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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.
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:
People under 60 years of age tend to have a more favourable prognosis than those over 60.
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.
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.
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 statusPerformance statusThe measure of how well a person is able to perform ordinary tasks and carry out daily activities. 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).
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.
60 or younger
I or II
III or IV
no lymphoma outside of lymph nodes
lymphoma in only 1 area outside of lymph nodes
lymphoma in more than 1 organ of the body outside of lymph nodes
good performance status
poor performance status
Other prognostic factors may also be considered.
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.
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.
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.
People with normal hemoglobin levels have a better outcome than those with low hemoglobin levels and anemia.
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.
The Canadian Cancer Society is actively lobbying the federal government to establish a national caregivers strategy to ensure there is more financial support for this important group of people.