Diffuse large B-cell lymphoma (DLBCL) care involves the use of a specific staging system. Expert Dr. Loretta Nastoupil shares insight about the DLBCL staging system and explains what is occurring in the body during each stage.
Dr. Loretta Nastoupil is Director of the Lymphoma Outcomes Database in the Department of Lymphoma/Myeloma at The University of Texas MD Anderson Cancer Center. Learn more about Dr. Nastoupil, here.
What are the stages of DLBCL?
So, we currently use what’s called the Ann Arbor staging system. And, again, this is very different from the staging applied in solid tumors.
And so, the way we define stage is based off where the tumor is in relationship to the diaphragm. So, if you have the disease just in lymph nodes and it’s all confined to one side of the diaphragm, it’s either going to be stage I or II. And how we distinguish between I or II is just really not are they in close proximity and something that we would fit in one radiation field.
If you have disease that’s above and below the diaphragm, that’s generally at least stage III. stage IV is generally when it’s now outside of the lymph node. So, what we call extranodal location. So, those are generally organs, lung, liver, skin, bone, etcetera.
It can be very complicated in that you could have just one extranodal site. So, say you just have stomach involvement, or you just have one area of the bone. That could be a 1E.
So, it’s important to recognize every patient has a stage. What that means is whether or not we would give a full course of therapy in terms of systemic treatment that goes through the vein or maybe a shortened course in radiation is dependent on that stage.