Prognosis of non Hodgkin's lymphoma

Prognosis: (1)

• around 2 in 3 (64.6%) people diagnosed with non-Hodgkin lymphoma in the UK survive their disease for ten years or more, it is predicted (2018).
• non-Hodgkin Lymphoma ten-year survival in the UK is higher in females than in males (2018).
• non-Hodgkin Lymphoma survival has increased in the last 50 years in the UK.
• in the 1970s, almost 1 in 4 (22.8%) people diagnosed with non-Hodgkin lymphoma survived their disease beyond ten years, by 2018 it was around 2 in 3 (64.6%).
• non-Hodgkin lymphoma survival is improving and has tripled in the last 40 years in the UK. In the 1970s, more than a fifth of people diagnosed with Non-Hodgkin lymphoma cancer survived their disease beyond ten years, now it's almost two-thirds
  
• when diagnosed at its earliest stage, 7 in 10 people with Non-Hodgkin lymphoma will survive their disease for five years or more, compared with less than 6 in 10 of people when diagnosed at the latest stage
  
  
• low-grade lymphomas have indolent clinical behaviour
  • low grade non-Hodgkin's lymphomas usually have a follicular histology and constitute 30% of the total
  • 90% of patients are over 50 years old
  • symptoms are often non-specific and the disease is usually disseminated at presentation.
  • associated with a comparatively prolonged survival (median survival is 6-10 y)
  • little potential for curative treatment
  • tendency to transform to high-grade lymphomas
    
    
• intermediate and high-grade NHL
  • intermediate grade accounts for 65% of non-Hodgkin's lymphoma
    • incidence is rapidly increasing. Intermediate grade lymphomas occur at all ages, with a median age of 65 years
    • two-thirds arise in lymph nodes, the patient presenting with lymphadenopathy. Other sites include GI tract, skin and brain
    • most common histological type is large cell B cell lymphoma. The tumours are rapidly fatal if not treated
  • high-grade NHL
    • a rare non-Hodgkin's lymphoma found primarily in children and young adults
      • main types are: lymphoblastic lymphoma Burkitt's lymphoma
      • tumour lysis syndrome is a frequent problem during the initiation of chemotherapy.
  • approximately 70% of all patients with intermediate- and high-grade NHL relapse or never respond to initial therapy
  • recurrences are most often within the first 2 years after therapy completion
  • if relapsed or resistant NHL then prognosis is very poor (< 5-10% are alive at 2 years with conventional salvage chemotherapy regimens)
• if congenital or acquired immunodeficiency then there is an increased risk of lymphoma - these patients respond poorly to therapy
• aggressive T- or NK-cell lymphomas, in general, have worse prognoses than those with B-cell lymphomas
  • with the exception the Ki-1 anaplastic large T- or null-cell lymphomas
• low levels of vitamin D have been associated with a decrease in clinical end points (event-free survival and overall survival) in subsets of patients with aggressive B-cell lymphoma (3)

Reference:

1. CRUK. Non-Hodgkin lymphoma statistics
2. NICE. Non-Hodgkin’s lymphoma: diagnosis and management. NICE guideline NG52. Published July 2016.
3. Drake MT et al. Vitamin D insufficiency and prognosis in non-Hodgkin's lymphoma. J Clin Oncol. Sep 20 2010;28(27):4191-8