Types and grades of non-Hodgkin lymphoma
Diffuse large B cell lymphoma (DLBCL) is a type of non-Hodgkin lymphoma (NHL).
NHL is a type of blood cancer that affects white blood cells called . It is a cancer of the .
DLBCL is fast growing (high grade). You have treatment soon after diagnosis. Treatment usually includes together with a called rituximab. Doctors call this chemoimmunotherapy.
This page is about DLBCL in adults.
Each year about 5,000 people are diagnosed with DLBCL in the UK. This makes up more than 40 out of 100 cases (40%) of NHL in adults.
DLBCL is more common in males than females.
Most people do not have a specific type of DLBCL. This is called DLBCL not otherwise specified (DLBCL NOS).
There are also some quite rare sub types of DLBCL. The treatment for most subtypes is similar.
These rare types include:
T-cell/histiocyte-rich large B-cell lymphoma
Epstein Barr virus positive DLBCL
ALK positive large B cell lymphoma
primary mediastinal (thymic) large B cell lymphoma
intravascular large B cell lymphoma
We have a separate information page about DLBCL that starts in the brain (primary CNS lymphoma).
Read about primary CNS lymphoma
For most people, the aim of treatment is to cure your lymphoma.
Treatment might also aim to:
control the lymphoma for as long as possible
control symptoms
stop lymphoma spreading to other parts of the body (such as the cerebrospinal fluid)
stop lymphoma coming back
Talk to your doctor or specialist nurse if you want to find out more about the aim of your treatment.
As DLBCL is fast growing (high grade) you have treatment soon after diagnosis. If there is no sign of lymphoma following treatment, this is called remission. Sometimes, lymphoma can come back (relapse). You would usually then have more treatment.
Treatment decisions
Your treatment depends on:
where your lymphoma is (the stage)
your symptoms
your general health and fitness
levels of some chemicals in your blood
whether your lymphoma is likely to come back after treatment
The main treatment options for DLBCL are:
combined with and a - doctors call this chemoimmunotherapy
chemotherapy to stop lymphoma spreading to your brain
Some people might have after chemoimmunotherapy.
You have the chemoimmunotherapy drugs on certain days. This is usually over 3 weeks. Each 3 week period is called a cycle of treatment. How many cycles you have depends on your situation.
You usually have chemoimmunotherapy as an outpatient, unless there is a reason why you need to stay in hospital.
After treatment, NHL sometimes doesn't go away or comes back. Your specialist might suggest other types of treatment in this situation including:
CAR-T cell therapy
targeted cancer drugs on their own, or together with chemotherapy
Read about the different treatment types for NHL
It isn't very common to be diagnosed with early stage DLBCL. Most people have advanced disease.
You usually have chemoimmunotherapy. You have it on its own, or combined with radiotherapy.
You might have one of the following:
4 cycles of R-CHOP - your doctor might recommend radiotherapy afterwards
6 cycles of R-CHOP
R-CHOP is one of the main chemoimmunotherapy combinations. It includes the drugs rituximab, cyclophosphamide, doxorubicin, vincristine and a steroid called prednisolone.
Go to our A-Z list of cancer drugs to read about the different drugs
You usually have chemoimmunotherapy. You might have one of the following:
6 cycles of Pola-R-CHP (rituximab, cyclophosphamide, doxorubicin hydrochloride, prednisolone and polatuzumab vedotin)
6 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine and prednisolone)
Your doctor looks at your test results to work out your prognostic score. They use this score to work out if you have a low, intermediate (medium), or high risk of the lymphoma coming back after treatment. This helps the doctor plan your treatment.
You might have more intensive treatment if you have a high risk of your lymphoma coming back.
There is no for this situation. This means treatment might vary between hospitals, depending on what treatment your doctors recommends.
You might have:
R-CODOX-M (rituximab, cyclophosphamide, vincristine, doxorubicin and methotrexate)
followed by R-IVAC (rituximab, ifosfamide, etoposide and cytarabine)
Or you might have:
R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone)
Pola-R-CHP (rituximab, cyclophosphamide, doxorubicin, prednisolone and polatuzumab vedotin)
You may have a less intensive treatment combination if you are older, or less fit and well. These might exclude certain drugs or have lower doses of drugs to reduce the side effects. For example, R-mini-CHOP.
