Diffuse Large B-Cell Lymphoma (Non-Hodgkin Lymphoma) Staging 

Updated: Dec 10, 2019
  • Author: Francisco J Hernandez-Ilizaliturri, MD; Chief Editor: Koyamangalath Krishnan, MD, FRCP, FACP  more...
  • Print

Staging of Diffuse Large B-Cell Lymphoma

Systems for staging diffuse large B-cell lymphoma (DLBCL) are provided below, including the World Health Organization (WHO) classification [1, 2] and the Cotswolds modification of the Ann Arbor system. Risk stratification with the International Prognostic Index (IPI) score is also provided. [3]

WHO classification

DLBCL, not otherwise specified (NOS) includes the following:

  • Germinal center B-cell type
  • Activated B-cell type

Other forms include the following:

  • Primary DLBCL of the central nervous system (CNS)
  • Primary cutaneous DLBCL, leg type
  • Epstein-Barr virus (EBV)–positive DLBCL NOS
  • DLBCL associated with chronic inflammation
  • Human herpes virus 8 (HHV8)–positive DLBCL, NOS

Table. Cotswolds modification of Ann Arbor staging system (Open Table in a new window)

Stage

Area of Involvement

I

Single lymph node group

II

Multiple lymph node groups on same side of diaphragm

II

Multiple lymph node groups on both sides of diaphragm

IV

Multiple extranodal sites or lymph nodes and extranodal disease

X

Bulk > 10 cm

E

Extranodal extension or single isolated site of extranodal disease

A/B

B symptoms: weight loss > 10%, fever, drenching night sweats

Risk stratification (IPI score)

Factors (1 point for each factor present):

  • Age ≥60y
  • Eastern Cooperative Oncology Group (ECOG) performance status ≥2
  • Elevated lactate dehydrogenase (LDH) level
  • Ann Arbor stage III or IV
  • ≥2 extranodal sites of disease

Risk category (factors):

  • Low (0 or 1)
  • Low-intermediate (2)
  • High-intermediate (3)
  • High (4 or 5)
Next: