From the Guidelines
The prognosis of Non-Hodgkin's Lymphoma (NHL) is highly variable, with an overall 5-year survival rate averaging around 73%, and the most recent evidence suggests that modern treatments have significantly improved survival rates, even for previously poor-prognosis cases. The prognosis of NHL depends on several factors, including the specific subtype, disease stage at diagnosis, patient age, performance status, and presence of certain biomarkers 1. Aggressive subtypes like diffuse large B-cell lymphoma can be potentially curable with R-CHOP chemotherapy, while indolent types like follicular lymphoma typically follow a more chronic course requiring intermittent treatment.
Key Prognostic Factors
- Specific NHL subtype
- Disease stage at diagnosis
- Patient age
- Performance status
- Presence of certain biomarkers
The International Prognostic Index (IPI) helps predict outcomes based on age, stage, LDH levels, performance status, and extranodal involvement. Early-stage disease (stages I-II) generally has better outcomes with 5-year survival rates exceeding 80%, while advanced disease (stages III-IV) has more variable outcomes.
Treatment Options
- R-CHOP chemotherapy for aggressive subtypes
- Intermittent treatment for indolent types
- Targeted therapies
- Immunotherapies
- CAR-T cell therapy
Modern treatments, including targeted therapies, immunotherapies, and CAR-T cell therapy, have significantly improved survival rates even for previously poor-prognosis cases, as highlighted in a study on mantle cell lymphoma, which accounts for approximately 6% of non-Hodgkin lymphoma (NHL) 1. Regular follow-up with oncologists is essential as some indolent lymphomas can transform into more aggressive types over time. Overall, the prognosis of NHL has improved significantly with modern treatments, and individualized treatment approaches based on disease biology and risk can lead to better outcomes.
From the FDA Drug Label
The main outcome measure of the study was progression-free survival, defined as the time from randomization to the first of progression, relapse, or death Among all enrolled patients, 62% had centrally confirmed DLBCL histology, 73% had Stage III–IV disease, 56% had IPI scores greater than or equal to 2,86% had ECOG performance status of < 2,57% had elevated LDH levels, and 30% had two or more extranodal disease sites involved Efficacy results are presented in Table 15. Table 15 Efficacy Results in NHL Studies 7,8, and 9 Study 7(n = 632) Study 8(n = 399) Study 9(n = 823) R-CHOPCHOPR-CHOPCHOPR-ChemoChemo Main outcomeProgression-free survival(years)Event-free survival(years)Time to treatment failure(years)
- NE = Not reliably estimable. † R-CHOP vs. CHOP. ‡ Significant at p < 0.05,2-sided. § Kaplan-Meier estimates. Median of main outcome measure3.11.62.91. 1NENE Hazard ratio†0.69‡0.60‡0.45‡ Overall survival at 2 years§74%63%69%58%95%86% Hazard ratio†0.72‡0.68‡0.40‡ In NHL Study 8, overall survival estimates at 5 years were 58% vs. 46% for R-CHOP and CHOP, respectively.
The prognosis of Non-Hodgkin's Lymphoma (NHL) varies depending on the stage and type of disease.
- Overall survival rates for patients with DLBCL are:
- 74% at 2 years for R-CHOP
- 63% at 2 years for CHOP
- 58% at 5 years for CHOP
- Progression-free survival rates are also reported, with median rates of 3.1 years for R-CHOP and 1.6 years for CHOP. However, the hazard ratios and Kaplan-Meier estimates suggest that R-CHOP is associated with improved overall survival and progression-free survival compared to CHOP. It is essential to note that these results are based on specific studies and may not be generalizable to all patients with NHL. 2
From the Research
Prognosis of Non-Hodgkin's Lymphoma (NHL)
The prognosis of NHL depends on several factors, including the histo-pathologic type, prognostic factors, and treatment 3. According to the WHO classification, NHLs are divided into two prognostic groups: indolent lymphomas and aggressive lymphomas 3.
Indolent Lymphomas
- Indolent NHLs have a good prognosis, with median survival as long as 10 years 3
- Early stage (I and II) indolent NHLs can be treated with radiation therapy alone, with 70% to 90% 5-year overall survival rates 3
Aggressive Lymphomas
- Aggressive NHLs have shorter natural histories, but the number of patients cured with intensive chemotherapy is increasing 3
- Overall survival at 5 years is approximately 50% to 60% 3
- Patients with stage I and contiguous stage II aggressive NHLs have excellent survival rates when treated with a combined modality including chemotherapy (CHOP) and radiation therapy 3, 4
- Localized presentations of extranodal NHLs can be treated with involved-field techniques with significant success 3
International Prognostic Index (IPI)
- The IPI is a 4-part index based on 5 prognostic factors, which permits the allocation of patients with NHL into 2 well-defined prognostic groups: good prognosis and poor prognosis 4
- Conventional chemotherapy with CHOP or other equivalent third-generation regimens may be considered the standard treatment for the good prognosis group 4
- In the poor prognosis group, the probability of long-term survival is less than 40% with conventional chemotherapy, and early intensification with high-dose therapy following peripheral stem cell transplantation (PSCT) should be considered 4
Stem Cell Transplantation
- Patients with early transformation of non-Hodgkin lymphoma may benefit from stem cell transplantation (SCT) 5
- Early transformation was independently associated with improved overall survival (OS) and event-free survival (EFS) 5
Molecular and Cellular Genetics
- Advances in molecular biology and cytogenetic techniques have led to the discovery of several oncogenic pathways involved in lymphomagenesis, which has amplified the diagnostic and therapeutic approaches available for NHL 6
- The prognosis of a newly diagnosed NHL patient depends on the specific subtype of lymphoma, stage of the disease, and age of the patient 6