Diffuse large B-cell lymphoma (DLBCL) is the most common type ofnon-Hodgkin’s lymphoma (NHL)。It’s a fast-growing blood cancer that requires treatment as soon as possible.
作为一种lymphoma,DLBCL affects your body’s white blood cells and ability to fight infections. Treatments for DLBCL are improving and typically include chemotherapy and radiation. You might also receive immunotherapy or have a stem cell transplant in some cases.
In this article, we take a closer look at this type of cancer, including symptoms, treatment options, and outlook.
弥漫性大B细胞淋巴瘤（DLBCL）是一种称为淋巴瘤的血液癌。淋巴瘤有两种类型：霍奇金和非霍奇金。弥漫性大B细胞淋巴瘤是非霍奇金淋巴瘤（NHL）。实际上，这是最常见的NHL类型。
DLBCL is also an aggressive form of NHL. It can be fatal if left untreated.
一个ll lymphomas, including DLBCL, affect the organs of your lymphatic system. Your lymphatic system is what allows your body to fight infections. Lymphomas such as DLBCL affect the organs in your lymphatic system. This includes your:
- 骨髓
- 胸腺
- spleen
- 淋巴结
B-cells are cells your immune system relies on to make antibodies and fight infection. When you have DLBCL, your normal B-cells get overwhelmed by the cancerous abnormal cells. This means your body can’t make the antibodies your immune system needs.
The cause of DLBCL isn’t known. However, there are a few factors that are known to increase your risk. These factors include:
- 一个ge.It usually affects those who are middle-aged or older. The average age at diagnosis is 64.
- Ethnicity.DLBCL is more likely to affect white people than any other group in the United States.
- Sex at birth.Men have a slightly higher risk than women.
- DLBCL的家庭成员。拥有DLBCL或其他形式的淋巴瘤的父母或兄弟姐妹会增加您的风险。
- 一个weakened immune system.如果您的免疫系统因HIV等慢性病或进行器官移植而削弱了您的免疫系统，您就会面临更大的风险。
Some studies have also suggested there might be a link between the following factorsand an increased risk of DLBCL:
- 有肥胖症（仍然需要进行更多的研究来确认此链接）
- 暴露于辐射（仍然需要更多的研究来确认此链接）
- 接触herbicide glyphosate (Roundup)
另外，低度，非侵略性淋巴瘤具有转化为DLBCL的潜力，估计转化速率2 to 3 percent per year。
The following are the primary symptoms you may experience with DLBCL:
- enlarged lymph nodes
- 夜汗
- 不寻常的减肥
- loss of appetite
- extreme tiredness or fatigue
- fever
- extreme itchiness
根据DLBCL的位置，您可能会遇到某些其他症状。这些其他症状可能包括：
- abdominal pain
- diarrhea
- 粪便中的血液
- cough
- shortness of breath
DLBCL通过执行biopsy部分或全部的肿块,淋巴结肿大,或area with the abnormalities. A biopsy is the act of removing tissue and then examining the tissue under a microscope to determine if lymphoma is present.
Depending on various factors, including the location of the affected area, this procedure may be done under general or local anesthesia.
Your doctor will also interview you for details on your medical issues and symptoms, and give you a physical exam.
在活检确认后，您的医生将进行一些其他测试以确定DLBCL的阶段。
Treatment of DLBCL is determined by several factors. However, the most important factor your doctor will use to determine treatment options is whether your disease is localized or advanced.
- Localized means it hasn’t spread.
- 一个dvanced is usually when the disease has spread to more than one location in your body.
The treatments commonly used on DLBCL are described below. You might have treatments separately or in combination.
化学疗法for DLBCL
化学疗法works by slowing down the ability of the rapidly growing cancer cells to reproduce. You’ll take chemotherapy medication orally or through anIV。
The most common chemotherapy treatment is referred to asR-CHOP。R-CHOP代表化疗和免疫疗法的组合利妥昔单抗，，，，环磷酰胺，，，，阿霉素，，，，and vincristine, along with强的松。
R-CHOP is given through an IV for four of the medications, and prednisone is taken by mouth. R-CHOP is usually administered every 3 weeks for 4 to 6 cycles.
