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Causes and Symptoms of Diffuse Large B-Cell Lymphoma

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Published on July 9, 2020

Approximately 30,000 people in the United States are diagnosed with diffuse large B-cell lymphoma each year, making it the most common type of lymphoid malignancy in adults. DLBCL is considered a particularly aggressive non-hodgkin lymphoma, and treatment is typically required soon after diagnosis.
 
How is DLBCL diagnosed? Where does this type of lymphoma manifest in the body? Does age or gender play a role in disease development? 
  
Patient Power founder Andrew Schorr talks with leading expert Dr. Jason Westin, from the University of Texas MD Anderson Cancer Center, about the signs and symptoms of diffuse large B-cell lymphoma, what testing is done at diagnosis and potential causes.  
 

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Transcript | Causes and Symptoms of Diffuse Large B-Cell Lymphoma

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Hello, and welcome to Patient Power. I'm Andrew Schorr. We're talking about Non-Hodgkin's lymphoma and specifically diffuse large B-Cell lymphoma, which is an aggressive lymphoma. And with us is an expert in that, Dr. Jason Westin from MD Anderson in Houston. Dr. Westin, first of all, you've got a long title. We want to make sure we get it right. What is your title there at MD Anderson?

Dr. Westin:

Sure. Hi Andrew. Thank you for having me today on Patient Power. I at MD Anderson am the Director of Lymphoma Clinical Research and the Section Chief for Aggressive Lymphomas.

Andrew Schorr:

Okay. And diffuse large B-Cell lymphoma is an aggressive lymphoma. And my understanding is it's the most common type of Non-Hodgkin's lymphoma. Is that right?

Dr. Westin:

That's right. It's the most common lymphoid malignancy in adults, the most common Non-Hodgkin lymphoma. And it affects about 30,000 people each year in the United States.

Andrew Schorr:

Okay. So first of all, how do you describe that? So if I were a new patient and this diagnosis was confirmed and you're trying to help me understand what is it, what do you tell me and my wife?

Dr. Westin:

What I would say is that diffuse large B-Cell lymphoma is a cancer of the immune system. Lymphomas come from lymphocytes or the lymph nodes, hence the term lymphoma. And those are part of the immune system. And it can show up in any part of the body, most commonly in lymph nodes, but diffuse large B-Cell lymphoma is different than other lymphomas in that it is quite aggressive.

This is not a disease where we would consider to observe it, or we would consider to follow without treatment. This is a cancer where treatments are required very soon after diagnosis, usually within a few weeks because the disease will continue to get worse if it's not treated and is potentially life threatening. However, the good news is, there are treatments and those treatments can work quite well for the majority of patients.

Andrew Schorr:

What are the symptoms that people have usually when they come to you and this is suspected or confirmed?

Dr. Westin:

This is a disease that often is found because of symptoms. Some other lymphomas can be slower growing and perhaps will be picked up serendipitously or by accident. Somebody is going for a different test and a lymph node is seen, that's not the case for most patients with diffuse large B-Cell lymphoma.

Usually, the patients will report a symptom. What is this new mass? What is this swelling? What is this pain I have, and that will prompt a workup. And so those symptoms that can be seen often are due to where is the disease in the body. And as mentioned, it can show up in any location. So a new mass, a new pain, a new swelling doesn't mean that it is lymphoma, but it could be consistent with lymphoma and a biopsy would be required.

Other symptoms aside from local symptoms such as pain could include weight loss of more than 10% of the body weight, fevers, night sweats, malaise, not feeling well. So those are kind of nondescript symptoms. The main symptoms that are localized symptoms for large cell lymphoma would be pain or a palpable mass.

Andrew Schorr:

Okay. And what about age or even gender? Is that a factor at all?

Dr. Westin:

It's not necessarily a factor. Large cell lymphoma can be seen across the age spectrum. And there are some subtypes that are more common in younger patients. Some subtypes that are more common in older patients. The average age of a person with large cell lymphoma is around 64, 65 years old. So the majority of people are of an advanced age.

It's uncommon to see this in the very, very young, but it can occur. Age is something we pay attention to in terms of our treatments and in terms of our expectation for prognosis, but it's not a limiting factor for who could be diagnosed. Gender, there may be a slight predisposition for males over females, but that's almost even.

Andrew Schorr:

There's been a lot in the news and lawyers advertising whether certain pesticides or other things cause it, so what do we know today about what causes it?

Dr. Westin:

Yeah, it's an important question of what causes it, because we get this a lot in clinic. A lot of patients who come to see me have been exposed to different chemicals in the past, they lived on a farm as a kid, or they've lived in an area where there's crop dusting or something else that occurs. The shorter answer is we don't yet know for the majority of patients what's the true trigger for their disease.

Compounds like Roundup potentially could be implicated in some cases, however, lymphoma existed before those chemicals were widely utilized, and many people have no known exposures to those and still develop disease.

Infections are always thought to be a possibility and sometimes viral infections, Epstein-BARR virus, or the mono virus is implicated in some people with lymphomas, but there's not a known pattern or a known exposure or a known genetic syndrome that puts people at risk for this disease. Most cases are sporadic or of an unknown etiology. We don't have the trigger for what prompted the disease to show up. Sometimes frustratingly, it seems like it may be random as to who gets this disease.

Andrew Schorr:

What about a hereditary connection? If there was a blood cancer lymphoid condition in my family, I'm living with chronic lymphocytic leukemia, so there's the L in there, would someone in my family be more at risk and it could show up as diffuse large B-Cell lymphoma?

Dr. Westin:

There is, although it's a very, very slight increased risk. And so we think that people that have a first degree relative, that have a Non-Hodgkin lymphoma may have a subtle, increased risk in terms of their family members risk of having a subsequent diagnosis of a Non-Hodgkin lymphoma. But that risk in compared to the general population is nearly equivalent.

So if we say that there's a subtle increased risk, if the risk to the general population is this much, the patient whose sibling or son or family member that they're worried about, their risk might be hard to see the difference because it's technically increased, but still quite low.

Andrew Schorr:

Dr. Westin, what about testing to understand what you're dealing with, with a specific patient situation? So are you going to do a biopsy? Are you going to do some analysis of the blood, what happens next when somebody has come to you?

Dr. Westin:

Yeah. Lymphomas are a disease that might be suspected based on physical exam. Somebody shows up with a new mass in a lymph node area of their body, but it's only diagnosed with a biopsy, and it should really be diagnosed with either an excisional biopsy, a surgical biopsy, or what's called a core needle biopsy, which is a rather large needle, doesn't sound very pleasant. But if we don't get that, we don't get the piece of the tissue for the pathologist to look at where do the cells live next to each other? We're unable to accurately subtype what the cancer really is, and therefore treatments are not as easy to decide, what's the right treatment.

So getting a biopsy is an absolutely essential part of a workup for a patient as they're becoming newly acquainted with the term lymphoma. Other tests that are often done include imaging, either a CT scan of the neck through the pelvis or a PET-CT scan, which is an image that has both the CT, as well as the nuclear medicine component.

Sometimes a bone marrow biopsy might be required, although that sometimes falling out of fashion if the scans don't show concerns for the bones to be involved. But the biopsy and a really good quality biopsy is absolutely critical for getting the right diagnosis.

Andrew Schorr:

Now, in some other areas of cancer they look at, are their driver genes, cancer genes that are driving someone's cancer. And we wonder about an aggressive lymphoid malignancy like that. Do you take a look and does that then lead to some kind of targeted therapy that could try to turn off that gene?

Dr. Westin:

Absolutely. And I think that's true across cancers in general, that the more research we do, the more we learn about what the underpinnings of the cancer and potential vulnerabilities or things that we could target. Drivers of the cancer, if you target that driver, hopefully you could cause the cancer to become much easier to treat.

For diffuse large B-cell lymphoma or aggressive lymphomas in general, there are a few genes that are occasionally implicated, but there's not a one-size-fit-all. This is the gene that drives this cancer to grow or to potentially be resistant.

Most doctors know quite well, which genes to test it's in the World Health Organization algorithm, that most pathologists would follow to test for certain genes. Some of those are called MYC or M-Y-C, BCL-2 , BCL-6. Those are commonly assessed, and if they are found to be abnormal might have an implication on the treatments that are chosen.

Andrew Schorr:

A hopeful story. A positive story. Dr. Jason Westin from MD Anderson and a lymphoma specialist, thank you for explaining this to us, and your work in moving research forward so that the options that can help people continue to grow. Thanks for being with us.

Dr. Westin:

Thank you for having me, it’s my pleasure.

Andrew Schorr:

I’m Andrew Schorr, remember; knowledge can be the best medicine of all.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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