Survival Rates and Factors That Affect Prognosis (Outlook) for Non-Hodgkin Lymphoma

Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time (usually 5 years) after they were diagnosed. They can’t tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.

Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they can’t predict what will happen in any particular person’s case. These statistics can be confusing and may lead you to have more questions. Talk with your doctor about how these numbers may apply to you, as he or she is familiar with your situation.

What is a 5-year relative survival rate?

A relative survival rate compares people with the same type and stage of non-Hodgkin lymphoma (NHL) to people in the overall population. For example, if the 5-year relative survival rate for a specific stage of NHL is 70%, it means that people who have that cancer are, on average, about 70% as likely as people who don’t have that cancer to live for at least 5 years after being diagnosed.

Where do these numbers come from?

The American Cancer Society relies on information from the SEER* database, maintained by the National Cancer Institute (NCI), to provide survival statistics for different types of cancer.

The SEER database tracks 5-year relative survival rates for NHL in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by the Lugano classification (stage 1, stage 2, stage 3, etc.). Instead, it groups cancers into localized, regional, and distant stages:

  • Localized: The cancer is limited to one lymph node area, one lymphoid organ, or one organ outside the lymph system. 
  • Regional: The cancer reaches from one lymph node area to a nearby organ, is found in two or more lymph node areas on the same side of the diaphragm, or is considered bulky disease. 
  • Distant: The cancer has spread to distant parts of the body such as the lungs, liver, or bone marrow, or to lymph node areas above and below the diaphragm. 

5-year relative survival rates for NHL

The overall 5-year relative survival rate for people with NHL is 71%. But it’s important to keep in mind that survival rates can vary widely for different types and stages of lymphoma. Below are the 5-year relative survival rates for two common types of NHL - diffuse large B-cell lymphoma and follicular lymphoma - based on people diagnosed between 2008 and 2014.

Diffuse large B-cell lymphoma

SEER Stage

5-Year Relative Survival Rate

Localized

72%

Regional

72%

Distant

55%

All SEER stages combined

63%

 

Follicular lymphoma

SEER Stage

5-Year Relative Survival Rate

Localized

95%

Regional

90%

Distant

84%

All SEER stages combined

88%

Understanding the numbers

  • These numbers apply only to the stage of the cancer when it is first diagnosed. They do not apply later on if the cancer grows, spreads, or comes back after treatment.
  • People now being diagnosed with NHL may have a better outlook than these numbers show. Treatments improve over time, and these numbers are based on people who were diagnosed and treated at least five years earlier.
  • These numbers don’t take everything into account. Survival rates are grouped based on how far the cancer has spread, but your age, overall health, the type of NHL, how well the cancer responds to treatment, and other factors (see below) can also affect your outlook.

Prognostic factors for non-Hodgkin lymphoma

For some types of lymphoma the stage isn’t too helpful in determining a person’s outlook. In these cases, other factors can give doctors a better idea about a person’s prognosis.

International Prognostic Index (IPI)

The International Prognostic Index (IPI) was first developed to help doctors determine the outlook (prognosis) for people with fast-growing (aggressive) lymphomas. However, it has proven useful for most other lymphomas as well (other than slow-growing [indolent] follicular lymphomas, which are discussed below). The IPI allows doctors to plan treatment better than they could just based on the type and stage of the lymphoma. This has become more important as new, more effective treatments have been developed that sometimes have more side effects. The index helps doctors figure out whether these treatments are needed.

The index depends on 5 factors:

  • The patient’s age
  • The stage of the lymphoma
  • Whether or not the lymphoma is in organs outside the lymph system
  • Performance status (PS) – how well a person can complete normal daily activities
  • The blood level of lactate dehydrogenase (LDH), which goes up with the amount of lymphoma in the body

Good prognostic factors

Poor prognostic factors

Age 60 or below

Age above 60

Stage I or II

Stage III or IV

No lymphoma outside of lymph nodes, or lymphoma in only 1 area outside of lymph nodes

Lymphoma is in more than 1 organ of the body outside of lymph nodes

PS: Able to function normally

PS: Needs a lot of help with daily activities

Serum LDH is normal

Serum LDH is high

Each poor prognostic factor is assigned 1 point. People without any poor prognostic factors would have a score of 0, while those with all poor prognostic factors would have a score of 5. The index divides people with lymphomas into 4 risk groups:

  • Low risk (0 or 1 poor prognostic factors)
  • Low-intermediate risk (2 poor prognostic factors)
  • High-intermediate risk (3 poor prognostic factors)
  • High risk (4 or 5 poor prognostic factors)

Follicular Lymphoma International Prognostic Index (FLIPI)

The IPI is useful for most lymphomas, but it’s not as helpful for follicular lymphomas, which tend to be slower growing. Doctors have developed the Follicular Lymphoma International Prognostic Index (FLIPI) specifically for this type of lymphoma. It uses slightly different prognostic factors than the IPI.

Good prognostic factors

Poor prognostic factors

Age 60 or below

Age above 60

Stage I or II

Stage III or IV

Blood hemoglobin 12 g/dL or above

Blood hemoglobin level below 12 g/dL

4 or fewer lymph node areas affected

More than 4 lymph node areas affected

Serum LDH is normal

Serum LDH is high

Patients are assigned a point for each poor prognostic factor. People without any poor prognostic factors would have a score of 0, while those with all poor prognostic factors would have a score of 5. The index then divides people with follicular lymphoma into 3 groups:

  • Low risk (no or 1 poor prognostic factor[s])
  • Intermediate risk (2 poor prognostic factors)
  • High risk (3 or more poor prognostic factors)

For both the IPI and FLIPI, people in the low risk group tend to have a better prognosis than those in the high risk group.

*SEER= Surveillance, Epidemiology, and End Results

 

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

National Comprehensive Cancer Network, Clinical Practice Guidelines in Oncology (NCCN Guidelines®), B-cell Lymphomas, Version 2.2019 -- March 6, 2019. Accessed at www.nccn.org/professionals/physician_gls/pdf/b-cell.pdf on March 21, 2019.

Noone AM, Howlader N, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2015, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2015/, based on November 2017 SEER data submission, posted to the SEER web site, April 2018.

Solal-Celigny P, Roy P, Colombat P, et al. Follicular Lymphoma International Prognostic Index. Blood. 2004;104:1258-1265.

Last Medical Review: August 1, 2018 Last Revised: April 4, 2019

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