What Is B-Cell Lymphoma?

Written by Deanna Altomara, Marijke Vroomen Durning, RN
Medically Reviewed by Laura J. Martin, MD and Elmer Huerta, MD, MPH on March 22, 2025
14 min read

B-cell lymphoma is a cancer that forms in your white blood cells called lymphocytes. These cells are made by your lymphatic system, which plays an important role in immunity. The lymphatic system includes a few organs and runs across your entire body, so B-cell lymphoma can form in different places. The symptoms you have depend on where the cancer forms. 

Getting a diagnosis of cancer can be scary, but there are many doctors who can help you through it. It’s also a good idea to reach out to family and friends to get the emotional backing you need while you learn about how to manage your condition.

There are two types of lymphoma: Hodgkin's lymphoma and non-Hodgkin's lymphoma. Most B-cell lymphomas are non-Hodgkin's lymphoma.

B-cell lymphomas come in many types. Some grow quickly and others grow slowly. Your doctor will explain which type you have and how to treat it.

Large B-cell lymphoma

The most common type of non-Hodgkin's lymphoma is called diffuse large B-cell lymphoma (DLBCL). One in three people with lymphoma have this type, and it mainly affects older adults. It’s a fast-growing cancer that can start in your lymph nodes or related organs like your thymus, spleen, or tonsils. It usually responds well to treatment and is often cured.

Follicular lymphoma

About one in five people with lymphoma have follicular lymphoma. This is a slow-growing form that mainly affects older adults. It might start in your lymph nodes, bone marrow, or other places. Doctors usually wait until it starts causing symptoms before they treat it. 

Chronic lymphocytic leukemia/small lymphocytic leukemia (CLL/SLL)

These are two closely related types of B-cell lymphoma. They grow slowly, starting in your blood and bone marrow (CLL) or spleen (SLL). It’s hard to cure these types of cancer. But because they grow so slowly, you can live with them for years or even decades. 

Mantle cell lymphoma

This type affects 1 in 20 people with lymphoma and is more common in older adults and men. It forms in your spleen, lymph nodes, or bone marrow. Mantle cell lymphoma grows slowly but can be hard to treat.

Marginal zone lymphomas

In this type of lymphoma, small cells grow slowly in places called marginal zones. These places could be in your stomach, skin, lungs, salivary gland, thyroid, or the area around your eyes.

Burkitt lymphoma

This is a rare disease that typically affects children. It grows quickly, so people with this type will need intensive (in-depth) chemotherapy.

Lymphoplasmacytic lymphoma (Waldenstrom's macroglobulinemia)

This is a rare and slow-growing lymphoma. It usually starts in your bone marrow but also can grow in your lymphatic system.

Primary mediastinal large B-cell lymphoma

This is a rare type of DLBCL. Unlike regular large B-cell lymphoma, this type mainly affects young women. It’s a fast-growing cancer that starts in your chest. As it gets bigger, it can press on your windpipe, causing breathing problems. It also might block the flow of blood to your heart, causing your face and arms to swell.

Primary central nervous system (CNS) lymphoma

This is a rare type of lymphoma that affects your central nervous system (brain or spinal cord). It’s more likely to happen in older adults and people with weakened immune systems. 

Primary intraocular lymphoma (lymphoma of the eye)

This type of lymphoma affects your eyeball. It’s more common in older adults, people with weakened immune systems, and people with primary CNS lymphoma. 

Other types of B-cell lymphomas

Some other types include:

  • High-grade B-cell lymphoma
  • Cutaneous B-cell lymphoma
  • Hairy cell leukemia

These cancers begin when lymphocytes grow out of control. Doctors don't know what makes that happen. 

The role of lymphocytes

There are two main types of lymphocytes, called B cells and T cells. But the kinds involved in this type of lymphoma are B cells. These cells make antibodies, which are proteins that help your body fight germs like bacteria and viruses.

Lymphocytes travel around your body through a network called the lymphatic system. Lymph nodes – small glands in your neck, armpits, and groin – are part of this system. Lymphoma grows in your lymph nodes or any other area of the body that has lymph tissue, including your spleen, bone marrow, thymus, adenoids, tonsils, and stomach.

When you have B-cell lymphoma, your body makes too many abnormal B cells. These cells can't fight infections well. They can also spread to other parts of your body.

Usually, your body makes new lymphocytes only when you need them to replace old cells that have died. In B-cell lymphoma, lymphocytes grow when you don't need them. And they keep multiplying.

