B-cell lymphomas are a type of lymphoma. Lymphoma is cancer that affects the lymphatic system. The lymphatic system is made up of organs, glands, tubelike vessels and clusters of cells called lymph nodes. It's part of the body's germ-fighting immune system. B-cell lymphomas can affect lymph nodes, blood, bone marrow, and other tissues throughout the body, such as in the gastrointestinal system, central nervous system, bones or skin.

There are many types of lymphoma. They are often divided into two categories: Hodgkin lymphoma and non-Hodgkin lymphoma. B-cell lymphomas are a type of non-Hodgkin lymphoma. There are many subtypes of B-cell lymphoma.

B-cell lymphomas get their names from the kind of cell that makes up these cancers. These cancers start in germ-fighting white blood cells called B cells. B cells also are called B lymphocytes.

Treatment for B-cell lymphomas may include a "watch and wait" approach, immunotherapy, chemotherapy, radiation therapy, targeted therapy, clinical trials, chimeric antigen receptor (CAR)-T cell therapy, and bone marrow transplant, also called bone marrow stem cell transplant.

Types

There are many types of B-cell lymphoma, including:

• Burkitt lymphoma. This type is very aggressive but can be highly treatable if therapy begins right away. It may be found in the lymph nodes, bone marrow, gastrointestinal system, jaw or other bones in the face.
• Chronic lymphocytic leukemia/small lymphocytic lymphoma. This type grows slowly and may not need treatment right away. It may be found while testing for other conditions. It's usually found in the blood and bone marrow. Small lymphocytic lymphoma involves lymph nodes.
• Diffuse large B-cell lymphoma. This is the most common B-cell lymphoma. It grows quickly and needs to be treated right away for the best prognosis. It may be found in the lymph nodes, bone marrow, gastrointestinal system, central nervous system, bones or skin.
• Follicular lymphoma. This type grows slowly and may not need treatment right away. However, it also can become more aggressive over time. It's usually found in the lymph nodes, bone marrow or spleen.
• Mantle cell lymphoma. This type typically grows quickly but may act as a slow- or fast-growing lymphoma. It can be found in the lymph nodes, bone marrow, gastrointestinal tract and, sometimes, the spleen.
• Marginal zone lymphoma. This type is slow-growing and may not need treatment right away. It has three subtypes that tell where the cancer is in the body. Extranodal marginal zone lymphoma (MALT lymphoma) is found outside of the lymph nodes, most commonly in the stomach. Nodal marginal zone lymphoma is found in the lymph nodes. And splenic marginal zone lymphoma affects the spleen and sometimes the blood and bone marrow.
• Primary central nervous system lymphoma. This rare type grows quickly. It involves the brain, spinal cord and, sometimes, tissues around the spinal cord. It also may affect the eyes, known as primary intraocular lymphoma.
• Primary cutaneous B-cell lymphoma. This rare type affects the skin. It can cause lumps or hard patches of skin.
• Primary mediastinal large B-cell lymphoma. This rare type grows quickly. It starts in the chest and can cause a mass that leads to trouble breathing or swelling in the face and neck.
• Waldenstrom macroglobulinemia. Also known as lymphoplasmacytic lymphoma, this type grows slowly and may not cause symptoms for years. It may not need treatment right away. Waldenstrom macroglobulinemia is mainly found in the bone marrow, lymph nodes and spleen.

Healthcare professionals may describe B-cell lymphomas as either aggressive or indolent. Aggressive lymphomas grow quickly and may have more symptoms. Indolent lymphomas grow slowly and may not have symptoms at first. Treatments may vary depending on whether the lymphoma is aggressive or indolent. Some indolent lymphomas can change into aggressive lymphomas.

Symptoms of B-cell lymphomas vary depending on the type you have and what part of the body it affects. You may not have symptoms. When they happen, symptoms of B-cell lymphomas include:

• Swollen lymph nodes in the neck, armpit and groin.
• Fever.
• Drenching night sweats.
• Fatigue.
• Weight loss without trying.
• Loss of appetite.

When to see a doctor

Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you.

It's not clear what causes B-cell lymphomas. Cancer happens when cells develop changes in their DNA. A cell's DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA gives instructions to grow and multiply at a set rate. The instructions tell the cells to die at a set time. In cancer cells, the DNA changes give different instructions. The changes tell the cancer cells to make many more cells quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells.

B-cell lymphomas get their names from the kind of cell that makes up these cancers. These cancers start in germ-fighting white blood cells called B cells. B cells also are called B lymphocytes.

