Prognosis

Prognosis depends on the type of lymphoma, stage of disease, treatment, and comorbidities.

Worse prognosis is indicated by the following:

  • B symptoms (fever, weight loss, night sweats)

  • Lymphadenopathy

  • Organomegaly

  • Extranodal involvement

  • Poor Eastern Cooperative Oncology Group (ECOG) performance status.

A sizeable proportion of patients with aggressive lymphomas are curable with modern chemotherapy. Indolent lymphomas are generally not curable.

Prognosis by NHL subtype

Diffuse large B-cell lymphoma (DLBCL)

Five-year survival rates (stage at diagnosis, National Cancer Institute Surveillance, Epidemiology, and End Results Program data 2012 to 2018):[163]

  • Stage I: 79.5%

  • Stage II: 74.6%

  • Stage III: 65.5%

  • Stage IV: 54.7%.

Follicular lymphoma

Five-year survival rates (stage at diagnosis, National Cancer Institute Surveillance, Epidemiology, and End Results Program data 2012 to 2018):[164]

  • Stage I: 97%

  • Stage II: 90.7%

  • Stage III: 88.8%

  • Stage IV: 84.3%.

Primary CNS

  • Methotrexate-based chemotherapy with whole-brain radiotherapy results in 2-year survival of 40% to 70%.[165]

Primary effusion lymphoma/body cavity lymphoma

  • Median survival is 6 months.[166]

Burkitt's lymphoma

  • Intensive multi-agent chemotherapy regimens such as hyper-CVAD (cyclophosphamide, vincristine, doxorubicin, and dexamethasone) and CODOX-M (cyclophosphamide, doxorubicin, vincristine, methotrexate, and folinic acid)/IVAC (ifosfamide, etoposide, and cytarabine) have improved prognosis significantly.

  • Addition of rituximab to intensive chemotherapy regimens may improve event-free survival.[167][168]

Mantle cell lymphoma

  • Cytarabine-based combinations improve survival.

  • Consolidation autologous transplant in first complete remission improves progression-free survival.

Subcutaneous panniculitis-like peripheral T-cell lymphoma

  • Has a very aggressive course, with poor prognosis.

Systemic anaplastic large cell lymphoma

  • For anaplastic large cell lymphoma-negative variants, the prognosis is unfavourable and upfront autologous stem cell transplant should be considered.

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)

  •  Has a slow (indolent) disease course, with excellent prognosis following surgery in patients with localised disease (i.e., confined to the fibrous scar capsule) with no mass.[169]

  • Patients presenting with a mass or advanced-stage disease have a poorer prognosis.[169][170]

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