• Monday May 25,2020

Diffuse B-cell lymphoma

Diffuse B-cell lymphoma is one of the most common malignant neoplasms of the lymphatic system. B-cell lymphomas belong to the group of non-Hodgkin's lymphomas.

What is a diffuse B-cell lymphoma?

The main symptom of diffuse large B-cell lymphoma is a rapidly progressive enlargement of the lymph nodes. The lymph nodes are enlarged, but not painful.
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The diffuse large B-cell lymphoma (DLCBL) is derived from mature B-cells. It is a tumor of B lymphocytes. B lymphocytes, also called B cells for short, belong to the white blood cells (leukocytes). Together with the T lymphocytes they form a crucial part of the adaptive immune system.

B cells are the carriers of the humoral immune response. They are the only cells in the body capable of producing antibodies. According to the WHO subdivision, diffuse large B-cell lymphoma belongs to the mature-cell, blastic B-cell neoplasms. These malignant cancers are considered very aggressive. Morphologically it is subdivided into centroblastic lymphoma, immunoblastic lymphoma and anaplastic lymphoma.

The diffuse large B-cell lymphoma is one of the most common neoplasms of the lymphatic system. Eight out of every 100, 000 people get ill every year. In children, the disease is rare. Mainly men are affected at the age of about 70 years.

causes

The diffuse large B-cell lymphoma is based on a malignant transformation of B lymphocytes in different stages of differentiation and maturity. The disease is due to the unrestrained division of B cells in a simultaneous absence of programmed cell death (apoptosis). As a result, more and more B lymphocytes exist and other cells are displaced.

Why the lymphomas develop, has not yet been fully clarified. Genetic changes seem to play a significant role in the development of lymphoma. Typical are certain chromosome translocations. As a result, various cancer genes (oncogenes) get out of control and thus help the cell to undergo a malignant transformation. Although the disease is characterized by genetic changes, but can not be inherited.

In addition to the genetic predisposition, there are risk factors that may favor the development of the disease. This includes the radiation exposure by X-ray or gamma radiation. Even a therapy with cytostatics is a risk factor. Such cytostatic therapies are used, for example, in the treatment of other malignancies.

An autoimmune disease can also promote the development of the disease. Furthermore, infection with HIV can lead to lymphoma. There are also various viruses and bacteria that favor diffuse large B-cell lymphoma in its development.

Symptoms, complaints & signs

The main symptom of diffuse large B-cell lymphoma is a rapidly progressive enlargement of the lymph nodes. The lymph nodes are enlarged, but not painful. Lymph node enlargement is also called lymphadenopathy. In addition to this swelling, there is decreased performance and fatigue.

Eventually, so-called B symptoms appear. These include fever, night sweats and weight loss. The affected persons are infectious. Displacement by B lymphocytes may affect other blood cells, causing changes in the blood count. When the erythrocytes are displaced by the B lymphocytes, anemia develops. This is characterized by symptoms such as hair loss, shortness of breath during exercise, paleness and tiredness.

Also, the platelets can be displaced by the degenerate B cells. This creates a deficiency of platelets, a so-called thrombocytopenia. The lack of platelets can cause spontaneous bleeding such as nose bleeds and bruises. Also petechiae of the skin and gastrointestinal bleeding can arise.

diagnosis

Initial evidence for a diffuse large B-cell lymphoma provides the clinical picture. Painless, swollen lymph nodes are always suspected of causing cancer. If a lymphoma is suspected, a blood picture is taken. Depending on the extent of the disease, this indicates anemia, an increase or decrease in white blood cells (leukocytosis or leukopenia) and a decreased iron value.

The ferritin value is higher. Inflammatory signs such as erythrocyte sedimentation rate, α2-globulins and fibrinogen are also elevated. An antibody deficiency syndrome is often seen in association with B-cell lymphoma. In addition, characteristic changes in lactate dehydrogenase and ß2-microglobulin can be diagnosed in the blood. The diagnosis is confirmed histologically by biopsy of an affected lymph node.

The extracted tissue is assessed histomorphologically. For more detailed classification, dyeing techniques are used. In order to determine the exact stage of the disease, further investigations must be carried out. These include X-rays of the chest, ultrasound of the abdomen and computed tomography of the chest, abdomen and neck.

To obtain a bone marrow histology and to exclude bone marrow infestation, a bone marrow puncture is performed in most cases. Precise staging and classification of lymphoma is needed for targeted therapy.

complications

B-cell lymphoma enlarges the lymph nodes. This usually progresses very fast, but does not cause any pain at first. The patient suffers from tiredness, which can not be neutralized by sufficient sleep.

Also, the patient's performance drops and ordinary tasks can not be readily accomplished. At night it comes to sweats and fever, in addition, the person loses much weight. Furthermore, the hair loss occurs. In case of exertion, those affected suffer from respiratory distress and are afraid of suffocation.

The shortness of breath can lead to a loss of consciousness. Quality of life is severely limited and reduced by B-cell lymphoma. In most cases, treatment of B-cell lymphoma is mediated. However, only early treatment can achieve complete success.

