How is the prognosis of non-Hodgkin lymphoma (NHL) determined?

Updated: Feb 25, 2021
  • Author: Sanjay Vinjamaram, MD, MPH; Chief Editor: Emmanuel C Besa, MD  more...
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The International Prognostic Index (IPI), which was originally designed as a prognostic factor model for aggressive NHL, also appears to be useful for predicting the outcome of patients with low-grade lymphoma and mantle cell lymphoma. This index is also used to identify patients at high risk of relapse, based on specific sites of involvement, including bone marrow, CNS, liver, testis, lung, and spleen. These patients may be considered for clinical trials that aim at improving the current treatment standard.

An age-adjusted model for patients younger than 60 years has been proposed. In younger patients, stage III or IV disease, high LDH levels, and nonambulatory performance status are independently associated with decreased survival rates.

Pediatric and adolescent patients have better outcome than adults with CNS lymphoma. [10] An ECOG performance status score of 0-1 is associated with improved survival. Higher dose methotrexate is associated with slightly better response.

Clinical features included in the IPI that are independently predictive of survival include the following:

  • Age - Younger than 60 years versus older than 60 years
  • LDH level - Within the reference range versus elevated
  • Performance status - Eastern Cooperative Oncology Group ( ECOG) grade 0-1 versus 2-4
  • Ann Arbor stage - Stage I-II versus III-IV
  • Number of extranodal sites - Zero to 1 versus more than 1

With this model, relapse-free and overall survival rates at 5 years are as follows:

  • 0-1 risk factors - 75%
  • 2-3 risk factors - 50%
  • 4-5 risk factors - 25%

For patients with follicular lymphoma—the second most common subtype of NHL—the Follicular Lymphoma International Prognostic Index (FLIPI) score appears to be more discriminating than the IPI. [11] The FLIPI score is calculated on the basis of 5 adverse prognostic factors, as follows:

  • Age (> 60 y)
  • Ann Arbor stage (III-IV)
  • Hemoglobin level (< 12 g/dL)
  • Number of nodal areas (> 4)
  • Serum LDH level (above normal)

Three risk groups are defined by FLIPI score:

  • Low risk (0-1 adverse factor)
  • Intermediate risk (2 factors)
  • Poor risk (3 or more adverse factors)

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