This type of cancer begins in the body’s white blood cells, called lymphocytes, which are part of the immune system.3 NHL develops when a lymphocyte undergoes a malignant (cancerous) change and then multiplies, creating tumors in lymph nodes, lymphatic tissue or the spleen.1,4,5
To date, more than 60 different subtypes of NHL have been identified. The most common NHL subtype is diffuse large B-cell lymphoma (DLBCL).6CHOKNITI KHONGCHUM/SHUTTERSTOCK
Here are five key things to know about DLBCL, from its diagnosis and prognosis to treatment advances on the horizon.
1. If you’re facing a DLBCL diagnosis, you’re not alone. DLBCL accounts for one in every three cases of NHL.7
DLBCL is an aggressive type of B-cell NHL that grows rapidly in the lymph nodes and frequently involves the spleen, liver, bone marrow or other organs.4 Although the disease can affect people of any age, it most commonly occurs in older adults, and the median age at the time of diagnosis is 67.8
2. There are some key symptoms to look out for with DLBCL. Its tendency to progress rapidly makes early diagnosis and treatment imperative.
The most common early sign of DLBCL is painless swelling in one or more lymph nodes, commonly observed in the neck, groin or abdomen. However, the disease may begin somewhere other than the lymph nodes, such as the bones or lungs or even skin,4 making DLBCL challenging to detect and diagnose. In fact, about 60% to 70% of people with this type of NHL are not diagnosed until the disease is in an advanced stage.9 Because of its aggressive nature, DLBCL should be diagnosed and treated as early as possible. If you or a family member detects unusual symptoms, it’s a good idea to be proactive and consult a healthcare provider.
3. Despite the urgent need for early and effective treatment options, limited progress has been made during the last 20 years for people newly diagnosed with DLBCL.GORODENKOFF/SHUTTERSTOCK
The most common initial (first-line) treatment for DLBCL is chemotherapy – typically a regimen of three chemotherapy medicines and a steroid – plus immunotherapy.4 This regimen became the standard of care for newly diagnosed DLBCL nearly 20 years ago.10 Since then, researchers have tried to improve the effectiveness of this regimen by adding different medicines, but these combinations have proven less effective or less safe than the standard of care.
4. Among newly diagnosed people who receive treatment, about 40% will have recurring disease or will not respond to initial therapy at all, after which treatment options are limited.11
Many people with DLBCL are responsive to initial therapy, but about 40% will either stop responding to treatment or will relapse, experiencing a return of their cancer after remission.11 At that point, treatment options remain limited and survival rates are generally low.12
5. Emerging treatment approaches could help reduce the chance of the cancer returning and offer new hope for people living with DLBCL.
Although initial therapy is ultimately unsuccessful for about 40% of people with DLBCL,11 new treatment approaches have the potential to improve management of this disease.
Researchers are evaluating the potential of new types of therapies to improve upon the standard of care for those who have not been previously treated.10
Antibody-drug conjugates (ADCs), designed to target and destroy cancerous B cells affected by DLBCL, are one of the types of therapies being researched. There are already commercially available ADCs for previously treated DLBCL, and they are currently being developed as potential therapeutics for those who have not been previously treated.
Researchers are also working to create new treatment options for those with DLBCL who have relapsed or are refractory following prior treatments and require additional therapy – and results to date are promising.10 For example, researchers are evaluating potential treatment using bispecific antibodies for this group of people. Bispecific antibodies are designed to target the cells from which NHL arises by recruiting the body’s own immune system to destroy them. This approach is being developed for several diseases, including DLBCL.
Advancements and innovations such as these may offer the promise of improving care for people living with this aggressive lymphoma.
To continue learning about DLBCL and other blood cancers, including recent research, please visit https://www.gene.com/hematology.
About Genentech in Hematology
For more than 20 years, Genentech has been developing medicines with the goal to redefine treatment in hematology. Today, we’re investing more than ever in our effort to bring innovative treatment options to people with diseases of the blood. For more information visit http://www.gene.com/hematology.
- What are the most common blood cancers in adults? Dana Farber Cancer Institute. https://blog.dana-farber.org/insight/2019/11/what-are-the-most-common-blood-cancers-in-adults/. Published November 20, 2019. Accessed September 7, 2021.
- Key statistics for non-Hodgkin lymphoma. American Cancer Society. https://www.cancer.org/cancer/non-hodgkin-lymphoma/about/key-statistics.html. Accessed September 7, 2021.
- What is non-Hodgkin lymphoma? American Cancer Society. https://www.cancer.org/cancer/non-hodgkin-lymphoma/about/what-is-non-hodgkin-lymphoma.html. Accessed September 7, 2021.
- Non-Hodgkin lymphoma. Leukemia & Lymphoma Society. https://www.lls.org/sites/default/files/file_assets/PS58_NHL_Booklet_2020FINAL_rev.pdf. Accessed September 7, 2021.
- Non-Hodgkin lymphoma. Leukemia & Lymphoma Society. https://lls.org/lymphoma/non-hodgkin-lymphoma. Accessed September 7, 2021.
- NHL subtypes. Leukemia & Lymphoma Society. https://lls.org/lymphoma/non-hodgkin-lymphoma/nhl-subtypes. Accessed September 7, 2021.
- Sehn LH, Salles G. Diffuse large B-cell lymphoma. N Engl J Med. 2021;384:842-858. doi:10.1056/nejmra2027612.
- Cancer stat facts – non-Hodgkin lymphoma. National Cancer Institute. Surveillance, Epidemiology, and End Results Program (SEER). https://seer.cancer.gov/statfacts/html/nhl.html. Accessed September 7, 2021.
- Susanibar‐Adaniya S, Barta SK. 2021 update on diffuse large B cell lymphoma: a review of current data and potential applications on risk stratification and management. Am J Hematol. 2021;96:617-629. doi:10.1002/ajh.26151.
- Wang L, Li L, Young KH. New agents and regimens for diffuse large B cell lymphoma. J Hematol Oncol. 2020;13. doi:10.1186/s13045-020-01011-z.
- Sarkozy C, Sehn LH. Management of relapsed/refractory DLBCL. Best Prac Res Clin Haematol. 2018;31:209-216. doi:10.1016/j.beha.2018.07.014.
- Crump M, Neelapu SS, Farooq U, et al. Outcomes in refractory diffuse large B-cell lymphoma: results from the international SCHOLAR-1 study. Blood. 2017;131:587-588. doi:10.1182/blood-2017-11-817775.