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DLBCL Prognosis: Fear, Hope, and Understanding Survival Rates

Medically reviewed by Richard LoCicero, M.D. — Written by Maureen McNulty
Posted on May 1, 2023
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  • The majority of people with diffuse large B-cell lymphoma (DLBCL) will live with their condition for five years or more.
  • Your individual outlook is influenced by many characteristics related to your health and your lymphoma.
  • Your doctor can help you better understand what to expect while living with DLBCL and recommend treatments that best fit your individual health condition.

If you’ve been diagnosed with diffuse large B-cell lymphoma, you may have concerns about your disease prognosis. Your prognosis (outlook) is an estimate of how your condition is likely to progress and what your outcome may look like. It describes your likelihood of responding to treatment, recovering, and surviving.

Your prognosis is partly determined by the DLBCL survival rate, a statistical tool used by doctors to measure how long people with DLBCL tend to live after receiving their diagnosis. Overall, health experts estimate that about 65 percent of people survive this type of lymphoma for five years or more. However, this rate varies significantly depending on individual factors.

Factors That Affect Prognosis

To estimate your DLBCL prognosis, your doctor will take into account prognostic factors — details that make you likely to have a better or worse outlook. Prognostic factors may include your personal risk factors, your overall health, and the characteristics of your DLBCL.

Age

Younger adults with DLBCL tend to have a better outlook compared with older adults. For instance, according to the National Cancer Institute:

  • Nearly 80 percent of those under age 55 will live for five years or more.
  • About 70 percent of people between 55 and 64 will live at least five years.
  • About 55 percent of those 65 or older will live five years or more.

Performance Status

Doctors use a measurement called performance status to describe the degree to which a person is affected by their lymphoma. Your performance status estimates how well you can complete daily activities such as taking care of yourself, doing things around the house, walking, and working.

If you have a better performance status score while living with DLBCL, you’re likely to have a better prognosis. If you have a worse score — for example, you can’t work, need someone to help you around the house, or must stay in bed — you may have a worse prognosis.

Other Health Conditions

Some studies have found that people with autoimmune disorders such as Sjӧgren’s syndrome, rheumatoid arthritis, and systemic lupus erythematosus (the most common type of lupus) tend to have a worse DLBCL prognosis.

Health experts don’t know for sure why autoimmune disorders may influence lymphoma outlook. It may be that people with these conditions tend to have worse performance status. Alternatively, having an autoimmune disorder may make it more difficult to tolerate aggressive chemotherapy regimens.

Lymphoma Stage

According to the American Cancer Society, a lymphoma’s stage describes how much cancer there is in the body. Health experts classify DLBCL into stages based on how many lymph nodes or organs contain cancer cells. Lymph nodes are the small structures located throughout your body that help filter out germs, extra fluid, and cancer cells from the surrounding tissues. The more cancer-containing lymph nodes you have, the higher your lymphoma stage (which is sometimes written as a Roman numeral).

If you have advanced-stage lymphoma, you are likely to have a worse prognosis. The five-year survival rates, which describe how many people live at least five years with a condition, are as follows:

  • Stage 1 (cancer found in just one location) — 79 percent
  • Stage 2 (cancer cells in at least two lymph nodes on the same side of the body) — 74.5 percent
  • Stage 3 (cancer located on both sides of the body) — 66.6 percent
  • Stage 4 (cancer found in organs like the liver, lungs, or bone marrow) — 54.8 percent

    Extranodal Involvement

    DLBCL cells are generally located in the lymph nodes. However, they may spread to other tissues or organs in advanced lymphoma cases. This is known as extranodal involvement. Having two or more sites of extranodal involvement is associated with a worse prognosis.

    Lactate Dehydrogenase

    Lactate dehydrogenase (LDH) is an enzyme found in many tissues throughout your body. When these tissues undergo damage due to an illness like cancer, levels of LDH in your blood rise. A simple blood test can help measure the amount of LDH in your body.

    Higher levels of LDH are linked to a worse prognosis for people with DLBCL and many other types of non-Hodgkin lymphoma (NHL).

    Gene Mutations

    Lymphoma develops when white blood cells undergo gene changes that cause them to turn cancerous and grow out of control. Multiple types of gene mutations can lead to DLBCL.

    Doctors sometimes analyze gene changes to estimate prognosis. For example, if you have changes that affect the MYC, BCL2, or BCL6 genes, you may have a worse outlook.

    Measuring Prognosis of DLBCL

    When measuring your individual outlook with DLBCL, your doctor may use different models to evaluate prognostic factors, predict outcomes, and determine your risk of experiencing a relapse (return of your lymphoma).

    This information can help your doctor create the optimal treatment plan. If you have a poor prognosis, your doctor may recommend more aggressive treatments that could be more effective at fighting your lymphoma. However, if your outlook is good, your doctor may suggest avoiding these treatments so that you don’t have to experience their more severe side effects.

    International Prognostic Index

    The International Prognostic Index (IPI) combines multiple prognostic factors into one assessment. This model takes into account your:

    • Age
    • Performance status
    • Lymphoma stage
    • Extranodal involvement (or lack of any)
    • LDH levels

    The more poor prognostic factors you have, the more likely you are to experience a poor outcome. You may have a worse outlook if:

    • You’re older
    • You need help taking care of yourself
    • You have stage 3 or 4 lymphoma
    • You have lymphoma cells in multiple locations outside the lymph nodes
    • You have high LDH levels

    Other Prognostic Models

    Although the IPI is one of the most commonly used prognostic models for people with DLBCL, researchers have developed additional models that can predict outcomes with even greater accuracy. Your doctor may use these or other models when determining your prognosis.

    One alternative model, the revised International Prognostic Index (R-IPI), uses the same prognostic factors as the IPI but calculates outlook in a slightly different way. The R-IPI is very useful in determining prognosis for people with DLBCL who undergo chemotherapy in addition to receiving rituximab (Rituxan), a targeted therapy drug.

    Prognosis of DLBCL

    The American Cancer Society reports that the overall five-year survival rate for DLBCL is 65 percent.

    This overall survival rate is calculated based on information from people across the United States who were diagnosed with this blood cancer between 2012 and 2018. However, cancer therapies are constantly improving, and many new treatment options have been developed since then. Therefore, people diagnosed with DLBCL today might have an improved prognosis.

    It’s important to keep in mind that survival rates don’t automatically reflect your outlook. Many individual factors also have an impact on prognosis. Talk to your health care team to get a better sense of your individual outlook and how this might be affected by different treatment options.

    Talk With Others Who Understand

    MyLymphomaTeam is the social network for people with lymphoma and their loved ones. On MyLymphomaTeam, more than 14,000 members come together to ask questions, give advice, and share their stories with others who understand life with lymphoma.

    Have you been diagnosed with DLBCL? Do you still have questions about your prognosis? Share your experiences in the comments below, or start a conversation by posting on your Activities page.

    Posted on May 1, 2023
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    Richard LoCicero, M.D. has a private practice specializing in hematology and medical oncology at the Longstreet Clinic Cancer Center, in Gainesville, Georgia. Review provided by VeriMed Healthcare Network. Learn more about him here.
    Maureen McNulty studied molecular genetics and English at Ohio State University. Learn more about her here.

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