What are B symptoms in lymphoma, specifically in patients with Hodgkin lymphoma?

B Symptoms in Lymphoma

B symptoms are a triad of constitutional symptoms consisting of unexplained fever >38°C, drenching night sweats, and weight loss >10% of body weight within 6 months prior to diagnosis. 1

Definition and Clinical Significance

The presence or absence of B symptoms is a critical staging modifier in Hodgkin lymphoma, dividing each Ann Arbor stage into "A" (no systemic symptoms) or "B" (B symptoms present). 1

The Three Components:

• Fever: Unexplained temperature >38°C (100.4°F) 1
• Night sweats: Specifically described as "drenching" night sweats that require changing of bedclothes 1
• Weight loss: >10% of body weight within the 6 months preceding diagnosis 1

Clinical Presentation Context

B symptoms are more common in patients with HIV-associated Hodgkin lymphoma and should always prompt investigation for opportunistic infections in this population. 1 In people living with HIV, approximately 90% of Hodgkin lymphoma cases are Epstein-Barr virus (EBV)-associated, and these patients more commonly present with advanced disease, extranodal involvement, and B symptoms. 1

Additional Symptoms to Assess:

During history and physical examination, clinicians should also evaluate for:

• Alcohol intolerance 1
• Pruritus 1
• Fatigue 1
• Performance status 1

Prognostic Impact

The presence of B symptoms is an unfavorable prognostic factor that influences treatment decisions in early-stage disease. 1 Patients with stage I-II disease and B symptoms are classified as "early-stage unfavorable" rather than "early-stage favorable," which affects the intensity and duration of therapy. 1

Risk Stratification:

• Early favorable: Stage I-II without B symptoms or other unfavorable factors 1
• Early unfavorable: Stage I-II with B symptoms or other risk factors (bulky disease, ESR ≥50, >3 nodal sites) 1
• Advanced stage: Stage III-IV (B symptoms contribute to International Prognostic Score) 1

Clinical Pitfalls

Do not confuse B symptoms with other causes of fever, night sweats, or weight loss—particularly infectious etiologies in immunocompromised patients. 1 In patients with HIV or other immunosuppression, an infectious disease workup should be performed when B symptoms are present, as opportunistic infections can mimic lymphoma presentation. 1

The erythrocyte sedimentation rate (ESR) threshold for unfavorable prognosis differs based on B symptom status: ESR >50 with B symptoms versus ESR >30 without B symptoms. 1