Factors that can increase the risk of B-cell lymphomas include:

• A family history of lymphoma. Having a blood relative, such as a parent or sibling, with lymphoma may increase your risk of B-cell lymphomas.
• A weakened immune system or an autoimmune condition. Having a condition that affects the immune system can increase the risk of B-cell lymphomas. Conditions may include Hashimoto disease, Sjogren syndrome, ataxia-telangiectasia, rheumatoid arthritis and lupus. The immune system also may be weakened after organ transplant.
• Some infections. Some infections have been linked to types of B-cell lymphoma. These infections include human immunodeficiency virus (HIV), Epstein-Barr virus, Helicobacter pylori (H. pylori), hepatitis C and others.

Complications of B-cell lymphomas may include:

• Relapse. Even after successful treatment, B-cell lymphomas may come back. This is called a relapse. Sometimes the relapse happens years later. Some people may have multiple relapses.
• Transformation. Some types of slow-growing B-cell lymphomas can change into more aggressive types. These lymphomas often have a worse prognosis and need stronger treatments.

Diagnosis of B-cell lymphomas often begins with a physical exam that checks for swollen lymph nodes in the neck, underarms and groin and an enlarged spleen or liver. Other tests and procedures include blood tests, imaging tests and taking a sample of tissue for lab testing.

Blood tests

Blood tests can sometimes show whether lymphoma cells are present. Blood tests may be used to test for viruses, including Epstein-Barr virus, HIV and hepatitis C virus. Blood tests also measure levels of lactate dehydrogenase (LDH), which is often higher in people with lymphoma.

Imaging tests

Imaging tests make pictures of the body. They can show the location and extent of B-cell lymphoma. Tests might include MRI, CT and positron emission tomography (PET) scans.

Biopsy

Your healthcare professional may suggest a lymph node biopsy or a biopsy of other tissue to look for cancer cells. A biopsy is a procedure to remove a sample of tissue for testing in a lab. A lymph node biopsy involves removing all or part of a lymph node. A sample may be taken from other parts of the body depending on symptoms and imaging test results. In the lab, tests may show whether you have a B-cell lymphoma.

Bone marrow aspiration and biopsy

Bone marrow aspiration and biopsy are procedures to collect cells from the bone marrow for testing. Bone marrow is the soft matter inside bones where blood cells are made. Bone marrow has a solid part and a liquid part.

In a bone marrow aspiration, a needle is used to collect a sample of the fluid. In a bone marrow biopsy, a needle is used to collect a small amount of the solid tissue. Most often, the samples are taken from the hip bone. The samples go to a lab for testing. In B-cell lymphomas, this procedure can show if the bone marrow is involved and help determine the cancer's extent.

Lumbar puncture

A lumbar puncture is a procedure to collect fluid from around the spinal cord. A lumbar puncture, also called a spinal tap, uses a needle. A healthcare professional inserts the needle between two bones in the lower back and draws out some of the fluid that surrounds the brain and spinal cord. This fluid is called cerebrospinal fluid. The fluid goes to a lab where it's tested for cancer cells.

For B-cell lymphomas, a lumbar puncture may be done if you have neurological symptoms. It also may be done if you are at higher risk of lymphoma of the central nervous system.

Endoscopy

An endoscopy is a procedure to look at the inside of the esophagus, stomach and first part of the small intestine. A thin, tubelike instrument with a light and a lens for viewing, called an endoscope, is inserted through the mouth and passed down the throat. Tools are passed through the tube to remove a sample of tissue for testing. It may be used if your healthcare professional thinks you have a B-cell lymphoma in the stomach.

Testing lymphoma cells in the lab

Lymphoma cells collected from a biopsy or a bone marrow aspiration and biopsy go to a lab for testing. In the lab, specialized tests look for specific things about the cells. The healthcare team uses the results to find out the type of lymphoma that you have.

To learn whether the cells are B-cell lymphoma cells, the healthcare professionals in the lab look for:

• Proteins on the surface of the cancer cells. B-cell lymphoma cells have certain proteins on their surfaces that help identify them. These proteins are known as markers. These markers can help identify the type of B-cell lymphoma.
• Changes in the cancer cell DNA. Cancer happens when cells get changes in their DNA. A cell's DNA holds the instructions that tell the cell what to do. Some B-cell lymphomas have a gene change that causes their DNA to rearrange. This is known as translocation. Some genes also may be missing parts of their DNA, called deletion. These gene changes cause the cells to multiply rapidly.

B-cell lymphoma staging

If you're diagnosed with a B-cell lymphoma, the next step is to determine the cancer's extent, called the stage. Imaging tests, blood tests and biopsies may be used to determine the stage of a B-cell lymphoma. Your healthcare team uses the cancer stage to help create your treatment plan.

