Prognosis:

Survival rates for NHL vary widely, depending on the lymphoma type, stage, age of the patient, and other variables. According to the American Cancer Society, the overall 5-year relative survival rate for patients with non-Hodgkinâ ' s lymphoma is 63% and the 10-year relative survival rate is 51%. (The relative survival rate estimates the likelihood that a patient will survive a certain number years after diagnosis. It is calculated to exclude the likelihood of death from diseases other than the cancer.)

Because the outlook varies so widely, making a definite prognosis is very difficult. For example, patients with very slow growing (indolent) lymphomas can live many years. However, they are usually diagnosed at a late stage, after the cancer has spread, thus reducing the survival rate. Aggressive lymphomas are more likely to cause rapid death, but they are also often curable.

Survival rates for patients with NHL have greatly improved since the early 1990s, especially for patients under age 45. Advances in treatment have contributed to this improvement.

Outlook for Indolent Lymphomas

Follicular lymphomas, the most common indolent (slow-growing) NHLs, are potentially curable in early stages I and II. Unfortunately, however, these slow-growing malignancies produce no symptoms until they are in advanced stages. In most cases, these lymphomas are not diagnosed until they have spread to other sites, including the spleen and bone marrow. In such cases, they are difficult to cure. Predicting outcome for indolent follicular lymphomas is more difficult than for aggressive lymphomas. Even if treatment achieves a response, these tumors almost always recur. Even after relapse, however, the tumors can be treated again if they are still very slow-growing.

In general, the average survival rate for follicular lymphoma is 7 - 10 years, depending on other risk factors. New drug treatments, particularly monoclonal antibodies, have significantly improved survival rates. According to a recent study, 91% of patients with follicular lymphoma now survive the first 4 years after diagnosis, compared with 69% of patients treated in the past with older types of drugs.

Outlook for Aggressive Lymphomas

High-grade aggressive lymphomas are often symptomatic early on and are potentially curable with aggressive treatments. Diffuse large B-cell lymphoma (DLBLC), the most common aggressive non-Hodgkin's lymphomas, while fatal if not treated, is often curable with intensive chemotherapy combinations. If relapse occurs after chemotherapy, it usually does so within 2 years.

Most other aggressive lymphomas respond to aggressive chemotherapy. Some aggressive lymphomas, such as mantle cell lymphoma, are less responsive to standard chemotherapy.

International Prognostic Index

A scoring system called the International Prognostic Index has proved to be fairly accurate for predicting outcome in patients with most aggressive B-cell lymphomas such as DLBCL. It uses five risk factors to help predict survival odds:

• Being older than 60 -- this age group tends to have other medical conditions, which contribute to the poorer prognosis
• Having a disseminated tumor (stage III or IV)
• Disease that has spread to more than one site beyond the lymph nodes
• The patient's functional ability
• Having elevated levels of the lactate dehydrogenase (LDH) protein

Having one or none of these risk factors indicates the best outlook. Two factors indicate a low-to-intermediate likelihood of a poor outlook. Three factors predict an intermediate-to-high likelihood of poor outlooks. Finally, four or five factors pose the highest likelihood of poor survival. However, the International Prognostic Index was developed before the introduction of newer drug therapies like rituximab, which has dramatically helped improve the outcome of patients with DLBCL.

A similar prognostic index has been developed for follicular lymphoma.

Long-Term Complications of Treatments

Medical Problems. The radiation and chemotherapies used in treating NHL can have long-term effects on many organs in the body and can increase the risk for serious illnesses, including heart disease and certain cancers.

Emotional Problems. Depression and anxiety are common in survivors, particularly those who suffer additional medical conditions. Many patients also suffer from fatigue and aches and pains, called somatic symptoms, which have no apparent physical basis.