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The 70-Year-Old Secret: What are the surprising facts behind the diagnosis of DLBCL patients?
When it comes to lymphomas, blue large B-cell lymphoma (DLBCL) is undoubtedly the one that attracts the most attention. It is a malignant tumor derived from B cells, the type of white blood cells responsible for producing antibodies. As age increases, especially in those over 70 years old, the incidence rate increases significantly, making DLBCL the latest medical challenge.
DLBCL is the most common non-Hodgkin lymphoma, and its diagnosis faces many challenges, especially in the elderly.
Basic concepts of DLBCL
DLBCL has an annual incidence of 7–8 cases per 100,000 people in the United States and United Kingdom. This type of urea tumor usually grows rapidly in lymph nodes or other tissues and is accompanied by systemic symptoms such as fever, weight loss, and night sweats. These initial symptoms often confuse patients and lead to delayed diagnosis.
The key challenge is to perform surgery to sample the tumor for histological analysis, which is the only way to confirm the diagnosis.
DLBCL usually develops rapidly and can affect almost any part of the body. Although the disease usually originates from normal B cells, in some cases it may also arise due to malignant transformation of other lymphomas. The cause of DLBCL is not yet fully understood, but studies have pointed out that factors including immune deficiency and viral infection may increase its risk.
Subtypes of DLBCL
The subtypes of DLBCL are very diverse and exhibit different proportions of biological and clinical features. According to the World Health Organization classification, DLBCL can be divided into multiple subtypes. According to the 2016 reclassification, the most common subtype is "large B-cell lymphoma, not otherwise specified" (DLBCL, NOS), and this form accounts for 80–85% of all DLBCL.
Clear prognostic indicators
The prognosis of DLBCL is affected by many factors, including the patient's age, serum lactate dehydrogenase level and physical condition. Especially patients over 60 years old, or individuals with multiple affected lymph nodes, have a poor prognosis.
Depending on the type and initial location of the case, accumulation in the brain, adrenal glands and organs may have more serious consequences.
Discussion on pathophysiology
In pathophysiology, DLBCL is mainly caused by gene mutations and changes in gene expression. These changes will affect the signaling pathways of cell growth and survival. Studies have shown that changes in proto-oncogenes such as BCL2, MYC and BCL6 are common in patients, and these changes can promote the proliferation of tumor cells.
Diagnostic process of DLBCL
Diagnosing DLBCL usually requires a biopsy, where the removed tumor tissue is viewed under a microscope. After diagnosis, doctors will plan appropriate treatment plans based on different types of tumors. Most patients' tumor cells are labeled with CD20, which provides a good target for treatment.
Treatment and prognosis
Depending on the needs of different subtypes, treatment options for DLBCL usually include chemotherapy and monoclonal antibodies (such as rituximab). For the GBC variant, the first-line therapy is R-CHOP; while for the ABC variant, the DA-R-EPOCH regimen is recommended. The overall efficacy of these regimens is also relatively high and brings new hope to most DLBCL patients.
About half of DLBCL patients can be cured with treatment, and the five-year survival rate for elderly patients is about 58%.
However, even under highly effective treatment, the prognosis of DLBCL patients still depends on multiple factors, including genetic mutations and tumor progression. However, advances in overall treatment options have significantly improved the prognosis of GBC type.
With the continuous advancement of modern medicine, research on the cause, diagnosis and treatment of DLBCL has become a future prospect. However, as we face this condition, are there more effective treatment strategies that need to be further explored?
