Making Sense of Prognostic Factors in Lymphoma

Prognosis is the prior knowledge of the outcome of a disease. To be able to determine how a disease is likely to behave, with or without treatment, it is necessary to know certain facts about the disease. These are called prognostic factors.

Factors that predict a better outcome are called 'good' or 'favorable' prognostic factors. Those that predict for worse outcomes are called 'poor' prognostic factors. For some diseases and conditions, such as non-Hodgkin lymphomas, the factors are scored to give a prognostic index.

Prognostic Factors in Lymphoma

For cancers like lymphoma, many factors determine the outcome for each patient. Some are directly related to the disease, such as the disease stage at diagnosis, how large the disease is in its spread in the body, or which organs are involved. Other factors depend on the person involved, including the age at diagnosis, the sex of the individual, or his or her capacity to tolerate intensive treatment.

Outcomes are also dependent on the exact type of treatment received. Different treatments don't lead to the same results, some have a larger rate of success while others do not. By knowing the prognostic factors and ranking them in prognostic indexes, your healthcare provider can choose the most effective treatment course.

For Hodgkin disease there are different prognostic factors depending on early (stage I and II) versus late (stages III and IV).

Unfavorable prognostic factors in stage I to II include:

• Bulky disease: a mass in the chest that is one-third the width of the chest, or any lymph node mass greater than 10 centimeters
• Involvement of 3 or more lymph nodes
• B symptoms: fever, drenching night sweats and/or unexplained weight loss greater than 10 percent of body weight over 6 months
• Extranodal disease: involvement of an organ outside the lymphatic system
• Erythrocyte sedimentation rate (ESR) of 50 or higher

Seven factors provide a basis for recommending either aggressive or less-intensive treatment options in those with advanced cancer:

• Being male
• Age 45 or older
• Stage IV disease
• Albumin level below 4 g/dL (grams per deciliter)
• Hemoglobin level below 10.5 g/dL
• Leukocytosis: white blood cell count greater than 15,000/uL
• Lymphocytopenia: lymphocyte count less than 8% of the white blood cell count and/or lymphocyte count less than 600/uL
  

Follicular Lymphoma

The factors are grouped and scored in the follicular lymphoma International Prognostic Index, FLIPI. These include disease stage, number of lymph node sites involved, blood test results for LDH and hemoglobin and the patient's age. The scoring of these prognostic factors results in three prognostic groups: low risk, intermediate risk, and high risk. Studies show the survival rate at five years varies based on the risk score, with a 91% survival five-year survival rate for the low-risk score compared with 53% for the high-risk prognostic score group.

High-Grade (Aggressive) Non-Hodgkin Lymphoma

Prognostic factors for high-grade non-Hodgkin lymphoma are scored in the International Prognostic Index (IPI). They include age, LDH blood test result, performance status (how much help is needed with daily activities), stage, and involvement of organs outside the lymph system. The scores of the IPI are used to give a prognosis on a scale from low to high, with low being good. The index has been revised for people receiving rituximab, dividing the scores into three risk groups of very good, good, and poor. About 95% of people in the very good risk group lived at least four years.

Hodgkin Lymphoma

Prognostic factors for Hodgkin lymphoma include the disease stage, B symptoms (weight loss, fevers, drenching night sweats), number and size of lymph node masses, involvement of organs outside the lymph system, white blood cell count, red blood cell count, lymphocyte count, blood albumin level, erythrocyte sedimentation rate, age, and sex.

These factors and scores will help guide your healthcare provider to the best treatment regimen for your lymphoma. They cannot predict completely what your survival rate will be or how successful your treatment will be, but they are guides based on the best current research.