Diffuse large B-cell lymphoma (DLBCL) stage 4 is an advanced cancer. Despite its aggressive nature, DLBCL usually responds well to treatment, and new therapies are in development to help improve outcomes.
Lymphoma is a type of cancer that begins in the lymph nodes of your lymphatic system, the network of organs, vessels, and fluid that supports immune function and assists in maintaining your body’s fluid balance. While there are many types of lymphoma, DLBCL is the most common.
If you’ve received a diagnosis of DLBCL stage 4, learning as much as you can about your condition can be empowering and help you feel confident in your treatment decisions.
DLBCL is a type of non-Hodgkin’s lymphoma. It’s a cancer originating in your lymph nodes. “Non-Hodgkins” means DLBCL does not feature unique cells seen in other lymphomas known as
At
As a B-cell lymphoma, DLBCL begins in B lymphocytes, a type of white blood cell responsible for making antibodies for your immune system. Though B cells develop in your bone marrow, they travel to other areas in the body, like lymph nodes, to mature and carry out their functions.
DLBCL describes large B-cell lymphoma (LBCL) where cancer cells grow and spread rapidly, or have a “diffuse” pattern. They’re identified by their unusually large size.
DLBCL can fall into several cell of origin subtypes:
- Germinal center B-cell-like (GCB): Begins in B cells from the germinal center, a cellular microenvironment within lymphoid follicles of lymph nodes.
- Activated B-cell-like (ABC): Begins in B cells that have been activated by antigens but haven’t fully matured within the germinal center.
- Unclassified: Cancer does not clearly match with either GCB or ABC.
Other types of DLBCL exist, defined by characteristics such as unique genetic variations, the involvement of other cell types, and uncommon sites of origin, like the central nervous system (CNS).
Examples of other subtypes of DLBCL
- Primary mediastinal DLBCL: Primarily affecting the mediastinum, the space between the lungs.
- Primary CNS DLBCL: Primarily affecting the brain and spinal cord.
- Double-hit lymphoma (DHL): DLBCL involving genetic alterations of the MYC gene and the BCL2 or BCL6 gene.
- Triple-hit lymphoma (THL): DLBCL involving genetic alterations of the MYC, BCL2, and BCL6 genes.
What is CNS prophylaxis in DLBCL?
CNS prophylaxis is a preventive lymphoma treatment to help reduce the chance that cancer will spread to your CNS.
Your doctor will consider this therapy if you’re experiencing certain features that suggest high risk for CNS involvement, such as a high international prognostic index (IPI) score. Your IPI score evaluates factors such as cancer’s stage and locations, levels of blood biomarkers, and how it’s affecting you overall.
CNS prophylaxis involves one or both of the following:
- administering chemotherapy agents directly into the fluid of your spinal cord
- administering high dose methotrexate — a chemotherapy drug — intravenously, which is an injection given into your vein over time
The use of CNS prophylaxis
Experts consider DLBCL an aggressive cancer, meaning it grows and spreads more quickly than other types of lymphoma.
Despite its rate of progression, it responds well to first-line therapies. As many as
According to the American Cancer Society, the 5-year survival rate for stage 4 DLBCL is
Your overall outlook also depends on your IPI score. With stage 4 DLBCL, you can still be low to intermediate risk for a less favorable outlook if other metrics are good, like your blood level of lactate dehydrogenase.
How long can you live with DLBCL?
There’s no way to know how long someone can live with DLBCL. Your cancer stage, response to treatment, and overall health can all make a difference.
On average, the
Is DLBCL always terminal?
No, DLBCL is not always terminal or the cause of death. It’s considered a curable type of non-Hodgkin’s lymphoma for many people.
Outlook improves with early detection and diagnosis and can be affected by which subtype of DLBCL you have.
Treatment for stage 4 DLBCL involves first-line chemotherapy protocols known as R-CHOP and Pola-R-CHP. They combine monoclonal antibodies with certain chemotherapy drugs.
R-CHOP stands for:
- R: rituximab
- C: cyclophosphamide
- H: doxorubicin hydrochloride (Hydroxydaunomycin)
- O: vincristine sulfate (Oncovin)
- P: prednisone
Pola-R-CHP stands for:
- Pola: polatuzumab vedotin
- R: rituximab
- C: cyclophosphamide
- H: doxorubicin hydrochloride (Hydroxydaunomycin)
- P: prednisone
You’ll have several rounds of these treatments before your doctor requests diagnostic imaging to view cancer locations and determine the effectiveness of the treatment.
If doctors believe you are high risk for cancer returning after treatment or for CNS involvement, they may consider prophylaxis therapy.
For younger people with stage 4 DLBCL,
Clinical trials are a part of investigative research into potential therapies for cancer and other conditions. If you’ve received a diagnosis of stage 4 DLBCL, clinical trials offer access to new treatments that aren’t currently available to the general public.
If you’ve had low success with traditional treatments, a clinical trial may offer the opportunity to benefit from a novel therapy. You’ll also gain the support of an advanced medical team, usually at a significantly reduced cost.
You can find clinical trials for DLBCL at ClinicalTrials.gov.
Trials that are currently recruiting include:
Even though stage 4 DLBCL is considered advanced, it’s still possible to achieve remission — a period of time when clinical signs of cancer are improved or absent.
Taking care of your overall health, keeping up with treatments, and visiting your oncologist regularly can help you maintain a high quality of life.
Receiving a stage 4 DLBCL diagnosis can feel overwhelming, and it’s natural to have a lot of questions, concerns, and apprehension about what happens next.
Learning more about DLBCL helps promote a sense of empowerment about your diagnosis. With treatment, lifestyle improvements, and regular care, positive outcomes are possible even when DLBCL reaches stage 4.