B symptoms are a set of

symptoms Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality showi ...

, namely

fever Fever, also referred to as pyrexia, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using val ...

, night sweats, and unintentional weight loss, 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 patient's lymph nodes. The condition ...

and non-Hodgkin lymphoma. These symptoms are not specific to lymphomas, especially each one considered individually, and even as a trio they are not

pathognomonic Pathognomonic (rare 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 dou ...

for lymphomas, but the presence of the trio is sensitive enough for lymphomas to warrant diagnostic investigation and differential diagnosis. The presence or absence of B symptoms has prognostic significance in lymphomas and is reflected in their staging.

Description and nomenclature

B symptoms are so called because Ann Arbor staging 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 Pel–Ebstein fever is a rarely seen condition noted in patients with Hodgkin's lymphoma in which the patient experiences fevers which cyclically increase then decrease over an average period of one or two weeks. A cyclic fever may also be associat ...

, 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.

"B symptoms" in other diseases

Similar systemic symptoms can be found in non-cancerous states such as

tuberculosis Tuberculosis (TB) is an infectious disease usually caused by ''Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, in w ...

and various inflammatory or

rheumatologic Rheumatology (Greek ''ῥεῦμα'', ''rheûma'', flowing current) is a branch of medicine devoted to the diagnosis and management of disorders whose common feature is inflammation in the bones, muscles, joints, and internal organs. Rheumatolog ...

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. Also seen in chronic lymphocytic leukemia, Hodgkin's Lymphoma, Burkitt's Lymphoma.

References

{{Lymphoid malignancy Lymphoma Paraneoplastic syndromes Cancer staging