What are B-symptoms?

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Question: What are B-symptoms?

Answer:

B-symptoms may also be described as “systemic systems” or “general symptoms,” but in the case of lymphoma, the term refers to a specific set of three symptoms that may predict how the malignancy is likely to behave:

  • Fever (i.e., temperature >38°C [>100.4°F]) for 3 consecutive days
  • Weight loss exceeding 10% of body weight in 6 months
  • Drenching night sweats

A person with lymphoma and any one of the three symptoms above is said to have B symptoms.

There are two major categories of lymphoma – Hodgkin lymphoma (HL) and non-Hodgkin Lymphoma (NHL), and B symptoms may be present in either category. One of the most common symptoms of lymphoma is the enlargement of lymph nodes. B symptoms may or may not be present, but when they are, they can have significance in predicting how the lymphoma will behave and which treatments might be best to start with. B symptoms are most common in more rapidly growing lymphomas.

More on B Symptoms and Their Significance

In some cases, the presence B symptoms may also indicate that the disease may be present parts of the body other than where it had been initially detected. The presence or absence of B symptoms at the time of diagnosis can be indicated at the time of staging. When the doctor determines the stage of the disease and the individual has B symptoms, he or she adds the letter B after the stage (which may be between I to IV).

So if someone is stage II with B-symptoms, the stage is noted as II-B. The stages of those who don't have any of the B symptoms are noted as A.

Since there are many different types of lymphoma, and since the types can differ significantly from one another other, the presence of B symptoms can also be more or less of a factor in predicting how the lymphoma will behave.

B-Symptoms Associated with Transformation

Two of the most common types of NHL are follicular lymphoma (FL) and diffuse large B-cell lymphoma (DLBL). Follicular lymphoma is considered an indolent or slow-growing lymphoma, meaning it can “smolder” for many years before breaking out into a more aggressive, rapidly growing disease. When FL changes from smoldering to aggressive, this is referred to as transformation.

FL can transform into DLBCL, a more aggressive and rapidly growing lymphoma. Sometimes, an individual with FL never knew he or she had lymphoma and only comes to medical attention once the malignancy has transformed. One of the things that might lead a person to seek medical attention is the presence of B-symptoms.

Recently a group of researchers looked at factors associated with the transformation of FL among 2,652 patients. After watching them for roughly 6-7 years, about 14 percent of them transformed following the initial FL diagnosis, including 147 biopsy-confirmed and 232 clinically suspected cases.

They determined that lymphoma involvement outside of the lymph nodes, elevation of a blood marker called lactate dehydrogenase, and B symptoms at diagnosis were associated with transformation risk.

Sources

Wagner-Johnston ND, Link BK, Byrtek M, et al. Outcomes of transformed follicular lymphoma in the modern era: a report from the National LymphoCare Study (NLCS). Blood. 2015;126(7):851-857

Diagnostic and Therapeutic Advances in Hematologic Malignancies edited by Martin S. Tallman, Leo I. Gordon

Hematologic Malignancies. Demos Medical Publishing, Dec 17, 2012

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