People with non-Hodgkin lymphoma (NHL) may have questions about their prognosis and survival. Prognosis and survival depend on many factors. Only a doctor familiar with a person's medical history, type of cancer, stage, characteristics of the cancer, treatments chosen and response to treatment can put all of this information together with survival statistics to arrive at a prognosis.
A prognosis is the doctor's best estimate of how cancer will affect a person, and how it will respond to treatment. A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together and they both play a part in deciding on a treatment plan and a prognosis.
International Prognostic Index
Doctors often use the International Prognostic Index (IPI) to identify those people who will likely respond well to treatment and those whose cancer is likely to relapse. The IPI was developed to help determine the outcome for people with aggressive lymphomas and is used for most lymphomas. The main IPI prognostic factors for NHL are:
- age
- stage of NHL
- lactate dehydrogenase (LDH) level (measured in the blood)
- extranodal sites
- performance status
Age
People under 60 years of age tend to have a more favourable prognosis than those over 60.
Stage of NHL
The earlier or lower the stage of NHL (stage I or stage II), the more favourable the prognosis. Stage III and stage IV NHLs have a less favourable prognosis.
Lactate dehydrogenase (LDH) level
People with normal LDH blood levels tend to have a more favourable prognosis than those with higher LDH levels. Increased LDH is usually associated with more extensive disease and LDH is often higher in people with a fast-growing lymphoma.
Extranodal sites
Lymphoma that is confined to the lymph nodes is more treatable and has a more favourable prognosis than lymphoma that has spread outside of the lymph nodes (extranodal lymphoma) to organs, such as the bone marrow, liver, brain or spinal cord (central nervous system). People with lymphoma and without extranodal sites, or only 1 extranodal site, have a better prognosis than those with lymphoma in 2 or more extranodal sites.
Extranodal lymphomas that occur in the brain or testicles are associated with a less favourable prognosis.
Performance status
Performance status is ranked on a scale. Different performance status scales are used. Generally, the more active the person is and the more able they are to continue their normal activities of daily living, the better the performance status. People with a good performance status (those able to function fairly normally) have a better prognosis than those with a poor performance status (those who need help with daily living activities or need to spend a lot of time in bed).
IPI prognostic score
The IPI helps doctors determine a prognostic score based on the 5 prognostic factors for NHL. One point is given for each poor prognostic factor and the points are added to give a score between 0 and 5. This gives an indication of prognosis. The lower the score, the more favourable the prognosis.
|
age | 60 or younger | over 60 |
stage | I or II | III or IV |
LDH levels | normal LDH | increased LDH |
extranodal sites | no lymphoma outside of lymph nodes or lymphoma in only 1 area outside of lymph nodes | lymphoma in more than 1 organ of the body outside of lymph nodes |
|
Back to top
Other prognostic factors
Other prognostic factors may also be considered.
Type of lymphoma
People with B-cell lymphomas tend to have a better prognosis than those with T-cell lymphomas. However, anaplastic large cell lymphoma and cutaneous T-cell lymphoma are 2 subtypes of T-cell lymphomas that have a fairly good prognosis.
Of the 2 most common B-cell lymphomas, follicular lymphoma generally has a better prognosis than diffuse large B-cell lymphoma.
Tumour size (bulk)
The smaller the tumour, the more favourable the prognosis. Smaller tumours tend to respond better to treatment. A very large tumour (10 cm or more) may be referred to as a bulky tumour and large tumours often have a less favourable prognosis.
B symptoms
The lack of B symptoms (fever, night sweats and weight loss) is usually associated with earlier stages of NHL and a more favourable prognosis. B symptoms are usually associated with more extensive disease.
Hemoglobin levels
People with normal hemoglobin levels have a better outcome than those with low hemoglobin levels and anemia.
Back to top
Follicular lymphoma
A different prognostic factor index has been developed for people with follicular lymphoma, which tends to be a slower-growing lymphoma. It is called the Follicular Lymphoma International Prognostic Index (FLIPI). FLIPI uses slightly different prognostic factors than the IPI.
Back to top