Hodgkin's Lymphoma Survival Rates: What to Expect

Hodgkin lymphoma is one of the most curable forms of cancer. The overall survival rates for people with all stages of Hodgkin's lymphoma combined are:

• Survival rate at one year: 92%
• Survival rate at five years: 87%
• Survival rate at 10 years: 80%

Of course, an individual's prognosis and life expectancy will depend on the stage of their disease and other factors.

This article reviews the current survival statistics with Hodgkin lymphoma, factors that affect life expectancy (like the stage and age at diagnosis), and what can improve your prognosis.

Understanding Survival Rates and Life Expectancy

Survival rates are usually described as a percentage followed by a certain amount of time. For example, you may see one-year, five-year, or 10-year survival rates.

These numbers describe how long someone with any stage of Hodgkin lymphoma and other factors is expected to live. Yet, even when survival rates are broken down by age and stage, it's hard to predict how an individual person will do with the disease.

Limitations of Survival Rates

Survival rates may give you an estimate of what to expect, but there are several limitations:

• They give an average estimate of survival, but nobody is average.
• Five-year survival rates look at people diagnosed at least five years ago, but new treatments have developed during that time
• With advances in cancer treatment, survival rates are becoming less accurate. At best, they can tell you how the average person did after being treated with therapies that may not be used today.
• Long-term survival is even harder to predict. Research distinguishes deaths from Hodgkin disease and deaths from other causes, but doesn't always account for unrelated medical conditions that result from treatment, like secondary cancers.

Hodgkin's Lymphoma Survival Rate by Stage

Five-year survival rates by stage include:

• Stage I: Five-year survival rate is 90%
• Stage II: Five-year survival rate is 90%
• Stage III: Five-year survival rate is 80%
• Stage IV: Five-year survival rate is 65%

These rates are an average of all people with a certain stage of Hodgkin lymphoma, no matter their age or other factors that affect survival.

Long-Term Survival

Long-term survival with Hodgkin lymphoma is hard to estimate due to conditions like secondary cancers that may occur decades after treatment.

However, between 15 years and 30 years after Hodgkin lymphoma treatment, people are more likely to die from an unrelated cause than from Hodgkin lymphoma.

Survival Rate After Relapse

More than half of recurrences occur within two years of primary treatment. Up to 90% of recurrences happen before the five-year mark.

The occurrence of relapse after 10 years is rare. After 15 years, developing lymphoma is the same as its risk in the normal population. Even with a recurrence, many people with Hodgkin lymphoma go on to live long lives.

Factors That Affect Survival

Some variables can increase or decrease the chance of surviving Hodgkin lymphoma. Some examples are general health at diagnosis, other medical conditions, and whether the cancer is recurrent or progressive.

Other factors that affect survival include:

• Stage of the disease: Stage I or stage II disease carries a better prognosis than stage III or stage IV.
• Age: Younger people tend to do better than those who are older (over the age of 45).
• Sex: Women tend to have a higher life expectancy than men.
• Presence of B symptoms: Weight loss, night sweats, and fevers, the so-called B symptoms of lymphoma, are associated with a poorer prognosis (but still, most people can achieve long-term survival).
• Relapse: Prognosis is poorer for those who have a relapse in the first year following treatment.
• Response to treatment: Those who respond to first-line therapy have a better prognosis than those who do not.
• Albumin level: A low albumin level (less than 4 g/dL) is associated with a poorer prognosis.
• White blood cell count (WBC): An elevated white blood cell count (greater than 15,000 blood cells per mm3) is associated with a poorer prognosis.
• Low absolute lymphocyte count (ALC): An absolute lymphocyte count of less than 600 cells per mm3 is associated with a poorer prognosis.
• Less bulky disease has a better prognosis.
• Anemia: A low hemoglobin (less than 10.5 g/dL) is linked with a poorer prognosis than those with a higher hemoglobin level.
• Sed rate: An erythrocyte sedimentation rate (ESR) greater than 30 is associated with a poorer prognosis.
• Type of Hodgkin lymphoma: Some types of Hodgkin lymphomas are associated with a better survival rate than others (nodular lymphocyte predominant and nodular sclerosing types have a better prognosis in general).
  
