B-Cell Lymphoma Treatment Options

B-cell lymphoma is a type of non-Hodgkin's lymphoma (NHL) that originates in the B cells. B cells are white blood cells that play a key role in the immune system, including the production of antibodies. B-cell lymphoma is the most common type of lymphoma (cancer of the lymphatic system), accounting for about 80%–85% of all lymphomas in the United States.

B-cell lymphoma can occur in areas of the body with lymph tissue such as the spleen, bone marrow, thymus, adenoids, tonsils, and digestive tract.

Two of the most common B-cell lymphomas are diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma. Both may cause enlargement of one or more lymph nodes, in addition to other signs and symptoms.

B-cell lymphomas can also significantly differ in their aggressiveness, prognosis, and response to treatment. Some B-cell lymphomas can be cured, while others have no cure.

B-Cell Lymphoma

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Types of Treatment

There are several treatment options if you have B-cell lymphoma. Your healthcare professional will determine the type of treatment you receive based on the following factors:

  • The type of B-cell lymphoma you have
  • How fast it's growing
  • Where the cancer is found in your body
  • Your symptoms
  • Your age
  • Your overall health

With the appropriate treatment, many people with B-cell lymphoma go into remission, which means there are no signs of cancer left in the body.

Chemotherapy

Chemotherapy is the main way to treat most types of B-cell lymphoma. It involves using drugs to suppress cancer cell growth or kill cancer cells. The treatment is systemic, which means that it exposes the entire body to cancer-fighting drugs. It is administered intravenously (IV) or orally through a pill.

Systemic treatments are needed if cancer has spread beyond its initial location (metastasized) or if there is a chance that it is spread. Chemotherapy can also be given in combination with radiation and immunotherapy.

Radiation Therapy

Radiation therapy also can treat B-cell lymphoma. It uses focused, high energy photon beams to kill the genetic material (DNA) in cancer cells and shrink tumors.

Unlike chemotherapy, which exposes the entire body to cancer-fighting drugs, radiation therapy is a local treatment. This means that the high doses of radiation used are usually aimed at and affect only the part of the body being treated.

Although radiation therapy is specific, nearby normal cells can also be affected by radiation. However, most recover and return to working as they normally do. Radiation therapy also does not kill cancer cells right away. It can take days or weeks of treatment before DNA is damaged enough for cancer cells to die.

Types of Radiation Therapy

There are two main types of radiation therapy, external beam and internal (brachytherapy), although other types are available.

Immunotherapy

Immunotherapy includes cancer treatments that use your immune system to fight cancer cells. There are several aggressive types of B-cell lymphomas, including DLBCL, mantle cell lymphoma (MCL), primary effusion lymphoma (PEL), and Burkitt lymphoma.

Immunotherapy is based on the theory that your immune system already knows how to identify, label, and kill foreign pathogens such as bacteria and viruses that invade the body. Based on the same approach, cancer cells may also be tagged as abnormal and eliminated by the immune system.

CAR T-Cell Therapy

Chimeric antigen receptor (CAR) T-cell therapy is a type of immunotherapy that uses a person's own immune cells to treat cancer cells.

T cells, which are a type of white blood cell (WBC), are removed from a person's blood and genetically modified to produce chimeric antigen receptors (CARs), which can recognize proteins (antigens) that are present on the surface of cancer cells.

After the modified immune cells are reinfused, their changes cause them to bind to the cancer cells and cause their deaths. The immune cells then multiply within the body and work to help eradicate cancer. 

Targeted Therapy Drugs

Targeted treatments are medicines that have been designed to attack particular proteins on lymphoma cells, such as B-cell lymphoma (BCL-2) proteins. BCL-2 proteins are a group of regulatory proteins that control programmed cell death (apoptosis) in cancerous B cells. Without producing these proteins, cancer cells will stop dividing and die.

In general, targeted treatments attack lymphoma cells more precisely than chemotherapy. This is because they can kill lymphoma cells more readily without affecting nearby healthy cells, leading to fewer side effects.

