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Prognostic Factors, Risk Groups, and Survival Rates for Lymphoma in Children
Survival rates are a way to measure how many people survive a certain type of cancer over time. They can’t tell you for sure if treatment will be successful, but they may help you better understand your child’s outlook (prognosis).
You might also hear the cancer care team talk about risk groups and prognostic factors. These are other ways for doctors to understand the specifics of an individual child's disease and their outlook (prognosis).
Some people find this information helpful, while others prefer to focus more on the treatment plan and next steps.
Understanding prognostic factors, risk groups, and survival rates
What is a prognostic factor?
When a child has cancer, including lymphoma, certain factors can affect their outlook (prognosis). These are called prognostic factors.
Prognostic factors for childhood lymphoma might include:
- Certain features of the child, such as their age and overall health
- Features of the lymphoma, such as the type, symptoms, and spread
- Lab test results
These factors help doctors anticipate how a child’s cancer may respond to different treatments. In turn, this helps them decide how intense the treatment should be.
What is a risk group?
Children with lymphoma are often put into risk groups based on certain prognostic factors of their disease. These risk groups help the cancer care team determine the best treatment plan.
What is a 5-year survival rate?
The 5-year survival rate refers to the percentage of children who live at least 5 years after their lymphoma is diagnosed. With lymphoma, children who are free of the disease after 5 years are likely to be cured.
- Survival rates are different for each type of childhood lymphoma. Knowing the type of lymphoma your child has is important in estimating their outlook.
- Accurate survival rates can be hard to find for less common forms of lymphoma in children.
- Survival rates are rough estimates, at best. Your child’s cancer care team can tell you how these numbers might apply in your case.
Current 5-year survival rates are based on children first diagnosed and treated more than 5 years ago. Improvements in treatment since then might result in a better outlook for children diagnosed today.
Hodgkin lymphoma (HL) prognostic factors and risk groups
Children with Hodgkin lymphoma (HL) are often put into risk groups to help the cancer care team decide on the best treatment plan. These risk groups are based on prognostic factors such as a tumor’s stage and whether or not B symptoms or bulk were present at diagnosis.
Prognostic factors
While all of the following are prognostic factors, only certain ones are used to determine which risk group a child is in.
Children with stage III and IV disease tend to have HL that is more difficult to treat. They may get more intense treatment.
Children with more aggressive HL might have B symptoms such as weight loss, drenching night sweats and fevers, or bulky disease. Bulky disease is HL that presents with:
- A very large tumor, greater than 6 centimeters, or
- Lymph nodes in the chest greater than 1/3 the width of the chest
Children with fluid around the heart (pericardial effusion) or lungs (pleural effusion) when they are diagnosed with HL tend to have a worse outlook than those who don't have this extra fluid at the time of diagnosis.
Girls with HL tend to have a better outlook than boys.
ESR is a blood lab test that can be high if there is inflammation present.
A child diagnosed with Hodgkin lymphoma who has a normal ESR tends to have a better outlook than a child with an elevated ESR.
Albumin is a lab test for a certain type of protein. Children with low albumin at diagnosis tend to have a worse outlook than those with a normal albumin level.
Responding quickly to the early cycles of chemo treatment tends to be a good predictor of how well the cancer will respond to treatment overall.
Risk groups
Children with classical HL are often put into low, intermediate, and high-risk groups based on the stage of the tumor, as well as the presence of bulky disease and B symptoms (weight loss, fevers, or drenching night sweats).
There is no clear standard for categorizing HL into these risk groups, but in many cases these groups are defined as:
- Low-risk classical HL: Stage IA/IIA with disease in the lymph nodes and no bulk
- Intermediate-risk classical HL: Stage IA/IIA with bulk or tumors outside the lymph nodes and stage IB/IIB with or without bulk or tumors outside the lymph nodes
- High-risk classical HL: Stage III and IV disease
Doctors are working to standardize how risk groups are assigned in HL clinical trials to better understand how to treat the disease.
HL survival rates
Classical Hodgkin lymphoma: Overall, more than 95% of children with classical HL will be cured with current treatments. The stage and risk group of HL determines how much and what type of treatments may offer the best chance of cure.
Nodular lymphocyte-predominant HL (NLPHL): Treatments for the rarer NLPHL variant tend to respond very well to treatment. In some cases, NLPHL may return after initial treatment. However, the chance of cure is still very good when this happens.
Non-Hodgkin lymphoma (NHL) prognostic factors and risk groups
Children with non-Hodgkin lymphoma (NHL) are often put into risk groups to determine the best treatment plan. These risk groups are based on prognostic factors like a tumor’s stage, if it can be removed with surgery, and if it is located in the bone marrow or central nervous system (CNS).
Prognostic factors
While all of the following are prognostic factors, only certain ones are used to determine which risk group a child is in.
Children with stage I disease have an excellent outlook. Stage I is defined as a single tumor or nodal area outside the chest or abdomen that can be completely removed with surgery.
Children with lymphoma involving the central nervous system or bone marrow often need more intense treatments.
Children with NHL tend to have a better outlook than infants and adolescents.
