The B symptoms (a.k.a. inflammatory symptoms) are a triad of systemic symptoms associated with more advanced disease and a poorer outcome in lymphoma 1,2:
- >10% unintentional decrease in body weight in the 6 months preceding the diagnosis
- fever: >38°C
- night sweats
B symptoms are a poor prognostic factor in lymphoma (both Hodgkin and non-Hodgkin lymphomas). For this reason, if there are B symptoms, then the tumour is upstaged under the Lugano classification system. The presence of B symptoms correlates well with an elevated level of inflammatory cytokines in body fluids 1.
History and etymology
In the Rye staging system for Hodgkin disease, agreed in 1966, each stage was subclassified as A or B, according to the absence (A) or presence (B) of symptoms. In the Rye system the B symptoms were fever, night sweats and pruritus. In the Ann Arbor staging system introduced in 1971, which updated and superseded the Rye system, pruritus was dropped as a B symptom and replaced with weight loss 3,4.
- 1. Sharma R, Cunningham D, Smith P, Robertson G, Dent O, Clarke SJ. Inflammatory (B) symptoms are independent predictors of myelosuppression from chemotherapy in Non-Hodgkin Lymphoma (NHL) patients--analysis of data from a British National Lymphoma Investigation phase III trial comparing CHOP to PMitCEBO. (2009) BMC cancer. 9: 153. doi:10.1186/1471-2407-9-153 - Pubmed
- 2. Shanbhag S, Ambinder RF. Hodgkin lymphoma: A review and update on recent progress. (2018) CA: a cancer journal for clinicians. 68 (2): 116-132. doi:10.3322/caac.21438 - Pubmed
- 3. Rosenberg, S.A. (1966) Report of the committee on the staging of Hodgkin's disease. Cancer Research, 26, 1310
- 4. Rosenberg SA, Boiron M, DeVita VT, Johnson RE, Lee BJ, Ultmann JE, Viamonte M. Report of the Committee on Hodgkin's Disease Staging Procedures. (1971) Cancer research. 31 (11): 1862-3. Pubmed