DLBCL的辐射处理
Radiation therapyis a treatment where high-intensityX-raysare aimed at the cancer cells. Radiation can help kill cancer cells quickly, especially when it’s used in combination with chemotherapy.
Immunotherapy for DLBCL
Immunotherapy drugstarget groups of cancer cells with antibodies and work to destroy them. Immunotherapy helps your body’s immune system recognize and kill cancer cells. The immunotherapy drug, rituximab, specifically targets the B-cells or lymphocytes. Rituximab can affect the heart and may not be an option if you have certain heart conditions.
Surgery for DLBCL
手术很少用于治疗DLBCL。但是，如果癌症已经扩散到器官，例如脾脏或肾脏，则可以进行手术以去除受影响的区域。如果癌症尚未扩散，您会想进行辐射而不是手术。
Stem cell transplants for DLBCL
一个stem cell transplantreplaces the cancerous white blood cells in your bone marrow with new healthy white blood cells. The cells develop from your own stems cells or donor stem cells.
该治疗方法与非常高剂量的化学疗法结合使用以杀死所有剩余的癌细胞。一旦化学疗法杀死了癌细胞，健康的干细胞将返回您的体内。
Stem cell transplants are only used in DLBCL that has relapsed after initial treatment.
Treatment for early-stage DLBCL
早期DLBCL的初始治疗通常包括大约三轮R-Chop化学疗法。您还将进行放射治疗。
Treatment for advanced DLBCL
一个dvanced DLBCL is treated with the same R-CHOP combination of chemotherapy and immunotherapy medications. However, advanced DLBCL requires more rounds of the medications that are administered every 3 weeks.
晚期DLBCL通常需要6到8轮治疗。您的医生通常会在治疗中途进行另一次PET扫描，以确保其有效工作。如果该疾病仍然活跃或恢复，您的医生可能会包括其他一轮治疗。
三分之二 of people with DLBCL will be cured with first-line chemotherapy. (First-line treatment is the first treatment administered for a cancer.) The remainder of people will require further treatments.
Most people with DLBCL aren’t diagnosed until the later stages. This is because you may not have outward symptoms until later. After diagnosis, your doctor will perform tests to determine the stage of your lymphoma. These tests may include some of the following:
- 组合宠物和CT扫描，或单独进行CT扫描
- blood tests
- 骨髓活检
Staging tells your medical team how far the tumors have spread throughout your lymphatic system. The stages for DLBCL are as follows:
| 阶段 | Definition |
| stage 1 | 只有一个地区或站点的影响;这包括淋巴结，，，，lymph structure, or extranodal sites. |
| stage 2 | 涉及两个或多个淋巴结区域或两个或两个或多个淋巴结结构。在此阶段，所涉及的区域位于身体的同一侧。 |
| stage 3 | 所涉及的淋巴结区域和结构在隔膜上方和下方。 |
| stage 4 | 除淋巴结和淋巴结外，其他器官在整个体内都涉及。这些器官可能包括您的骨髓，肝脏或肺部。 |
These stages will also be accompanied by either an A or B after the stage number.
- The letter A means you aren’t having the common symptoms of fever, night sweats, or weight loss.
- The letter B means that you’re having these symptoms.
国际预后指数（IPI）得分
In addition to the staging and the A or B status, your doctor will also give you an IPI score. IPI stands for International Prognostic Index. The IPI score ranges from 1 to 5 and is based on how many of the factors you have that may lower your survival rate. These five factors are:
- being over 60 years of age
- having a higher than normal level of lactate dehydrogenase, a protein found in your blood
- being in poor overall health
- having the disease in stage 3 or 4
- involvement of more than one extranodal disease site
一个ll three of these diagnostic criteria will be combined to give you a prognosis. They will also help your doctor determine the best treatment options for you.
一个
Your exact risk of relapse depends on factors such as your age, overall health, and how well you respond to treatment. Talk with your doctor about the risk in your specific case.
DLBCL is considered a curable disease when treated early. The sooner you’re diagnosed, the better your outlook will be.
DLBCL的处理可能会产生严重的副作用。在开始治疗之前，请务必与您的医生讨论这些。
尽管产生了副作用，但重要的是要尽早快速地治疗DLBCL。在症状的第一迹象和接受治疗的情况下，看医生至关重要。如果未经治疗，它可能会威胁生命。