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Non-Hodgkin Lymphoma Prognosis: Fear, Hope, and Understanding Survival Rates

Posted on June 22, 2022
Medically reviewed by
Todd Gersten, M.D.
Article written by
Aminah Wali, Ph.D.

For a person diagnosed with non-Hodgkin lymphoma (NHL), disease prognosis is often a major concern. Prognosis (or outlook) refers to the estimated likelihood of treatment response and survival. Survival rate, a statistical tool used by doctors, is an important factor in determining a person’s prognosis.

Overall, the five-year survival rate (likelihood of living five years after diagnosis) for people with NHL is 73 percent. However, this rate can vary significantly depending on the type of NHL, your individual risk factors, and your overall health.

To estimate disease prognosis, doctors consider several variables.

Factors That Affect Prognosis

To estimate prognosis for NHL, doctors take into account many factors. These prognostic factors, as they’re called, include patient demographics and aspects of how the cancer grows.

Type of Lymphoma

NHL is a broad category of lymphoma that includes many forms, or subtypes. Some subtypes are aggressive, and others are indolent (slow-growing). Aggressive cancers are generally associated with a worse prognosis.

Stage of Disease

Cancer typically forms in one location but can spread to other organs. The extent of this spread is referred to as the stage of disease and ranges from 1 to 4. NHL that is at a higher stage (3 or 4) at the time of diagnosis has a worse prognosis than lower-stage disease (1 or 2).

Age

Diagnosis with NHL at 60 years or older is also a risk factor for poor prognosis. People diagnosed before age 60 tend to have a better prognosis.

Lactate Dehydrogenase Levels

Lactate dehydrogenase (LDH), a protein involved in energy metabolism, is found throughout most tissues in the body. A high LDH level can indicate tissue damage and is associated with a more advanced cancer and poorer prognosis for NHL.

Performance Status

Cancer causes physical ailments that can affect the ability to perform certain activities. Performance status is measured on a graded scale that defines a person’s daily functioning. The different scales reflect how well a person is able to carry out daily activities.

Extranodal Involvement

NHL generally forms in the lymph nodes, but cancer cells can also be found in or spread to other organs. When cancer spreads outside the lymph nodes, it is described as extranodal involvement, which can be an indicator of how advanced the disease is. Greater extranodal involvement in NHL is associated with a worse prognosis.

Measuring Prognosis of Non-Hodgkin Lymphoma

To measure the outlook of NHL, doctors may use different models to evaluate and quantify prognostic factors.

International Prognostic Index

The International Prognostic Index (IPI) is a predictive model designed to estimate outcomes of non-Hodgkin lymphoma. The IPI takes into account several of the prognostic factors described above:

  • Age
  • Performance status
  • Disease stage
  • LDH level
  • Extranodal involvement

For each variable, a risk factor for poor prognosis is assigned a point. A high level of LDH in the blood, for example, is associated with poor prognosis and would be assigned a point. The highest number of points across all categories is 5 and indicates the worst prognosis, and a zero indicates the best prognosis.

Revised International Prognostic Index

Whereas the original IPI was based on expected response to standard chemotherapy and radiation treatments, the Revised International Prognostic Index (R-IPI) takes into account rituximab (Rituxan). Rituximab is an antibody drug that targets cancer cells and is often used in combination with chemotherapy. The R-IPI is considered a better predictive model for people who receive rituximab in addition to conventional treatments.

Follicular Lymphoma International Prognostic Index

The IPI was developed primarily for aggressive non-Hodgkin lymphoma. For follicular lymphoma, the most common indolent form of NHL, the Follicular Lymphoma International Prognostic Index (FLIPI) offers a more effective predictive model. Although similar to the IPI, the FLIPI’s variables differ slightly and include:

  • Age
  • Disease stage
  • Blood hemoglobin level
  • Extranodal involvement
  • LDH level

Survival Rates

The survival rate is a measure that indicates the chance a person diagnosed with cancer will be alive after a certain time frame — commonly five years. This statistic is called the five-year survival rate.

Survival data is collected over time by the Surveillance, Epidemiology, and End Results (SEER) program from the National Institutes of Health. The five-year survival rate is calculated separately for each stage. SEER categorizes the disease stage of NHL as follows:

  • Localized — The cancer is located only in the lymph nodes or within lymphatic tissues.
  • Regional — The cancer has spread to a nearby organ.
  • Distant — The cancer has spread to an organ farther away.

The distant stage has the lowest survival rates.

Prognosis of Non-Hodgkin Lymphoma

According to the American Cancer Society, the overall five-year survival rate across all forms of NHL is 73 percent. This data is primarily collected from response to standard treatments including radiation therapy, chemotherapy, and rituximab. For newer treatments, such as targeted therapies, the impact on survival rate cannot be accurately estimated until more data is collected. With advancements in treatments, survival and outlook may be better than current estimates.

Although the overall survival for all types of NHL is nearly 75 percent, the disease prognosis can vary depending on the type of lymphoma. Indolent forms generally have a better prognosis than more aggressive forms. Follicular lymphoma generally has a good prognosis, with a five-year survival rate of 90 percent for all SEER stages combined, according to the American Cancer Society. In contrast, mantle cell lymphoma, a rare and aggressive form of NHL, has a much poorer prognosis.

A person diagnosed with NHL should consult with their doctor regarding the treatment options and prognosis for their particular form of the cancer.

Connect With Others Who Understand

A new cancer diagnosis can be a lot to handle. It may help to have the support of others who understand what you’re going through as you face new challenges. MyLymphomaTeam is the social network for people with lymphoma and their loved ones. More than 11,000 members understand what it’s like to face lymphoma and can provide support and answers.

Are you or a loved one newly diagnosed with non-Hodgkin lymphoma? Have you discussed the prognosis with a doctor or others? Share your experience at MyLymphomaTeam or comment below to start a conversation.

All updates must be accompanied by text or a picture.
Todd Gersten, M.D. is a hematologist-oncologist at the Florida Cancer Specialists & Research Institute in Wellington, Florida. Review provided by VeriMed Healthcare Network. Learn more about him here.
Aminah Wali, Ph.D. received her doctorate in genetics and molecular biology from the University of North Carolina at Chapel Hill. Learn more about her here.

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