In many cases, the patient dies if treatment is initiated late. Likewise sufferers suffer from increased susceptibility to infections and other diseases. Life expectancy is reduced by the disease. The patient must be prepared for a long hospital stay.

When should you go to the doctor?

If the lymph nodes grow rapidly, a doctor should be consulted. Also, fever, night sweats and other typical signs of diffuse B-cell lymphoma are best clarified immediately. In the event of respiratory distress and loss of consciousness, the affected person must be taken to the nearest hospital. There the symptoms can be examined and if necessary a treatment can be initiated. A diagnosed lymphoma must be hospitalized and closely monitored by a physician.

After the therapy, regular visits are indicated to rule out complications and to monitor the healing process. An immediate clarification of the symptoms is especially recommended for an existing autoimmune disease or HIV infection.

Even after repeated radiation exposure, such as X-rays or gamma radiation, the risk of diffuse B-cell lymphoma may be increased. For whom these risk factors apply, the ideally contacted directly the family doctor. Further contacts are the lymphologist or a specialist in internal medicine. In an emergency, the emergency medical service can also be switched on.

Treatment & Therapy

The diffuse large B-cell lymphoma can in principle be cured. However, the disease is rapidly fatal, so treatment should start as early as possible. B-cell lymphomas are usually treated chemotherapeutically according to the CHOP protocol. In addition, the drug rituximab is used. It is a biotechnologically produced chimeric monoclonal antibody.

Depending on the stage and form of the lymphoma, radiotherapy can be used as a supplement or alternative. The therapy also depends on the Ann Arbor stage. Using the Ann-Arbor classification, the degree of spread of the lymphoma can be determined. The prognosis varies greatly depending on the type and extent of the diagnosis. Some of them have good chances of recovery, partly the prognoses are hopeless.

In hopeless cases a palliative care takes place. Often patients have to spend a long time in the hospital. In particular, bone marrow insufficiencies with bleeding, anemia and increased susceptibility to infections pose great problems in the treatment.

Outlook & Forecast

If this disease does not result in treatment, the patient usually dies of the symptoms and the consequences of the disease. A self-healing does not occur, so it comes in any case to a bad course of disease without treatment.

Those affected suffer from severe tiredness and a fatigue, whereby the lymph nodes of the patient are significantly enlarged and sufferers suffer from weight loss and respiratory distress. Furthermore, it can also lead to a loss of consciousness or to anemia.

Also complaints in the area of ​​the stomach and the intestine occur thereby and reduce the quality of life of the affected person enormously. The tumor can also spread to other regions of the body and cause damage there. For this reason, the further course of the disease also depends very much on the time of diagnosis.

Chemotherapy or radiation therapy can relieve some discomfort, but a complete cure does not occur. The sufferers therefore also suffer from a reduced life expectancy. Only in rare cases and at a very early diagnosis can the disease be completely cured.

prevention

The diffuse large B-cell lymphoma can only be prevented to a limited extent. The disease is partly genetically caused so that no prevention is possible. However, risk factors such as cytostatics or ionizing radiation should nevertheless be avoided.

aftercare

In most cases, the person concerned has no special follow-up care for this disease. First and foremost, a comprehensive diagnosis with subsequent treatment must be carried out to prevent further complications and other complaints. The sooner B-cell lymphoma is recognized and treated, the better the outcome of the disease.

For this reason, the focus is on the early diagnosis of B-cell lymphoma, with a doctor should be sought at the very first signs and complaints. The treatment is usually done by a surgical procedure. The patient should rest and take care of his body.

Efforts or other stressful activities are foreseeable for the body to recover. In general, those affected by B-cell lymphoma also need care and support from friends and family, with psychological support as well. Since the disease also leads to a significantly increased susceptibility to infections, it is advisable to be particularly mindful of his health and to comply with appropriate measures of hygiene.

You can do that yourself

Diffuse large B-cell lymphoma (DLCBL) is a B-lymphocyte tumor that, if left untreated, can quickly kill. Chances of a complete cure usually only exist if the disease is discovered and adequately treated at a very early stage. Therefore, the most important self-help measure is to interpret the symptoms correctly and consult a doctor immediately.

Characteristic of the DLCBL are rapidly enlarging lymph nodes, but the swelling is not associated with pain. The patient also suffers from constant fatigue and decreased exercise capacity. As the disease progresses, fever, sweats and weight loss often occur.

Often also an increased susceptibility to infection is added. Anyone who observes such symptoms should in no way dismiss or otherwise trivialize this as a delayed cold. Such symptoms must always be taken seriously and promptly medically clarified.

The patient can only indirectly contribute to the treatment of the disease by following the instructions of the attending physician. Frequently scheduled chemotherapy must not be stopped spontaneously, even with severe side effects. If the disease is associated with a thrombocytopenia, ie a lack of platelets, the person concerned should take care not to hurt themselves, as even small bleeding in this case can no longer be stopped by the body without further ado.


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