The stages of B-cell lymphomas may vary slightly depending on which type you have. Overall, the stages range from 1 to 4:

• Stage 1 B-cell lymphoma. At stage 1, B-cell lymphoma affects only one lymph node region or one site outside of the lymph nodes.
• Stage 2 B-cell lymphoma. A stage 2 B-cell lymphoma involves two or more lymph node regions on the same side of the diaphragm.
• Stage 3 B-cell lymphoma. At stage 3, B-cell lymphoma involves lymph node regions on both sides of the diaphragm.
• Stage 4 B-cell lymphoma. A stage 4 B-cell lymphoma involves regions outside of the lymph nodes.

B-cell lymphoma prognosis

The cancer prognosis tells you how likely it is that the cancer can be treated or cured. Your personal prognosis may depend on:

• Your age.
• Your overall health.
• The cancer's stage.
• Your blood test results.

Talk with your healthcare team about your prognosis if you want to know what to expect. Members of your healthcare team can explain what they consider when thinking about your prognosis.

B-cell lymphoma survival rates

Survival rates are different for each type of B-cell lymphoma. They also depend on your overall health, the stage of your cancer and which treatments you are getting. For example, the most common B-cell lymphoma, diffuse large B-cell lymphoma, has a five-year survival rate of 80% at stage 1. As the cancer spreads, the survival rate gets lower. For stage 4 diffuse large B-cell lymphoma, the chance of surviving at least five years is about 55%.

Treatments for B-cell lymphomas may include immunotherapy, chemotherapy, radiation therapy, targeted therapy, CAR-T cell therapy and bone marrow transplant, also called bone marrow stem cell transplant. Which treatment is best for you depends on the type of B-cell lymphoma you have and the extent of your cancer, called the stage. Your healthcare team also considers how quickly the cancer is growing, your overall health and what you prefer.

Watch and wait

If your B-cell lymphoma doesn't cause symptoms, you might not need treatment right away. Instead, you may have checkups every few months. The checkups help your healthcare team watch your condition to see if your cancer is growing.

Immunotherapy

Immunotherapy for cancer is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.

Immunotherapy may be used as a first line treatment for some B-cell lymphomas. It may be combined with chemotherapy or other medicines. Immunotherapy also may be an option when other treatments haven't worked, known as refractory B-cell lymphoma, or for cancer that comes back after treatment, called relapsed B-cell lymphoma.

Chemotherapy

Chemotherapy treats cancer with strong medicines. There are many chemotherapy medicines. Most chemotherapy medicines are given through a vein. Some come in pill form.

Chemotherapy may be used as a first line treatment for some B-cell lymphomas. It may be combined with immunotherapy or other medicines. Chemotherapy also may be an option for some refractory or relapsed B-cell lymphomas.

Radiation therapy

Radiation therapy for cancer is a treatment that uses powerful energy beams to kill cancer cells. The energy can come from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points in your body.

Radiation therapy may be used as a first line treatment for some B-cell lymphomas. It may be combined with chemotherapy or other medicines. Radiation therapy also may be used to ease symptoms and improve quality of life for people with some types of B-cell lymphomas.

Targeted therapy

Targeted therapy for cancer is a treatment that uses medicines that attack specific chemicals in cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die.

Targeted therapy may be used as a first line treatment for some B-cell lymphomas. It also may be an option for some refractory or relapsed B-cell lymphomas.

Clinical trials

Clinical trials are studies of new treatments. These studies provide a chance to try the latest treatments. The risk of side effects might not be known. Ask your healthcare team if you might be able to be in a clinical trial.

CAR-T cell therapy

Chimeric antigen receptor (CAR)-T cell therapy trains the immune system cells to fight B-cell lymphoma. This treatment begins with removing some white blood cells, including T cells, from the blood.

The cells are sent to a lab. In the lab, the cells are treated so that they make special receptors. The receptors help the cells recognize a marker on the surface of the lymphoma cells. Then the cells go back into the body. They find and destroy the B-cell lymphoma cells.

CAR-T cell therapy might be an option for some refractory or relapsed B-cell lymphomas.

Bone marrow transplant

A bone marrow transplant, also called a bone marrow stem cell transplant, involves putting healthy bone marrow stem cells into the body. These cells replace cells hurt by chemotherapy and other treatments. Stem cells can come from your own body, called an autologous transplant. Stem cells also can come from a donor, called an allogeneic transplant.

A bone marrow transplant may only be an option for some types of B-cell lymphoma and for people who are younger and in good health. Chemotherapy is typically done before the transplant to suppress the immune system and bone marrow.