The most common targeted therapies for B-cell lymphoma are B-cell receptor (BCR) pathway inhibitors. BCR pathway inhibitors block the signals in cancerous B cells, which are necessary to produce BCL-2 proteins on cell surfaces.

Depending on the severity of your B-cell lymphoma, some targeted treatments are given on their own while others are given with chemotherapy.

Stem Cell Transplant

A stem cell transplant (also known as a bone marrow transplant) is sometimes used to treat lymphoma, including B-cell lymphoma, among patients who are in remission or have a relapse during or after treatment. Stem cell transplants also allow healthcare providers to administer higher doses of chemotherapy, sometimes along with radiation therapy.

Under normal circumstances, the amount of chemotherapy given is limited to prevent life-threatening side effects (such as severe damage to the bone marrow, which generates red and white blood cells).

With a stem cell transplant, healthcare providers can give high doses of chemotherapy to people, as they can receive a transplant of blood-forming stem cells to restore the bone marrow afterward.

Stem cell treatments are complex and can cause life-threatening side effects. If your healthcare provider believes this treatment is appropriate for you, it should be performed at a cancer center under the supervision of experienced medical personnel.

Factors Determining Your Best Treatment Option

There are many different types of B-cell lymphoma. Treatment usually depends both on the type of lymphoma and the stage of the disease, but many other factors can also be important.

Type of B-Cell Lymphoma

The two main types of B-cell lymphoma are diffuse large B-cell lymphoma (the most common type of B-cell lymphoma) and follicular lymphoma. DLBCL tends to grow quickly, and treatment often involves chemotherapy, using a regimen of four drugs known as CHOP:

  • C: Cytoxan (cyclophosphamide)
  • H: Adriamycin (hydroxydaunorubicin)
  • O: Oncovin (vincristine)
  • P: Prednisone

The immunotherapy drug Rituxan (rituximab) is often added to chemotherapy. This combo is called R-CHOP, a common way to treat B-cell lymphoma.

Although follicular lymphoma grows slowly and responds well to treatment, it is difficult to cure. Common treatments include R-CHOP and radiation therapy. If these treatments do not work well, it may be treated using different chemotherapy drugs, immunotherapy (CAR-T), or stem cell transplants.

Speed of Progression

Some types of B-cell lymphoma are indolent (slow growing), including small lymphocytic lymphoma (SLL) and chronic lymphocytic leukemia (CLL). If your cancer hasn't spread beyond the lymph nodes and isn’t an immediate risk to your health, you may not need to be treated right away. Your healthcare provider may use the watchful waiting approach, which involves monitoring your health closely until symptoms appear or change.

However, treatment is usually given soon after diagnosis for aggressive types of B-cell lymphoma, such as DLBCL and Burkitt lymphoma.

Location

Knowing the location of your B-cell lymphoma is important for your healthcare provider to determine the best treatment plan. For example, you may only need radiation therapy, which targets a specific area of the body, and not chemotherapy if your cancer isn't widespread.

However, people who have a higher risk of the lymphoma coming back later in the tissues around the brain and spinal cord may be treated with chemotherapy injected into the spinal fluid (called intrathecal chemotherapy).

Symptoms

If your B-cell lymphoma isn’t causing intense symptoms, your healthcare provider may put you on active monitoring (watchful waiting) until you need treatment.

Age

Non-Hodgkin's lymphoma is less common than Hodgkin's lymphoma in young adults, but the risk of NHL goes up as people get older. According to the American Cancer Society, the average age at the time of diagnosis for DLBCL is the mid-60s.

NHL can also occur in young adults. In this age group, it tends to grow quickly and require intensive treatment. But this population also tend to respond better to treatment than NHL in older adults.

Health

If you have other health issues, less intense chemotherapy regimens may be used to prevent side effects. Also, if lymphoma has spread to the bone marrow (spongy part of the bone that creates stem cells) or blood, stem cell transplant may not be a viable option, as it may be hard to get a stem cell sample that is free of cancer cells.

What to Expect

During your treatment for B-cell lymphoma, a wide range of healthcare experts will make sure you get the best possible care.

