Prognosis and survival for non-Hodgkin lymphoma

A prognosis is the doctor's best estimate of how cancer will affect you and how it will respond to treatment. Survival is the percentage of people with a disease who are alive at some point in time after their diagnosis. Prognosis and survival depend on many factors.

Only a doctor familiar with your medical history, the type, stage and other features of the cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis and chances of survival.

The doctor will look at certain aspects of the cancer or a characteristic of the person (such as their age or performance status). These are called prognostic factors. The doctor will also look at predictive factors, which influence how a cancer will respond to a certain treatment and how likely it is that the cancer will come back after treatment.

For some types of non-Hodgkin lymphoma (NHL), doctors use different versions of a special scoring system called the International Prognostic Index (IPI) to determine prognosis. The IPI combines certain prognostic and predictive factors rather than focusing on the factors on their own. It also gives doctors an estimate of how well NHL is likely to respond to treatment and how likely it is to come back (relapse) after treatment.

The following are prognostic and predictive factors for NHL.

People with B-cell lymphomas often have a better prognosis than those with T-cell lymphomas.

Of the 2 most common types of B-cell lymphoma, follicular lymphoma generally has a better prognosis than diffuse large B-cell lymphoma (DLBCL).

Anaplastic large-cell lymphoma (ALCL) and T-cell skin lymphoma are 2 subtypes of T-cell lymphoma that have a fairly good prognosis.

People younger than 60 tend to have a better prognosis than people older than 60.

People with a normal level of lactate dehydrogenase (LDH) in the blood tend to have a better prognosis than those with higher LDH levels. A higher than normal level of LDH usually means a more advanced cancer. LDH is often higher in people with a fast-growing type of NHL.

The lower the stage of NHL, the better the prognosis. Stages 1 and 2 have a better prognosis than stages 3 and 4.

Performance status measures how well a person can do ordinary tasks and daily activities. Generally, the more active someone is and the more able they are to continue their normal activities of daily living, the better their performance status. People with a good performance status (those who can function fairly normally) usually have a better prognosis than people with a poor performance status (those who need help with daily activities or need to spend a lot of time in bed).

When NHL spreads to an organ or tissue outside of the lymph nodes, it is called extranodal disease. NHL that is only in lymph nodes is more likely to be successfully treated and has a better prognosis than NHL with extranodal disease.

Bulky disease means that there is an NHL tumour or area of lymphoma bigger than 10 cm. (Sometimes bulky disease can be a smaller size for specific types of NHL.) Smaller tumours tend to respond better to treatment than larger ones, so bulky disease has a less favourable prognosis.

B symptoms include unexplained fever, drenching night sweats and unexplained weight loss. If B symptoms are present, the prognosis is less favourable.

People with normal hemoglobin levels have a better prognosis than those with low hemoglobin levels.