B-cell lymphoma risk factors

You're more likely to get B-cell lymphoma if you have a weakened immune system (the body’s defense system against germs).

Your chances of getting B-cell lymphoma may also be higher if you:

  • Are 60 years old or older
  • Are male
  • Have obesity
  • Take medicines that weaken your immune system (immunosuppressants) after an organ transplant or to treat an autoimmune disease
  • Have been infected with HIV, the Epstein-Barr virus, or other germs that raise your chances of getting non-Hodgkin's lymphoma
  • Had contact with large amounts of chemicals used to kill bugs and weeds
  • Have an inherited condition that affects your immune system
  • Have an autoimmune disease like Sjogren’s syndrome, rheumatoid arthritis, or inflammatory bowel disease
  • Have a family history of the disease

But still, many people without these risk factors will still develop B-cell lymphoma. Similarly, just because you have these risk factors doesn’t mean that you’ll get B-cell lymphoma.

B-cell lymphoma doesn’t always cause symptoms. If you have a slow-growing type, it might take months or years before symptoms start. As abnormal B cells multiply, they can cause areas that have lymph tissue to get bigger. Sometimes, you can even feel these lymph nodes once they’ve grown. 

B-cell lymphoma also causes symptoms like:

  • Night sweats
  • Fever
  • Unexplained weight loss
  • Fatigue
  • Appetite loss
  • Trouble breathing
  • Pain or swelling in your belly
  • Severe itching
  • Swollen, painless lumps in your lymph nodes (like in your armpits, neck, or groin)
  • Rash or bumps on your skin
  • Enlarged liver or spleen

First, your doctor will ask you about your symptoms and medical history. You’ll get a physical exam where the doctor checks your lymph nodes, liver, and spleen. They may recommend you see a hematologist-oncologist, a type of doctor who specializes in blood cancers.

There are a few tests to check for B-cell lymphoma:

Blood tests

Blood tests can tell your doctor a lot about your overall health. You might start with:

Complete blood count (CBC) with differential. This measures the levels of different types of blood cells, like red blood cells, white blood cells, and platelets. Having this done “with differential” will break down the different types of white blood cells. This can help doctors see if anything is wrong.

Comprehensive metabolic panel (CMP). This test checks on things in your blood that help to understand your organ function and metabolism. It looks at your electrolyte levels, blood sugar, liver and kidney function markers, and protein levels.

Lactate dehydrogenase (LDH) levels. With this test, your doctor can measure an enzyme – LDH – that’s in your body. High LDH levels may be a sign of lymphoma.

These tests can give your doctor clues about B cells and other important parts of your blood.

Imaging

These tests will help your doctor picture what is going on inside your body. This helps them look for tumors in your lymph nodes, liver, and spleen. Some imaging tests include:

Chest X-ray. Chest X-rays can show if there are enlarged lymph nodes in your chest or any other reason that may explain if you have trouble breathing.

Computed tomography (CT) scan. This is a specialized, multi- X-ray test, which provides more detailed images.

Magnetic resonance imaging (MRI). This type of scan uses magnets, instead of radiation, to see images inside your body. 

Positron emission tomography (PET) scan. This type of scan uses radioactive substances that doctors can see as they flow through your body.

Ultrasound. Ultrasound uses a wand that touches your skin. The wand makes sound waves that bounce off solid organs in your body and back, forming an image on a screen.

Biopsy

This is the only test that can clearly show whether you have B-cell lymphoma. Your doctor will take a sample of a lymph node and look for cancer cells. Some types of biopsy are:

Needle biopsy. There are two types of needle biopsies, fine needle aspiration (FNA) and core needle biopsy. For both, your doctor would numb the skin above the lymph node. For an FNA, the doctor inserts a fine needle attached to a syringe. Once in place, some tissue is pulled out of the lymph node. For core needle biopsy, the doctor inserts a larger needle so a larger piece of tissue can be removed.

Excisional or incisional biopsy. Your doctor would do this to remove all or part of the lymph node. If your doctor makes a cut to remove the whole node, it's an excisional biopsy. If the cut is smaller and only a portion of the lymph node is removed, it's an incisional biopsy.

Your doctor may also choose to recommend a bone marrow aspiration and biopsy. This is when your doctor removes some cells from inside a bone, usually the hip. You will get a local anesthetic where the aspiration and biopsy will be done. Then your doctor will insert a needle into the bone and remove some of the liquid bone marrow to send to the lab. This is the aspiration. After the aspiration, your doctor would insert a larger needle into the bone and remove some bone tissue.