Your medical team will likely include a hematologist (doctor who specializes in the blood, bone marrow, and lymphatic system), oncologists (doctors specializing in cancer treatment), nutritionists, and more. They'll help you make health decisions and guide you through treatment.

Prognosis

According to the National Cancer Society, the overall five-year relative survival rate for people with NHL is 72%. However, survival rates can vary widely for different types and stages of B-cell lymphoma.

For diffuse large B-cell lymphoma, five-year survival for localized or regional spread is 73%, but for people who have distant spread, it is 57%. The outlook is better for follicular lymphoma, with 96% five-year survival for localized spread, 90% for regional spread, and 85% for distant spread.

For this data, keep in mind that it is based on people who were diagnosed at least five years ago. It doesn't reflect any newer treatments that may be more effective. Also, many factors individual for each patient will influence their survival.

What If Treatment Doesn't Work?

If your B-cell lymphoma doesn’t respond to the initial treatment or comes back later, it may be treated with different chemotherapy drugs, immunotherapy, targeted drugs, or some combination of these. A stem cell transplant also may be an option.

Summary

B-cell lymphoma is a type of non-Hodgkin's lymphoma (NHL) that originates in the B cells, which play a key role in the immune system.

Two of the most common B-cell lymphomas are diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma, and they can significantly differ in their aggressiveness, prognosis, and response to treatment. Some B-cell lymphomas can be cured, while others have no cure yet.

Treatment depends on many factors, such as a person’s age, general health, and the type of NHL they have. Healthcare professionals will usually use a combination of treatments for NHL, including chemotherapy, radiation, targeted therapy, stem cell transplants, and sometimes surgery.

A Word From Verywell

A lymphoma diagnosis can be stressful and frightening. The more you know about the specific type of B-cell lymphoma you have, the earlier you can discuss treatment options with your healthcare provider.

While B-cell lymphoma survival rates are improving, it is important to take good care of your physical and mental health. Try to eat a healthy diet, and talk to a nutritionist if you're having trouble eating.

Some lymphoma treatments can also make you feel lethargic, so be sure to keep plenty of sleep. You may also wish to incorporate activities to reduce stress (yoga, meditation, and deep breathing exercises).

Frequently Asked Questions

  • How long can you live with B-cell lymphoma?

    Survival rates can vary widely for different types and stages of lymphoma. According to the National Cancer Society, the overall five-year relative survival rate for people with NHL is 72%.

  • Is B-cell lymphoma curable?

    Some types of B-cell lymphoma are curable with timely and appropriate treatment, including diffuse large B-cell lymphoma (DCLBL), the most common type of NHL.

  • How long does B-cell lymphoma treatment take?

    The length of treatment depends on the type of B-cell lymphoma you have. A short course of treatment usually takes six to 12 weeks, while a long course of treatment for advanced disease can last over six months.

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10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Cancer Society. About non-Hodgkin lymphoma.

  2. American Cancer Society. How radiation therapy is used to treat cancer.

  3. American Cancer Society. Radiation therapy for non-Hodgkin lymphoma.

  4. Said JW. Aggressive B-cell lymphomas: how many categories do we need? Modern Pathology. 2013;26(0 1):S42-S56. doi:10.1038/modpathol.2012.178

  5. Tran E, Longo DL, Urba WJ. A milestone for CAR T cells. New England Journal of Medicine. 2017;377(26):2593-2596. doi:10.1056/NEJMe1714680

  6. Hardwick JM, Soane L. Multiple functions of BCL-2 family proteins. Cold Spring Harbor Perspectives in Biology. 2013;5(2):a008722. doi:10.1101/cshperspect.a008722

  7. American Cancer Society. High-dose chemotherapy and stem cell transplant for non-Hodgkin lymphoma.

  8. American Cancer Society. Treating B-cell non-Hodgkin lymphoma. Updated September 15, 2021.

  9. American Cancer Society. Types of B-cell lymphoma.

  10. American Cancer Society. Survival rates and factors that affect prognosis (outlook) for non-Hodgkin lymphoma.