Living with diffuse large B-cell non-Hodgkin lymphoma

Dr Garrick Laudin unpacks diffuse large B-cell non-Hodgkin lymphoma and how such a diagnosis may impact your life.

You can listen to this article below, or by using your favourite podcast player at pod.link/oncologybuddies

What is diffuse large B-cell non-Hodgkin lymphoma?

The umbrella term, large B-cell lymphoma, encompasses diffuse large B-cell non-Hodgkin lymphoma (DLBCL) as one of its subtypes. 

DLBCL, the most common of the non-Hodgkin lymphomas, is a cancer of the lymph nodes or organs (liver and spleen) where the immune system is active. 

In certain patients, particularly those with weak immune systems due to the human immunodeficiency virus (HIV) may have disease almost anywhere in the body (extra nodal disease). 

The diagnosis of lymphoma and the classification into various subtypes, requires a biopsy of the tumour. 

What are the symptoms of diffuse large B-cell non-Hodgkin lymphoma?

Rapid swelling lymph nodes

Symptoms frequently experienced include painless, rapid swelling of the lymph nodes in the head and neck, underarms or groin. The lymph node groups listed above are nodes that you or your doctor may easily feel. 

For lymph node groups that are difficult to feel, particularly those of the abdomen and chest, specialised scans such CT-, PET- or PET-CT scans may be used to detect these enlarged lymph nodes. These scans not only assess the extent of the disease at diagnosis (stage) but will also be used to monitor the change in the size of the lymph nodes as a response to treatment. 

B symptoms

The B symptoms are symptoms that may co-exist with enlargement of lymph nodes. These symptoms include unexplained significant loss of weight, unexplained fever as well as drenching night sweats. 

In the advanced stages, particularly when the disease involves the bone marrow, symptoms of anaemia (fatigue and shortness of breath), recurrent infections (oral cavity and genitourinary system), and bleeding manifestations (oral and nasal) are often reported. 

What happens after a diagnosis is made? 

Once a histological (tissue) diagnosis is established, and relevant tests have been used to assess the extent of the disease, your doctor may request more tests like a heart sonar or lung function to assess your physical fitness prior to receiving chemo-immunotherapy. 

It’s also important to remember that there are services you and your family can engage to provide emotional and physical support during your journey. Palliative care services, for example, is an important part of comprehensive cancer care. 

The National Comprehensive Cancer Network (NCCN) defines the goals of palliative care as the control of disease symptoms, relief of emotional and physical suffering associated with a cancer diagnosis, and the improvement of the quality of life of people living with cancer as well as their family and caregivers. 

What treatment is available? 

When engaging with your doctor regarding the best possible treatment options, you should inquire about your eligibility for participation in clinical trials. Clinical trials involve using newer therapies to improve disease outcomes as well as aim to reducing the toxicities and side effects of therapy. 

A combination of chemotherapy, usually given via a drip into a vein (intravenously), and an immunotherapy remains the backbone of treatment in DLBCL. Immunotherapy uses medication administered through a drip to target specific molecules expressed by the cancer cells. 

The treatment landscape is evolving and newer therapies become available with time. 

For DLBCL that doesn’t respond as well as expected following initial therapy (refractory disease) or disease that comes back (relapsed disease) after receiving chemo-immunotherapy, there are further lines of therapy which could include additional chemo-immunotherapy or bone marrow transplantation. 

What is survivorship in diffuse large B-cell non-Hodgkin lymphoma?

Survivorship is part of your cancer journey and runs parallel with medical treatment. It’s holistic and focuses on your overall health and well-being from the time of receiving a cancer diagnosis and thereafter, or end-of-life care. It includes aspects of how to live a healthy life by embracing physical activity, limiting alcohol and tobacco use as well as maintaining a healthy body weight.

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