Questions to ask your doctor

When you find out you have cancer, it’s understandable to have questions. Questions can be great conversation starters that can help you learn more about the disease and what to expect. 

Here are some questions to get you started.

  • What kind of lymphoma do I have?
  • What is the stage of my cancer? 
  • What is my outlook for survival?
  • What tests do I need?
  • What are my treatment options? What are the pros and cons of each?
  • How long does treatment last?
  • What should I expect from treatment?
  • When should I call a doctor or go to the emergency room?
  • How can I reach you during an emergency?
  • Do I need to see any other doctors?

The type of treatment you get depends on your overall health, the type of lymphoma you have, and whether it has spread. You might get one treatment or a combination. Your doctor will help you find the treatment strategy that is right for you.

For example, diffuse large B-cell lymphoma grows quickly, so it might be treated more aggressively than another type. For many people, B-cell lymphomas don’t need treatment right away. Your doctor can choose to “watch and wait,” also called active surveillance. During this time, your doctor will watch you closely and send you for regular tests to see if the cancer is growing or spreading. If everything stays quiet, you continue with this plan. If there are any changes, your doctor might then recommend a treatment plan.

Chemotherapy. This medication kills cancer cells but also kills some healthy cells, which causes side effects. Medications can be used separately or combined. For example, if you have DLBCL, primary mediastinal B-cell lymphoma, or follicular lymphoma, you might get CHOP. This is a combination chemotherapy of cyclophosphamide, doxorubicin, vincristine, and prednisone. If you also get another drug called rituximab, this is called R-CHOP. 

Immunotherapy. This medication uses your own immune system to target cancer cells. 

Targeted therapy. These drugs target specific parts of the cancer cells.

Radiation therapy. Radiation can kill cancer cells.

Proton therapy. This similar to radiation therapy but is considered more accurate and uses a different type of energy.

Stem cell transplantation. Since lymphoma affects your bone marrow, sometimes treatment involves killing off all the bone marrow cells and replacing them, through your veins, with new stem cells. These cells go through your body and settle in the marrow.

Sometimes, cancer treatment can cause side effects. Everyone is different, so someone might get a side effect while another person doesn’t. Talk to your doctor about each of your treatment options and any side effects they might cause.

Common side effects include:

  • Diarrhea
  • Nausea
  • Fatigue
  • Fever
  • Low neutrophil levels (a type of white blood cell)

You don’t have to deal with these side effects on your own. You can get palliative care, a type of treatment designed to manage your symptoms and the side effects of treatment.

How large B-cell lymphoma may change over time

Occasionally, a slow-growing type of lymphoma can turn into a fast-growing type. Usually, it’ll turn into diffuse large B-cell lymphoma. But it can also transform into Burkitt lymphoma, Hodgkin’s lymphoma, or other fast-growing types of lymphoma. This can affect the way your cancer is treated.

B-cell lymphoma complications

Having B-cell lymphoma may lead to other health complications over time. They can include:

Heart disease. This could be caused by the chemotherapy drugs used to treat lymphoma.

Lung disease. If your lymphoma has spread to your lungs, it can cause breathing problems and make you have more chest infections, such as pneumonia.

Liver disease. Your liver can stop working the way it’s supposed to if the lymphoma has reached your liver. 

Thyroid disease. If lymphoma cells get into the thyroid, it could cause the thyroid to get larger and cause symptoms like a fever, night sweats, and weight loss.

Other health complications related to having chemotherapy for B-cell lymphoma include:

  • Fertility problems, both male and female
  • Early menopause
  • Dry eyes
  • Increased tooth decay
  • Osteoporosis

B-cell lymphoma and its treatment can have a big impact on your life. It’s important to take time for yourself, rest, and do things you enjoy.

Taking care of yourself

When you have cancer, you may need to spend more time on your self-care than usual, and that’s OK. Even small actions can help support your physical and mental well-being. 

Enjoy a balanced diet. You may not be feeling too hungry, which is a common side effect of chemotherapy. But right now, your body needs the fuel more than ever. Talk with a nutritionist about finding a meal plan that fits your needs and tastes.

Rest up. Your body needs time to recharge so it can fight the cancer. Take time to give it the rest and care it deserves.

Talk with someone. It can help to share your feelings with someone who cares, whether that’s a friend or a therapist. Their support can help you get through the tough times and celebrate the good ones.

Try new coping skills. Practices like yoga, meditation, and mindfulness can help you deal with stress.

Getting support

Other people can be a great source of comfort, advice, and support. If possible, consider reaching out to friends and family who can support you during this time. They can help you navigate the ups and downs of your cancer journey. 