• Health insurance: People who do not have health insurance have a poorer prognosis.
• Secondary cancers: People who have been treated for Hodgkin lymphoma have an increased risk of developing a secondary cancer, a cancer related to the carcinogenic effects of chemotherapy or radiation.

Understanding Prognosis

The National Cancer Institute reported the five-year Hodgkin lymphoma survival rate was 69.9% in 1975 and 85.4% in 2009. This increase is due to advancements in:

• Chemotherapy, such as ABVD chemotherapy and BEACOPP chemotherapy
• Radiation therapy
• Stem cell therapy

Survival rates continue to improve because of treatment advances, such as:

• High-dose salvage chemotherapy and stem cell transplants for people who relapse have further improved survival.
• Targeted therapy with monoclonal antibodies, immunotherapy with checkpoint inhibitors, and nonmyeloablative stem cell transplants offer additional methods of treatment that may further improve survival for Hodgkin lymphomas that are harder to treat.
• Better management of complications, like infections from chemotherapy-induced neutropenia (low white blood cell count), have made a difference.

Survival is not the only benefit of improved treatments. Less toxic chemotherapy and small-field radiation therapy reduce treatment side effects. They may also potentially reduce the long-term side effects of the disease.

Estimate Your Prognosis

The Hasenclever prognostic tool can estimate prognosis based on seven factors or risks. According to the tool, each factor reduces five-year survival by about 8%. These risks factors include:

• Serum albumin less than 4 grams per deciliter (g/dL)
• Hemoglobin less than 10.5 g/dL
• Age of 45 years or older
• Male sex
• Stage IV disease
• White blood cell count over 15,000 per milliliter (mL)
• Lymphocyte count of less than 600 per mL.

For those without any of these risk factors, the overall five-year estimated prognosis is 89%. For people with five or more risk factors, the estimated five-year survival rate is 56%.

Keep in mind that these tools estimate "average" prognosis, and nobody is average. Even if you have five or more risk factors, the majority—over 50% of people—are still alive five years after diagnosis.

Improve Your Prognosis

There are simple things you can do yourself to improve your prognosis. It's important to:

• Eat healthy: What you put in your body can make a difference in how well you tolerate treatments and how well you feel after treatment. If you are having any difficulties, ask your oncologist to set you up with an oncology nutritionist.
• Exercise: We now have a multitude of studies that have looked at the effect of regular exercise on the outcome of many different cancers, including Hodgkin lymphoma. Even small amounts of exercise are helpful. Keep in mind that it's better to exercise more frequently in smaller amounts than to exercise for long periods less often.
• Sleep well: We don't know about the effects of sleep disorders on Hodgkin lymphoma, but we know that with breast cancer these conditions may reduce survival. Talk to your oncologist if you are having this common side effect of treatment.
• Create a cancer survivor care plan: When you are done with treatment, fill out a survivor care plan with your healthcare provider. The risk of secondary cancers is real after Hodgkin treatment, and may even be increasing. Your healthcare provider may recommend earlier or more frequent screening for cancers such as breast cancer and follow up on symptoms of other cancers if they occur.

A Word From Verywell

Even when curable, the treatments to control Hodgkin lymphoma are challenging. Chemotherapy may continue longer, and especially with stem cell transplants, to a greater degree than with other cancers. The long-term side effects of Hodgkin lymphoma, like secondary cancers, will require lifelong monitoring.

If you or a loved one have gone through treatment for Hodgkin lymphoma, it's important to talk to your healthcare provider about survivorship. Many cancer clinics now have active cancer rehabilitation programs. There, they can fully address the late effects of cancer treatment, ranging from chronic pain to anxiety.