹/L) 1