Think about how the people in your network can best support you. Everyone has different strengths and can help in different ways. Some people might love to cook you dinner after a long day of treatment. Others could give you a ride to doctor appointments, or simply talk with you on the phone when you’re feeling down.

You may also want to consider joining a support group. This is where you can meet people who are in the same situation as you, so they understand what you’re going through. Ask your doctor about cancer support groups in your area.

B-cell lymphoma is currently treated with chemotherapy, radiation, immunotherapy, and targeted therapy. Most current research focuses on the last two types. 

Immunotherapy fires up the immune system so that it can fight off the cancer. In one type of immunotherapy (CAR T-cell therapy), doctors remove immune cells from your blood, supercharge them in a laboratory, and put them back into your bloodstream. There are also drugs and antibodies that can stimulate (activate) your immune system.

On the other hand, targeted therapies focus on a specific interaction between cancer cells. One promising new treatment is a drug called ibrutinib (Imbruvica), which has done well in several early studies. Different types of targeted therapy focus on other interactions between cancer cells.

There is a wide range of B-cell lymphoma survival because it depends on the type or subtype you have, as well as how advanced the disease is, how well you respond to treatment, and your overall health, such as if you have any other diseases. 

For example, the average life expectancy five years after someone is diagnosed with diffuse large B-cell lymphoma is 64.6% (slightly more than 64 people out of 100 are still alive), while people with follicular lymphoma have a five-year survival rate of 90% (90 out of 100 are still alive).

Doctors use the International Prognostic Index (IPI) to help find out a patient’s outlook if they have any type of lymphoma. The index looks at your:

Age. If you’re younger than 60, the index gives you a better prognosis than if you're older than 60.

Stage of lymphoma. Stages I and II have better prognosis than stages III or IV.

Whether the lymphoma has spread to your organs. If lymphoma is in the lymph nodes or only one area outside of the nodes, there is a better prognosis than if the lymphoma has reached more than one organ outside the nodes.

How well you can do your everyday activities. Being able to function the way you normally would gives you a better prognosis than if you are struggling with daily activities.

What your lactate dehydrogenase (LDH) level is. A normal LDH level provides a better prognosis than a high level, which means there is more lymphoma in your body.

Using these details, your prognostic factor is described based on good factors or poor ones:

  • Low risk if you have no poor factors, or only one 
  • Low to intermediate if you have two poor factors
  • High to intermediate if you have three poor factors
  • High risk if you have four or five poor factors

Another tool called the Follicular Lymphoma International Prognostic Index (FLIPI) is used for follicular lymphoma (a slow-growing type of B-cell lymphoma) because the IPI is not that good for this type. This index looks at your:

Age. Same as IPI.

Stage. Same as IPI.

Blood hemoglobin. If your blood hemoglobin is 12 g/dL or higher, you have a better prognosis than if it is lower than that.

Number of lymph nodes that are affected. Four or fewer nodes is better than more than four.

LDH level. Same as IPI.

Using these details, your prognostic factor is:

  • Low risk if you have no or one poor factor
  • Intermediate if you have two poor factors
  • High risk if you have three or more poor factors 

Of the several types of B-cell lymphoma, the most common one is a fast-growing type called diffuse large B-cell lymphoma, or DLBCL. Other types of lymphoma grow more slowly, and people can live longer with treatment. If you have B-cell lymphoma, speak to your doctor about your treatment options, what your individual outlook or prognosis is, and what your treatment plan will be.

What are the first symptoms of B-cell lymphoma? Swollen lymph nodes, a fever, and unexplained weight loss are some of the symptoms you might notice. But it might take years before you notice any symptoms from certain B-cell lymphomas. Later on, symptoms may change or become more obvious.

How fast does B-cell lymphoma spread? Some types are aggressive (fast-spreading) and some types are indolent (slow-spreading).

How aggressive is large B-cell lymphoma? Large B-cell lymphoma is a fast-growing type of cancer.

Does B-cell lymphoma run in families? Diffuse large B-cell lymphoma doesn’t run in families.

Can you be cured of B-cell lymphoma? For many people, treatment can cure B-cell lymphoma.

Does B-cell lymphoma show up in bloodwork? Blood tests can give your doctor clues about the health of your B cells, but only a biopsy can show if you have cancer for sure.

Is B-cell lymphoma the same as leukemia? No. Leukemia usually starts in your bone marrow, whereas lymphoma usually starts in your lymph nodes or spleen.