Monitoring after treatment

After treatment is complete, you may have frequent follow-up appointments to see if the cancer has come back, known as a relapse. You may have repeat blood and imaging tests and, if needed, biopsies, to check for relapse.

Side effects of treatment

Treatments for B-cell lymphomas may have side effects. These may include nausea, vomiting, fatigue, fever, rash, diarrhea and more. Harmful side effects from treatments may include:

• Bone marrow suppression. When the bone marrow is suppressed, it can't produce enough blood cells, including white blood cells. White blood cells help fight infections, so with a lower amount, you are at a higher risk of infections.
• Febrile neutropenia. Febrile neutropenia is a serious condition that can happen in people being treated for cancer. Febrile means having a fever. Neutropenia means having a low number of neutrophils, which are a type of white blood cell that helps fight infections. In febrile neutropenia, the body is trying to fight an infection but doesn't have enough neutrophils.
• Medicine toxicity. Some medicines used to treat cancer can be harmful to the body. They can cause organ damage and other issues. Whether a medicine is toxic depends on the type and how much you take. There are many different medicine options, so your healthcare team can work with you to find the best medicines for you.
• Reactivating viruses. If you have had a viral infection in the past such as hepatitis B or hepatitis C, some treatments can cause the virus to become active again. This can lead to liver inflammation, liver damage and other complications.
• Tumor lysis syndrome. Tumor lysis syndrome is a serious condition that can happen when cancer cells break down quickly after treatment. When these cells die, they release substances into the bloodstream that can overwhelm the body. This can lead to issues with the kidneys and other organs. You may take medicines to treat or prevent harmful side effects.

With time, you'll likely find what helps you cope with the uncertainty and worry of a cancer diagnosis. Until then, you may find that it helps to:

Learn enough about B-cell lymphoma to make decisions about your care

Ask your healthcare team about your cancer, including your test results, treatment options and, if you want, your prognosis. As you learn more about B-cell lymphomas, you may become more confident in making treatment decisions.

Keep friends and family close

Keeping your close relationships strong can help you deal with your B-cell lymphoma. Friends and family can provide the practical support you may need, such as helping take care of your home if you're in the hospital. And they can serve as emotional support when you feel overwhelmed by having cancer.

Find someone to talk with

Find someone who is willing to listen to you talk about your hopes and worries. This person may be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful.

Ask your healthcare team about support groups in your area. Other sources of information include the National Cancer Institute, the American Cancer Society, the Leukemia & Lymphoma Society and the Lymphoma Research Foundation.

Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you.

If your healthcare professional thinks you might have a B-cell lymphoma, you may be referred to a doctor who specializes in diseases that affect blood cells, called a hematologist. If a cancer diagnosis is made, you also may be referred to a doctor who specializes in treating cancer, called an oncologist.

Because appointments can be brief, it's a good idea to be prepared. Here's some information to help you get ready.

What you can do

• Be aware of anything you need to do ahead of time. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down symptoms you have, including any that may not seem related to the reason for which you scheduled the appointment.
• Write down important personal information, including major stresses or recent life changes.
• Make a list of all medicines, vitamins and supplements you're taking and the doses.
• Take a family member or friend along. It can be hard to remember all the information you get during an appointment. Someone who goes with you may remember something that you missed or forgot.
• Write down questions to ask your healthcare team.

Your time with your healthcare team is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For B-cell lymphomas, some basic questions to ask include:

• Do I have a B-cell lymphoma?
• What type of B-cell lymphoma do I have?
• What is the stage of my B-cell lymphoma?
• Has my B-cell lymphoma spread to other parts of my body?
• Will I need more tests?
• What are the treatment options?
• How much does each treatment prolong my life or increase my chances of a cure?
• What are the potential side effects of each treatment?
• How will each treatment affect my daily life?
• Is there one treatment option you believe is the best?
• What would you recommend to a friend or family member in my situation?
• Should I see a specialist?
• Are there any brochures or other printed material that I can take with me? What websites do you recommend?
• What will determine whether I should plan for a follow-up visit?

Don't hesitate to ask other questions.

What to expect from your doctor

Be prepared to answer questions, such as:

• When did your symptoms begin?
• Do your symptoms happen all the time or do you have them now and then?
• How bad are your symptoms?
• What, if anything, seems to make symptoms better?
• What, if anything, seems to worsen your symptoms?
• Have you had any fevers, night sweats or weight loss?
• Have you noticed any lumps, swelling or pain anywhere in your body?
• Have you had any chest pain, coughing or trouble breathing?
• Have you had any recent infections?
• Do you have any other health conditions, such as diabetes, heart disease or kidney disease?
• What are your biggest worries about your diagnosis or treatment?