hematology and oncology
Non Hodgkin Lymphomas
Prognosis for Non Hodgkin Lymphomas
Prognosis varies by the type and stage of lymphoma and individual patient factors. In general, patients with peripheral T-cell or natural killer (NK)/T-cell lymphomas typically have a worse prognosis than those with B-cell non-Hodgkin lymphoma. Within each non-Hodgkin lymphoma variant, prognosis is related to differences in tumor cell biology. The most commonly used prognostic scoring system is theInternational Prognostic Index (IPI) for diffuse large B-cell lymphoma). However, the IPI score is used only for diffuse large B-cell lymphoma (DLBCL). There are also scoring systems for follicular lymphoma (FLIPI) and mantle cell lymphoma (MIPI). Online calculators are available to estimate prognosis in other types of non-Hodgkin lymphoma as well. The IPI considers 5 risk factors: Age>60 years Poor performance status (can be measured using theEastern Cooperative Oncology Group tool) Elevated lactate dehydrogenase (LDH) level >1 extranodal site Stage III or IV disease Outcome is worse with an increasing number of risk factors. Patients in the highest risk groups (patients with 4 or 5 risk factors) have a 50% 5-year survival. Patients without any of the risk factors have a very high cure rate. The original IPI score uses the 5 factors as discrete variables (eg, either age over 60 or under 60). A modification, theDiffuse Large B-cell Lymphoma Prognosis (IPI24), which calculates the chance of being disease free at 24 months from diagnosis, includes the above factors as continuous variables and also includes absolute lymphocyte count. 