Prognosis and survival for non-Hodgkin lymphoma

If you have non-Hodgkin lymphoma (NHL), you may have questions about your prognosis. A prognosis is the doctor’s best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with your health history, the type, stage and 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 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.

The Revised IPI (R-IPI) is a more recent version of the International Prognostic Index (IPI) that was developed to help determine the outcome for people with aggressive (fast-growing) types of NHL.

The R-IPI is based on treatment with newer drugs including rituximab (Rituxan). It helps doctors assign people to risk groups based on the number of poor prognostic factors they have. The R-IPI uses the same factors as the IPI and divides people into 3 risk groups.

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

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

People with a normal level of 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.

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

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 living activities or need to spend a lot of time in bed).

Doctors assign a prognostic score based on the R-IPI. They give 1 point for each poor prognostic factor. The lower the number of poor prognostic factors, the more favourable the prognosis.

• A very good prognosis has no poor prognostic factors.
• A good prognosis has 1 or 2 poor prognostic factors.
• A poor prognosis has 3 or more poor prognostic factors.

Doctors use the R-IPI to identify a case of NHL that is likely to respond well to treatment and NHL that is likely to come back (relapse) after treatment.

Doctors will also consider the following factors when they estimate a prognosis 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 and cutaneous T-cell lymphoma are 2 subtypes of T-cell lymphoma that have a fairly good prognosis.

The smaller the tumour, the better the prognosis. Small tumours tend to respond better to treatment. Large tumours often have a less favourable prognosis. A very large tumour (10 cm or more) may be called a bulky tumour.

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.