Lymphoma can spread to your central nervous system (CNS). The CNS is your brain and spinal cord. Some types of DLBCL are more likely to spread to the CNS than others. If you have a high risk, your doctor might recommend treatment to prevent this.
Doctors are uncertain about the best way to prevent lymphoma spreading to the CNS. Research continues to look at this. Your specialist can tell you more about this. And they can tell you whether they think you should have preventative treatment.
You might have treatment to prevent CNS spread if your lymphoma is:
in your breast, testicles, adrenal gland, kidney or blood vessels (intravascular lymphoma)
likely to come back after treatment (high risk)
You might have a high dose of a chemotherapy drug called methotrexate. You have this into your vein (intravenously).
Occasionally, your doctor might suggest injections of methotrexate into the fluid around your spinal cord. This is called . It is very similar to having a lumbar puncture.
Read more about intrathecal chemotherapy
Lymphoma that does not go away with treatment is called refractory lymphoma. Lymphoma that comes back after treatment is called relapsed disease. You might have:
chemoimmunotherapy followed by a
CAR T-cell therapy
chemoimmunotherapy on its own
a targeted cancer drug treatment
radiotherapy
Your treatment plan will depend on what treatment you have already had, and how well you are.
Stem cell transplant
A stem cell transplant allows you to have very high doses of chemotherapy. You can have a transplant using:
your own stem cells (autologous stem cell transplant)
a donor’s stem cells (allogeneic stem cell transplant)
Most people have an autologous stem cell transplant. It is less common for people with DLBCL to have an allogeneic stem cell transplant.
Read more about stem cell transplants
CAR-T cell therapy
For CAR-T cell therapy a specialist collects and makes a small change to cells called s. After a few weeks, you have a drip containing these cells back into your bloodstream. The CAR T-cells then recognise and attack the cancer cells. This is a form of immunotherapy.
You might have it if your lymphoma has continued to grow or relapsed following at least 1 treatment. You need to be well enough for this treatment.
Read more about CAR-T cell therapy
Other treatments
Other treatments you might have include the following drugs:
glofitamab
epcoritamab
loncastuximab tesirine
Read more about targeted cancer drugs for NHL
If you aren't well enough for these treatments, you might have chemoimmunotherapy. You might have polatuzumab vedotin together with bendamustine (chemotherapy) and rituximab.
You might also have radiotherapy to help control symptoms caused by your lymphoma.
Lymphoma and its treatment can cause problems. Supportive treatments can help to either prevent or control these problems.
Supportive treatments you might need include:
medicines to prevent bacterial or viral infections
injections to boost your immune system (GCSF)
Researchers around the world are looking at the treatments for NHL. Your doctor might suggest you take part in a clinical trial.
Read more about research into NHL
DLBCL and treatment is likely to cause physical changes in your body. The treatment can be very intense. You might be in and out of hospital for at least a few months. These changes can be hard to cope with and can affect the way you feel about yourself.
You might also have to cope with feeling very tired and lethargic a lot of the time, especially for a while after treatment.
Ask your medical team about possible support and help.
It can help to talk to friends and family. Or join a support group to meet people in a similar situation.
Our discussion forum Cancer Chat is a place for anyone affected by cancer. You can share experiences, stories and information with other people who know what you are going through.
You might need practical advice about benefits or financial help. There is help and support available.
Last reviewed: 08 Mar 2024
Next review due: 08 Mar 2027
You usually start by seeing your GP. They might refer you to a specialist doctor (haematologist) and organise tests.
Your treatment depends on the type and stage of your NHL. Common treatments include chemotherapy, targeted and immunotherapy drugs, radiotherapy and a stem cell transplant.
Practical and emotional support is available to help you cope with non-Hodgkin lymphoma.
Non-Hodgkin lymphoma (NHL) is a cancer of the lymphatic system. There are more than 60 different types of non-Hodgkin lymphoma. They can behave in very different ways and need different treatments.
Non-Hodgkin lymphoma (NHL) in children is a type of blood cancer that affects white blood cells. It is also called a cancer of the lymphatic system.
There are many cancer drugs, cancer drug combinations and they have individual side effects.
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What to ask your doctor about clinical trials.
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