Lymphoma is a cancer of the lymphatic system, the body’s network for fighting infections. It begins in cells called lymphocytes, and when these are B-cells—a type of white blood cell that produces antibodies—the cancer is known as B-cell lymphoma. The term “aggressive” signifies that the cancer cells multiply and spread quickly, necessitating prompt medical intervention. This condition is a category of non-Hodgkin lymphoma that includes various fast-growing cancers.
Recognizing the Symptoms
A set of indicators known as “B symptoms” can signal the presence of an aggressive B-cell lymphoma. These include fevers with no clear cause, drenching night sweats that can soak through clothing and bedding, and noticeable, unintentional weight loss. These are systemic symptoms, meaning they affect the entire body as a result of the cancer’s activity.
Other physical signs may appear depending on where the lymphoma is growing. The most common sign is a painless swelling in the lymph nodes, detected as lumps in the neck, armpits, or groin. Some individuals might experience severe fatigue that rest does not alleviate, which can be due to anemia from the lymphoma affecting bone marrow. If the lymphoma affects organs like the spleen or liver, it can cause abdominal pain, a feeling of fullness, or visible swelling.
Common Subtypes of Aggressive B-Cell Lymphoma
Diffuse Large B-cell Lymphoma (DLBCL) is the most frequently diagnosed form of non-Hodgkin lymphoma worldwide. This subtype is marked by its rapid growth and can arise in lymph nodes or other body parts, including the gastrointestinal tract, bones, or brain. DLBCL can affect people of any age but is most common in individuals in their mid-60s.
Another highly aggressive form is Burkitt lymphoma, recognized as one of the fastest-growing human tumors. It is characterized by the swift multiplication of lymphoma cells, which can cause it to double in size in days. This subtype often presents in the jaw, central nervous system, bowel, or kidneys. There are three main variants, each associated with different geographic locations and patient populations.
Mantle Cell Lymphoma (MCL) is another subtype that is typically aggressive. It arises from B-cells in the “mantle zone” of the lymph node. While some forms of MCL can be slow-growing, it most often presents as a widespread disease that has spread to the lymph nodes, bone marrow, and other organs by the time it is discovered. Its aggressive nature requires immediate and intensive treatment.
Diagnostic Procedures
A definitive diagnosis is made through a biopsy. This procedure involves the removal of tissue, most commonly an entire lymph node in an excisional biopsy, to be examined under a microscope by a pathologist. In some cases, a core needle biopsy, which removes a small cylinder of tissue, may be performed.
Once a biopsy confirms lymphoma, imaging tests determine the extent, or stage, of the disease. Positron Emission Tomography (PET) scans and Computed Tomography (CT) scans are standard imaging tools. These scans create detailed pictures of the inside of the body, revealing which lymph nodes and organs are affected by the cancer.
Blood tests are also part of the diagnostic workup. A complete blood count (CBC) can show if the lymphoma has affected the bone marrow, leading to low levels of blood cells or platelets. Other blood tests assess the function of organs like the liver and kidneys and measure levels of proteins like lactate dehydrogenase (LDH), which can be elevated in fast-growing lymphomas.
Standard Treatment Approaches
The primary treatment for most aggressive B-cell lymphomas is chemoimmunotherapy, a combination of chemotherapy and immunotherapy. The most common regimen is R-CHOP, an acronym for Rituximab and four chemotherapy drugs: Cyclophosphamide, Doxorubicin (also known as Hydroxydaunorubicin), Vincristine (brand name Oncovin), and Prednisone. Rituximab is a monoclonal antibody that targets a protein on B-cells, working with the chemotherapy to kill cancer cells.
For patients whose lymphoma does not respond to initial treatment or returns after remission, more advanced therapies are available. CAR T-cell therapy is an immunotherapy where a patient’s own T-cells are genetically engineered to recognize and attack lymphoma cells. These modified cells are then infused back into the patient to fight the cancer.
A stem cell transplant may be another option for certain patients, particularly those with relapsed disease. This procedure uses high doses of chemotherapy to eliminate the lymphoma, after which the patient receives an infusion of healthy blood-forming stem cells, either their own or from a donor, to restore the bone marrow. Radiation therapy may be applied to target specific, localized areas of lymphoma.
Factors Influencing Prognosis
The prognosis for aggressive B-cell lymphoma is influenced by several factors. The particular subtype is a primary consideration, as some forms have better response rates to standard therapy. A patient’s age and overall health are also important, as younger patients with fewer coexisting health problems can better tolerate intensive treatments.
The cancer’s stage at diagnosis also plays a significant role; earlier-stage, localized cancers have a more favorable outlook. Doctors use the International Prognostic Index (IPI) to estimate a patient’s outlook, considering five factors: age, lymphoma stage, whether the lymphoma is in organs outside the lymphatic system, performance status, and the level of lactate dehydrogenase (LDH). How well the lymphoma responds to the initial treatment is also a strong indicator of the long-term prognosis.