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

Updated: Oct 26, 2023
  • Author: Francisco J Hernandez-Ilizaliturri, MD; Chief Editor: Matthew C Foster, MD  more...
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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)


Area of Involvement


Single lymph node group


Multiple lymph node groups on same side of diaphragm


Multiple lymph node groups on both sides of diaphragm


Multiple extranodal sites or lymph nodes and extranodal disease


Bulk > 10 cm


Extranodal extension or single isolated site of extranodal disease


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)

See also the following calculators: