B symptoms refer to systemic symptoms of fever, night sweats, and weight loss which can be associated with both Hodgkin's lymphoma and non-Hodgkin's lymphoma. The presence or absence of B symptoms has prognostic significance and is reflected in the staging of these lymphomas.
Description and nomenclature
B symptoms are so called because lymphoma staging includes both a number (I-IV) and a letter (A or B). "A" indicates the absence of systemic symptoms, while "B" indicates their presence.
B symptoms include:
- Fever greater than 38°C. Pel-Ebstein fever, the classic intermittent fever associated with Hodgkin disease, occurs at variable intervals of days to weeks and lasts for 1-2 weeks before resolving. However, fever associated with lymphoma can follow virtually any pattern.
- Drenching sweats, especially at night.
- Unintentional weight loss of >10% of normal body weight over a period of 6 months or less.
The presence of B symptoms is a marker for more advanced disease with systemic, rather than merely local, involvement. B symptoms are a clear negative prognostic factor in Hodgkin lymphoma. The relevance of B symptoms in non-Hodgkin lymphoma is less clear, although here also B symptoms tend to correlate with disease that is either more widespread or of a higher histologic grade.
Relative importance of specific B symptoms
It has been suggested that, in Hodgkin lymphoma, fever and weight loss are much more prognostically significant than night sweats. In one series of patients with early-stage Hodgkin disease, the presence or absence of night sweats had no impact on cure rates and outcome. However, fever and weight loss had a pronounced negative impact on cure and survival rates, regardless of treatment modality.
"B symptoms" in other diseases
Similar systemic symptoms can be found in non-cancerous states such as tuberculosis and various inflammatory or rheumatologic conditions. In these settings, the term "B symptoms" is sometimes colloquially applied to refer to such systemic or constitutional symptoms. However, in a pure sense, the term "B symptoms" is restricted to lymphoma staging.
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- Malignant lymphoma: the histology and staging of 473 patients at the National Cancer Institute. Anderson T; Chabner BA; Young RC; Berard CW; Garvin AJ; Simon RM; DeVita VT Jr. Cancer 1982 Dec 15;50(12):2699-707.
- Stage I to IIB Hodgkin's disease: the combined experience at Stanford University and the Joint Center for Radiation Therapy. Crnkovich MJ; Leopold K; Hoppe RT; Mauch PM. J Clin Oncol 1987 Jul;5(7):1041-9.