B symptoms are a set of
symptoms
Signs and symptoms are diagnostic indications of an illness, injury, or condition.
Signs are objective and externally observable; symptoms are a person's reported subjective experiences.
A sign for example may be a higher or lower temperature ...
, namely
fever
Fever or pyrexia in humans is a symptom of an anti-infection defense mechanism that appears with Human body temperature, body temperature exceeding the normal range caused by an increase in the body's temperature Human body temperature#Fever, s ...
,
night sweats
Night sweats or nocturnal hyperhydrosis is the repeated occurrence of excessive sweating during sleep. The person may or may not also perspire excessively while awake.
One of the most common causes of night sweats in women over 40 is the horm ...
, and
unintentional weight loss
Weight loss, in the context of medicine, health, or physical fitness, refers to a reduction of the total body mass, by a mean loss of fluid, body fat (adipose tissue), or lean mass (namely bone mineral deposits, muscle, tendon, and other con ...
, that can be associated with both
Hodgkin lymphoma
Hodgkin lymphoma (HL) is a type of lymphoma in which cancer originates from a specific type of white blood cell called lymphocytes, where multinucleated Reed–Sternberg cells (RS cells) are present in the lymph nodes. The condition was named a ...
and
non-Hodgkin lymphoma
Non-Hodgkin lymphoma (NHL), also known as non-Hodgkin's lymphoma, is a group of blood cancers that includes all types of lymphomas except Hodgkin lymphomas. Symptoms include enlarged lymph nodes, fever, night sweats, weight loss, and tiredn ...
. These symptoms are
not specific to lymphomas, especially each one considered individually, and even as a trio they are not
pathognomonic
Pathognomonic (synonym ''pathognomic'') is a term, often used in medicine, that means "characteristic for a particular disease". A pathognomonic sign is a particular sign whose presence means that a particular disease is present beyond any doubt. ...
for lymphomas, but the presence of the trio is
sensitive enough for lymphomas to warrant
diagnostic
Diagnosis (: diagnoses) is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in a lot of different academic discipline, disciplines, with variations in the use of logic, analytics, and experience, to determine " ...
investigation and
differential diagnosis
In healthcare, a differential diagnosis (DDx) is a method of analysis that distinguishes a particular disease or condition from others that present with similar clinical features. Differential diagnostic procedures are used by clinicians to di ...
. The presence or absence of B symptoms has
prognostic
Prognosis (Greek: πρόγνωσις "fore-knowing, foreseeing"; : prognoses) is a medical term for predicting the likelihood or expected development of a disease, including whether the signs and symptoms will improve or worsen (and how quickly) o ...
significance in lymphomas and is reflected in their
staging.
Description and nomenclature
B symptoms are so called because
Ann Arbor staging
Ann Arbor staging is the staging system for lymphomas, both in Hodgkin's lymphoma (formerly designated Hodgkin's disease) and non-Hodgkin lymphoma (abbreviated NHL). It was initially developed for Hodgkin's, but has some use in NHL. It has roughly ...
of lymphomas 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.
Prognostic importance
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 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.
[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.]
References
{{Lymphoid malignancy
Lymphoma
Paraneoplastic syndromes
Cancer staging