PET Scan (areas in red represent lymphoma)

Patient Education: Diffuse Large B Cell Lymphoma

by Mackenzie Gignac

Diffuse Large B Cell Lymphoma (DLBCL) is a common fast-growing lymphoma. Such a diagnosis often comes as a shock to patients. We spoke with St Vincent’s Hospital Clinical and Laboratory Haematologist Dr Matthew Ku to understand and learn more about DLBCL, how it can impact patients’ lives, what routine tests are conducted, what treatment options are available and the potential underlying causes.

What is Diffuse Large B Cell Lymphoma?

Lymphomas are blood cancers that can affect lymph glands, blood and other organs. Lymphomas can be subdivided into Hodgkin and Non-Hodgkin Lymphomas and DLBCL is an aggressive form of Non-Hodgkin Lymphoma. It is the most common type of lymphoma and accounts for 30 percent of all lymphomas, says Dr. Matthew Ku.

Although a cancer diagnosis is always worrisome, DLBCL is a curable cancer. Dr. Ku says patients recently diagnosed with DLBCL should stay positive. ‘DLBCL has a good chance of responding to therapy with the chance of a cure at 50 to 60 percent, which is better than most cancers.’

Dr. Ku gives hope to patients that have been diagnosed with DLBCL. ‘If you are managed by an experienced haematologist then you are in good hands, since there are proven therapies that are effective.’

Will the DLBCL diagnosis impact my life?

Dr. Ku says unfortunately, there will be a short to medium impact on the life of a patient that has been diagnosed with DLBCL. There are two primary areas affected: psychosocial and physical

  1. Psychosocial Impact

After the initial diagnosis, patients can undergo a period of anxiety, grief and disbelief upon receiving the news. The news of a cancer diagnosis tends to have a psychological effect on the patients themself as well as their families and friends.

Dr Ku says patients should be encouraged to know that they are not alone, and that support is available for them to help alleviate psychological stress. Most tertiary hospitals offer psycho-oncology which provide counseling to cancer patients and their families. Additionally, Dr Ku advises that there are family and social support options through social work, as well as external support through third-party organisations, such as theLeukemia Foundation.

The social impact of a DLBCL diagnosis might also cause disruption to the patients’ studies or employment. ‘I tell my patients not to be too stoic, and try to take some time off to see how they go with chemotherapy.’

  1. Physical Effects

Dr. Ku says there are two ways the diagnosis of DLBCL could exert physical impact on the patients. The first is how DLBCL directly affects the body. DLBCL could cause symptoms such as enlarged lymph nodes, fevers, significant night sweats and weight loss (>10% in body weight).

The second way is how the therapy for DLBCL could negatively impact the patients. The most common chemotherapy used for the treatment of DLBCL is RCHOP. RCHOP combines a variety of drugs that are usually given every 21 days. Dr Ku says while some patients don’t have significant side effects with chemotherapy, many do develop side effects and haematologists can’t always predict how everyone will react to chemotherapy. There are some side effects that patients might encounter with chemotherapy including hair loss, nerve irritation or damage (neuropathy), low blood cell counts or low immunity, fertility issues, and reduced heart function, especially in the elderly patients. For this reason, patients receiving RCHOP chemotherapy should have their heart function tested before and possibly during chemotherapy.

What are my treatment options for DLBCL?

DLBCL is a curable lymphoma and the standard first line of therapy is RCHOP chemotherapy. ‘RCHOP chemotherapy has been shown to be the most effective first line treatment for DLBCL,’ says Dr. Ku. ‘There have been many studies that tried to improve RCHOP but RCHOP is still the best at the moment.’

Many patients respond well to RCHOP treatment. However, for those patients that do not respond and progress or relapse later, their next option is salvage therapy followed by stem cell (‘bone marrow”) transplant. ‘However, many patients don’t go into remission and they don’t make it to stem cell transplant,’ says Dr Ku. In that situation, clinical trials are offered as the next line of treatment.

Dr. Ku says that the length of chemotherapy treatment depends on the “stage” of the DLBCL.

Early stage DLBCL might require three to four cycles of RCHOP chemotherapy, possibly followed by radiation treatment. As RCHOP is given every 21 days, this would be around three months of chemotherapy for those in stage I-II.

The more advanced stage (III-IV) DLBCL usually requires six cycles of RCHOP chemotherapy, which will be around four to five months of treatment.

What tests can I expect for DLBCL?

When a patient is diagnosed with DLBCL there are tests that we do to further characterise the disease, and to assess a patient’s suitability for chemotherapy.

‘We do a baseline set of blood tests including full blood count, kidney function, liver function, calcium, magnesium, phosphate, LDH, Hepatitis B & C, and HIV.” Investigations such as PET/CT scans, as well as a bone marrow biopsy are also routinely performed to assess the “stage,” or the extent of DLBCL involvement. Dr. Ku explains, ‘PET scan measures the disease burden of DLBCL. Sometimes we do a bone marrow biopsy to see if the bone marrow is affected.’

What causes DLBCL?

Dr. Ku says most DLBCL can’t be traced back to a cause. If you have a first-degree relative with a blood cancer there is an increased chance. Additionally, some substances have been reported to be linked to higher rates of lymphoma, such as the weed pesticide RoundUp. However, for the majority of patients, unfortunately lymphoma occurs without a clear cause.

Are there any actions being taken by Melbourne Doctors to advance the care of patients now and for the future?

‘There is significant cooperation and collaboration among haematologists within the country to come up with ideas and strategies that can improve the outlook of our patients,’ says Dr. Ku.

The ALLG (Australasian Leukaemia and Lymphoma Group) and ALA (Australasian Lymphoma Alliance) gather lymphoma specialists from Australia and New Zealand to come up with new ideas to manage patients with DLBCL.

‘We are collecting data to see how we can improve the way future patients are treated and managed,’ says Dr. Ku.

Dr. Ku emphasizes that retrospective studies that work through big cooperative groups are very important to advance patient care.