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

Survival rates tell you what portion 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 about how likely it is that your treatment will be successful. Some people will want to know the survival rates for their cancer, and some people won’t. If you don’t want to know, you don’t have to.

What is a 5-year survival rate?

Statistics on the outlook for a certain type of cancer are often given as 5-year survival rates. The 5-year survival rate is the percentage of people who live at least 5 years after being diagnosed with cancer. For example, a 5-year survival rate of 70% means that an estimated 70 out of 100 people who have that cancer are still alive 5 years after being diagnosed. Keep in mind, however, that many of these people live much longer than 5 years after diagnosis.

Relative survival rates are a more accurate way to estimate the effect of cancer on survival. These rates compare people with a certain type of cancer to similar people in the overall population. For example, if the 5-year relative survival rate for a type of cancer is 80%, it means that people who have that type of cancer are, on average, about 80% as likely as people who don’t have that cancer to live for at least 5 years after being diagnosed.

But remember, all survival rates are estimates – your outlook can vary based on a number of factors specific to you.

Cancer survival rates don’t tell the whole story

Survival rates are often based on previous outcomes of large numbers of people who had the disease, but they can’t predict what will happen in any particular person’s case. There are a number of limitations to remember:

  • The numbers below are among the most current available. But to get 5-year (or 10-year) survival rates, doctors have to look at people who were treated at least 5 (or 10) years ago. As treatments are improving over time, people who are now being diagnosed with non-Hodgkin lymphoma (NHL) may have a better outlook than these statistics show.
  • These statistics are based on when the cancer was first diagnosed. They do not apply to cancers that later come back or spread, for example.
  • The outlook for people with lymphoma varies by the type and stage (extent) of the lymphoma – in general, the survival rates are higher for people with earlier stage cancers. But other factors can also affect a person’s outlook (see below). The outlook for each person is specific to their circumstances.

Your doctor can tell you how these numbers may apply to you, as he or she is familiar with your particular situation.

Survival rates for non-Hodgkin lymphoma

The overall 5-year relative survival rate for people with NHL is 70%, and the 10-year relative survival rate is 60%. But it’s important to keep in mind that survival rates can vary widely for different types and stages of 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 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 index depends on 5 factors:

  • The patient’s age
  • The stagestage 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 (serum) 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 with no poor prognostic factors would have a score of 0, while those with all of the 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)

In the studies used to develop the index, about 75% of people in the lowest risk group lived at least 5 years, whereas only about 30% of people in the highest risk group lived at least 5 years. These numbers show the difference the index scores can make, but the IPI was devised in the early 1990s. Newer treatments have been developed since then, so current survival rates are likely to be higher.

Revised International Prognostic Index

A more recent version of the IPI is based on people with fast-growing lymphomas who have received more modern treatment, including a newer drug called rituximab (Rituxan), which is described in Immunotherapy for Non-Hodgkin Lymphoma. The revised IPI uses the same factors but divides patients into only 3 risk groups:

  • Very good (no poor prognostic factors)
  • Good (1 or 2 poor prognostic factors)
  • Poor (3 or more poor prognostic factors)

In the study used to develop this index, about 95% of people in the very good risk group lived at least 4 years, whereas only about 55% of people in the poor risk group lived at least 4 years.

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.

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)

The study used to develop the FLIPI produced the following survival rates:

Risk group

5-year survival rate

10-year survival rate

Low-risk

91%

71%

Intermediate-risk

78%

51%

High-risk

53%

36%

These rates reflect the number of people who lived for at least 5 or 10 years after being diagnosed – many people lived longer than this. The rates were based on people diagnosed with follicular lymphoma in the 1980s and 1990s. Newer treatments have been developed since then, so current survival rates are likely to be higher.

Remember, all of these survival rates are only estimates – they can’t predict what will happen to any individual person. We understand that these statistics can be confusing and may lead you to have more questions. Talk to your doctor to better understand your specific situation.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Freedman AS, Jacobson CA, Mauch P, Aster JC. Chapter 103: Non-Hodgkin’s lymphoma. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2015.

Roschewski MJ, Wilson WH. Chapter 106: Non-Hodgkin Lymphoma. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 5th ed. Philadelphia, Pa: Elsevier; 2014.

Sehn LH, Berry B, Chhanabhai M, et al. The revised International Prognostic Index (R-IPI) is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP. Blood. 2007;109:1857-1861.

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

Last Medical Review: May 31, 2016 Last Revised: May 31, 2016

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