High Grade (Aggressive) Non-Hodgkin Lymphoma Prognosis

The prognosis of cancer can be an estimate of a few different things and can refer to how someone will respond to treatments, or how long someone is expected to live. In turn, life expectancy can be broken down in many ways. We often use survival rates to talk about how long the average person will live—for example, cancer may have a 5-year survival rate of 79%. Sometimes with lymphomas, you may also hear about median survival. Median survival refers to the 50% point—the particular time after a diagnosis when 50% of people are alive, and 50% have passed away.

An elderly man getting a checkup
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It's important to remember that all of these estimates of prognosis are numbers—not people. They talk about "average" outcomes, but nobody is truly "average" and there are many individual factors that go into determining if someone's prognosis would be better or worse than expected.

What's by far most important to remember in this era—especially with regard to aggressive non-Hodgkin lymphoma, is that statistics are "old news." In essence, they tell you how someone would have done in the past with your particular cancer, but without any of the newer medications which are making a difference. In other words, they don't necessarily say much. What's more important if you want an estimate of how you will do, is looking at what factors affect your prognosis.

Factors That Determine Treatment Outcome

High grade (aggressive) non-Hodgkin lymphoma is a fast-growing disease. Yet it responds well to treatment and many patients can be cured. The outcome depends on five well-established prognostic factors that make up the International Prognostic Index (IPI). Here is a description of these prognostic factors and how they affect outcomes. Researchers often assign 1 point to each of these categories in order to get a number between 0 and 5 on which to predict prognosis and compare prognosis now with prognosis in the past.


Age is an important prognostic factor in high-grade NHL. Those individuals who develop NHL below 60 years of age do better than those over the age of 60. (1 point for over age 60, 0 points for under age 60.)

LDH (Blood Test Results)

The serum lactate dehydrogenase (LDH) is an indicator of how much disease there is in the body. The more the disease, the more the value of LDH. Individuals with high levels of LDH in their blood do worse than those with normal levels. (1 point for an elevated level, 0 points for a normal level.)

Performance Status

The performance status is an indicator that measures the fitness of an individual with cancer. It measures whether a person is symptomatic and how far the person is self-sufficient in his or her day-to-day activities. In NHL, like in many other cancers, those with better performance scores do better after treatment than those who are sicker or dependent for daily activities. (1 point if you need a lot of assistance in daily activities, 0 points if you can manage daily activities without assistance.)


The stage of lymphoma is a very important factor. Early stage disease—stages I and II have a better outcome than advanced stage disease—stages III and IV. (1 point for stage III or IV, 0 points for stage I or II.)

Involvement of Organs Outside the Lymph System

Lymphoma is a cancer of the lymph system. If the lymphoma affects organs outside the lymph system, like the liver, spine or brain, treatment results are generally inferior. (1 point for one or more organs outside the lymph system, 0 points if you have no involvement of organs outside the lymph system.)

Outcomes Are Improving

Researchers have looked at the change of survival rates over time by comparing people with different prognostic factors. For example, not long ago, the five-year survival rate overall for people with 0 to 1 point was 75% and 30% for those with 4 to 5 points. A more recent evaluation looking at these prognostic factors with newer treatments found that people with 0 points had a four-year survival rate of 94% and those having 1 point, 79%.

Coping and Growth

One thing that's not often mentioned when talking about cancer, is the good that can come from cancer. What? Certainly, nobody would go through cancer for the "fun" of it, but as you face your fears and all of what people have to go through in treatment, realize that research does indeed tell us that cancer can sometimes change people for the better. The term the scientists use is post-traumatic growth, and it seems that for all you are going through, you're likely to show more compassion to others because of your personal journey.

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5 Sources
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Additional Reading
  • American Cancer Society. Survival rates and factors that affect prognosis (outlook) for non-Hodgkin lymphoma. Updated 01/22/16.