Is DLBCL for non-Hodgkin lymphoma a different diagnosis than Richter's transformation?

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Question from Irene:

I have CLL, and am in a complete remission after bendamustine (Treanda®) and rituximab (Rituxan®) therapy a year ago.

My brother just completed 6 cycles of R-CHOP for his diagnosis of non-Hodgkin lymphoma, specifically, DLBCL. He's doing well, too.

First question: Is DLBCL for non-Hodgkin lymphoma a different diagnosis or disease presentation than the Richter's transformation to DLBCL that can happen in CLL?  (My brother's oncologist seems to be saying that there are two different types or possibly "flavors" of DLBCL).

Second question:  My brother's glucose that was normal before he began chemo has risen with each cycle of R-CHOP, which includes dexamethasone (Decadron®).  I am led to understand that steroids can create an increase in blood sugar.  How does this occur in the body?  What is the steroid doing that changes the metabolism of sugar?  Can a person become a permanent diabetic from this rise? Can the glucose level return to normal?

Thank you for any light you can shed on these matters.   I understand that one or both questions may be a little out of your bailiwick...if so, I'll take them back to the oncologist's I know. (So far I get very superficial answers...but I keep researching).

Thank you for your marvelous videos.  Your plain speak demystifies and simplifies these blood diseases. You are a national treasure.

Answer from Dr. Leclair:

DLBCL stands for diffuse large B-cell lymphoma. It is the most common non-Hodgkin lymphoma in the U.S. All lymphocytes are difficult to separate by morphology, so mostly we rely on flow cytometry which tests for the presence or absence of specific structures on the cell membrane.  DLBCJ is positive for markers: CD19, 22, 79a, ki67 and light chains presence, while Richter's is positive for structures such as CD 20, 5 - 23 and 38.  It is not important what these structures are. What is important is that clearly these two diseases—while they might look a lot alike,  really are not.

The limitation to that concept is that we are still at the beginning of understanding lymphocytes. The first time we figured out what they do normally was in the mid-1960s, and the instrument, flow cytometer, wasn't used until the mid-1980s. So while we know something about this cell line, we do not know enough to be sure. It COULD be that if you have CLL first, then you get one subset of large cell disease and if you do not have the CLL first, you go straight to the large cell disease. We just do not know. 

One of the functions of normal corticosteroid is to increase the glucose in the bloodstream in response to stress.  This is done by breaking down storage forms of glucose. Think of it this way—you are about to run for your life. Corticosteroids cause glucose to flood the bloodstream, so you have enough to provide energy while you run.  The trouble is, of course, that when you take corticosteroids, you are running anywhere. So suddenly there is a lot of glucose in the blood, overwhelming the ability of the cells to use it. So you get most of the consequences of a high blood glucose. Most people do not have a permanent state, but some folks who are on this medication for years may develop it. My guess would be that the short time and interrupted cycles of exposure would put the odds in his favor of not developing diabetes. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Have a question for the experts? Send them to questions@patientpower.info.

 

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Page last updated on April 25, 2019