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:
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Germinal center B-cell type
-
Activated B-cell type
Other forms include the following:
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Primary DLBCL of the central nervous system (CNS)
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Primary cutaneous DLBCL, leg type
-
Epstein-Barr virus (EBV)–positive DLBCL NOS
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DLBCL associated with chronic inflammation
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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):
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Age ≥60y
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Eastern Cooperative Oncology Group (ECOG) performance status ≥2
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Elevated lactate dehydrogenase (LDH) level
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Ann Arbor stage III or IV
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≥2 extranodal sites of disease
Risk category (factors):
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Low (0 or 1)
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Low-intermediate (2)
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High-intermediate (3)
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High (4 or 5)
See also the following calculators: