Diffuse Large B-Cell Lymphoma (DLBCL) represents an aggressive form of non-Hodgkin lymphoma, originating from B-lymphocytes. This cancer develops rapidly and requires prompt treatment. While many individuals respond well to therapy, the condition can prove fatal, making an understanding of mortality factors important. This article explores the various aspects contributing to death in individuals diagnosed with DLBCL.
Prognosis and Survival Rates for DLBCL
The outlook for individuals with DLBCL varies. The five-year relative survival rate for DLBCL, which indicates the percentage of patients alive five years after diagnosis compared to the general population, is approximately 65% based on data from 2014 to 2020. However, these figures are averages across all stages and patient demographics, meaning individual outcomes can differ significantly.
Survival rates for DLBCL are influenced by several variables, including the stage of the disease at diagnosis and the patient’s overall health. For localized disease, such as stage 1, the five-year survival rate can be as high as 79.2%. Conversely, for advanced-stage disease, the survival rate tends to be lower.
Factors Influencing Mortality in DLBCL
Several factors influence mortality in individuals with DLBCL. The extent of the disease at diagnosis, often determined by the Ann Arbor staging system, plays a substantial role. Patients diagnosed with advanced-stage DLBCL, such as stage III or IV, where the lymphoma has spread to multiple lymph node areas or organs, generally face a higher risk of mortality compared to those with localized stage I or II disease.
A patient’s age and overall health, including the presence of other medical conditions (comorbidities), also affect survival. Older patients, especially those aged 60 years or older, or those with significant pre-existing health issues, may not tolerate aggressive treatments well, potentially leading to poorer outcomes. Specific genetic and molecular characteristics of the lymphoma cells can impact mortality. For instance, “double-expression” lymphomas, involving overexpression of MYC and BCL2 proteins, are associated with a worse prognosis. The initial response to treatment is another important determinant; patients whose disease does not respond adequately to first-line therapy or who experience early relapse often have a poorer long-term outlook.
Common Causes of Death in DLBCL Patients
Death in individuals with DLBCL often results from the aggressive progression of the lymphoma itself or from complications arising from intensive treatments. The most frequent cause of death is the lymphoma itself, accounting for approximately 68.7% of deaths in patients with DLBCL. This occurs when the disease is refractory, meaning it does not respond to initial treatment, or when it relapses and progresses aggressively despite subsequent therapies. Uncontrolled growth of lymphoma cells can lead to organ dysfunction and failure.
Complications from intensive chemotherapy regimens, while necessary for treatment, can also be life-threatening. Severe infections are a common cause of death, as chemotherapy suppresses the bone marrow, leading to a dangerously low white blood cell count (neutropenia) that impairs the immune system’s ability to fight off pathogens. About 20.1% of deaths are due to non-cancer causes, with cardiovascular and infectious diseases being leading non-cancer causes. Organ toxicity, such as damage to the heart or other organs, can also occur due to certain chemotherapy drugs, potentially leading to organ failure. Less commonly, but still possible, death can result directly from the lymphoma’s impact on vital organs if the disease is widespread and uncontrolled, leading to direct interference with organ function.
Managing Advanced or Refractory DLBCL
When DLBCL becomes advanced, does not respond to initial treatment (refractory), or recurs after remission (relapsed), management strategies shift to address these challenging scenarios. Subsequent lines of treatment, often referred to as salvage therapies, are employed to achieve a new remission. These can include different chemotherapy regimens, often more intensive than initial treatments, aiming to reduce the tumor burden. For eligible patients, high-dose chemotherapy followed by an autologous stem cell transplant (ASCT) offers a chance of cure for those with chemosensitive relapsed or refractory DLBCL.
A more recent and highly effective approach for refractory or relapsed DLBCL is CAR T-cell therapy. This innovative treatment involves genetically modifying a patient’s own T-cells to recognize and attack lymphoma cells, offering a significant chance of durable remission for some patients. Three CAR T-cell products, axicabtagene ciloleucel (axi-cel), tisagenlecleucel (tisa-cel), and lisocabtagene maraleucel (liso-cel), are approved for the treatment of relapsed or refractory DLBCL. When curative options are limited or no longer feasible, palliative care becomes an integral part of management, focusing on alleviating symptoms and improving the overall quality of life for the patient.