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DLBCL Prognosis: Fear, Hope, and Understanding Survival Rates

Medically reviewed by Danielle Leonardo, M.D.
Written by Maureen McNulty
Updated on March 25, 2024

  • The majority of people with diffuse large B-cell lymphoma (DLBCL) will live with their condition for more than five years.
  • Your individual prognosis (outlook) is influenced by many factors 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 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 oncology specialists to measure how long people with DLBCL tend to live after receiving their cancer diagnosis. Overall, 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 DLBCL 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 such as family history of lymphoma, your overall health, and the characteristics of your DLBCL.

Based on studies between 2012 and 2018, 65 percent of people with DLBCL live for at least five years after diagnosis.

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Age

Younger adults 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

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

If you have a better performance status score while living with DLBCL, you are 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 coexisting autoimmune disorders such as Sjӧgren’s syndrome, rheumatoid arthritis, and systemic lupus erythematosus 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.

Some studies have found that people with coexisting autoimmune disorders, such as Sjӧgren’s syndrome, rheumatoid arthritis, and systemic lupus erythematosus, tend to have a worse DLBCL prognosis.

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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 later your lymphoma stage. (Cancer stages are sometimes noted with Roman numerals as stages I through IV.)

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, either in the upper or lower half) — 75.4 percent
  • Stage 3 (cancer located on both upper and lower halves 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 subtypes of non-Hodgkin lymphoma.

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.

Oncologists sometimes analyze gene changes to estimate prognosis. For example, if you have changes that affect your 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 a relapse (return of your lymphoma).

This information can help your doctor create the optimal cancer 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.

Many DLBCL treatments have been developed since the studies on which prognosis is based were done. People diagnosed with DLBCL today may have an improved prognosis.

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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:

  • Are older
  • Need help taking care of yourself
  • Have stage 3 or 4 lymphoma
  • Have lymphoma cells in multiple locations outside the lymph nodes
  • 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 17,000 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.

Updated on March 25, 2024
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Danielle Leonardo, M.D. is a board-certified specialist in internal medicine and medical oncology from the Philippines and has been practicing medicine since 2014. Learn more about her here.
Maureen McNulty studied molecular genetics and English at Ohio State University. Learn more about her here.

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