LDH is a blood test that can be used to monitor certain types of lymphoma. Children with very high levels of LDH at diagnosis have a worse prognosis and may need more intense treatments.
In most cases, NHL that doesn’t respond well to initial treatment has a worse outlook than tumors that respond well to initial treatment.
This is not the case for children with anaplastic large cell lymphoma (ALCL).
Risk groups
Children with NHL are often put into risk groups (either A through C or R1 through R4) based on the stage of the tumor, whether the tumor could be removed with surgery, and other factors.
Risk group is important for determining the right treatment plan and estimating the outlook for a child with NHL.
There are two main risk-grouping systems used for NHL:
- The FAB/LMB system uses groups A through C
- The BFM system uses groups R1 through R4
FAB/LMB
This system groups NHL into 3 strata:
- A: Stage IA (or stage II in the belly) that was completely removed with surgery
- B: Stage I, II, III, or IV disease that could not be removed with surgery, or children with multiple tumors/enlarged nodes outside the belly
- C: Mature B-cell ALL (Burkitt leukemia) with at least 25% disease in the bone marrow or involvement of the central nervous system (brain and spinal cord)
BFM
This system groups NHL into 4 strata:
- R1: Stage IA (or stage II in the belly) that was completely removed with surgery
- R2: Stage I/II that could not be removed with surgery and stage III with an LDH level less than 500
- R3: Stage III disease with an LDH of 500-9999 or stage IV mature B-cell ALL (Burkitt leukemia) with at least 25% disease in the bone marrow and no central nervous system (CNS) disease
- R4: Stage III/IV or mature B-cell ALL with an LDH level of 1000 or more; any NHL with CNS disease (involvement of the brain or spinal cord)
NHL survival rates
Advances in treatment have increased the overall survival rates for children and teens with NHL dramatically in recent decades.
The survival rate for children and adolescents under the age of 20 diagnosed with NHL is about 90%.
There are many different types of NHL that can occur in children. The ranges of numbers given below are based on the results of several studies that have used different treatment regimens or included slightly different groups of patients.
Stage I and II: With intensive treatment, the long-term survival rate for children and teens with limited stage lymphoblastic lymphoma is higher than 90%.
Stage III and IV: The long-term survival rate for more advanced lymphoblastic lymphomas is generally higher than 85%.
Stage I and II: Treatment of limited stage Burkitt lymphomas is usually very successful, with a long-term survival rate of over 90%.
Stage III and IV: The long-term survival rate for children and teens with more advanced Burkitt lymphoma ranges from about 80% to 90%.
Stage I and II: The long-term survival rate is over 90% for limited stage large B-cell lymphoma.
Stage III and IV: The long-term survival rate for children and teens with advanced disease ranges from about 80% to 90%.
Follicular lymphoma in children is rare. However, survival rates of 95% have been reported after initial therapy.
Marginal zone lymphomas in children are rare.
A study looking at children younger than 18 diagnosed with marginal zone lymphoma reported a 98% survival rate.
Children who had disease of the lymph nodes (mostly in the head and neck) had a better outlook than children with tumors outside the lymph nodes (extranodal). These tumors were more likely to return after treatment. Even after relapse, most were successfully treated.
Limited stage: The long-term survival rate for limited stage anaplastic large cell lymphoma (ALCL) is about 90%.
Advanced stage: ALCL is more likely to be advanced at the time it is diagnosed. The long-term survival rate for advanced stage ALCL is in the range of 60% to 75%.
Pediatric CNS lymphoma is very rare. Reports estimate survival rates for children with CNS lymphoma are between 70% to 80%.
This may be better than adults with this diagnosis.
Keep in mind that these survival rates are only estimates. They can't predict what will happen with any single child. These statistics can be confusing and may lead you to have more questions. Talk to your child’s cancer care team if you'd like a better understanding of what these numbers mean.
- Written by
- References
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
Appel BE, Chen L, Buxton AB, et al. Minimal Treatment of Low-Risk, Pediatric Lymphocyte-Predominant Hodgkin Lymphoma: A Report From the Children's Oncology Group. J Clin Oncol. 2016;34(20):2372-2379.
Cole PD, Parikh RR, Kelly KM. Chapter 18: Hodgkin Lymphoma. In: Blaney SM, Adamson PC, Helman LJ, eds. Pizzo and Poplack’s Pediatric Oncology. 8th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2021.
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National Cancer Institute. Childhood Hodgkin Lymphoma Treatment (PDQ). 2025. Accessed at https://www.cancer.gov/types/lymphoma/hp/child-hodgkin-treatment-pdq on November 11, 2025.
National Cancer Institute. Childhood Non-Hodgkin Lymphoma Treatment (PDQ). 2025. Accessed at https://www.cancer.gov/types/lymphoma/hp/child-nhl-treatment-pdq on November 11, 2025.
Teachey DT, Devidas M, Wood BL, et al. Children's Oncology Group Trial AALL1231: A Phase III Clinical Trial Testing Bortezomib in Newly Diagnosed T-Cell Acute Lymphoblastic Leukemia and Lymphoma. J Clin Oncol. 2022;40(19):2106-2118.
Last Revised: February 27, 2026
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