Non Hodgkin's Lymphoma
Cyberfamily
Treatment Outcomes
As you go through treatment, and read more about lymphoma you will hear a lot about the results of your treatment, or clinical trial results. Click on any of the terms below to go to their definition.
Cure:
Where there are no signs of the disease
reappearing, doctors may cautiously begin using the word cure. The ability to
cure NHL depends on the type of lymphoma. Many high-grade lymphomas can be
cured. Low-grade NHLs tend to reappear, even after long-term remission. The
usual standard for aggressive lymphomas is that you must be in
complete remission 5 years or more before they will consider calling
you cured.
Complete remission:
This term is used
when all signs of the disease have disappeared after treatment. Patients are
especially fond of calling this NED (No Evidence of Disease). Although this
does not mean that the disease is completely gone, the symptoms have disappeared
and the lymphoma cannot be detected using current tests. If this response is
maintained for a long period, it is called a durable remission. The longer a
patient is in remission the better the prognosis or outcome. However, as with
other cancers, the disease could still possibly return and long-term follow-up
is necessary.
Molecular
Remission
Sometimes (often in a clinical trial setting) advanced testing
techniques are used to detect minute quantities of lymphoma. Some of
these tests can detect just a single lymphoma cell in a sample of
10,000 cells or more. Some of the techniques used for such sensitive
testing are Polymerace Chain Reaction,
Flow Cytometry and
DNA Microarray.
Partial remission:
This term is used if the NHL is treated and the tumour
shrinks to less than one-half of its original size.
Improvement:
This term is used if the tumour shrinks following
therapy but is still more than one-half of its original size.
Stable disease:
The disease does not get better or worse following
therapy.
Refractory
A cancer that is resistant to treatment.
Prognosis
What is the likely outcome of the disease. Every patient wants to
know their prognosis. It is just natural to want to know, even
though doctors can only tell you statistically what is likely. They
cannot tell you what will happen to you. Yet in the quest to better
define the prognosis there exists the "IPI" below. Use it
with caution. It is designed to help define who is "at risk" of relapsing
not who is going to die tomorrow morning.
The International Prognostic Index
for aggressive NHL
An international index for aggressive NHL (diffuse large cell lymphoma)
identifies 5 significant risk factors prognostic of overall survival. For each
positive risk factor there is a greater risk of relapse. This index can also be
applied to the indolent forms of Lymphoma but with a smaller degree of accuracy.
Age (<60 years of age versus >60 years of age),
Serum lactate dehydrogenase-LDH (normal versus elevated),
Performance status (0 or 1 versus 2-4), (see definition below)
Stage (I or II versus III or IV),
Extranodal site involvement (0 or 1 versus 2-4).
In the pre-Rituximab era patients with 2 or more risk factors have less than a 50% chance of relapse-free and overall survival at 5 years. However the proposed revised IPI indicates since the inclusing of Rituxaimab with CHOP there are three distinct prognostic risk groups.
0 risk factors, very good - 90% progression free survival @ 5 years
1-2 risk factors, good - 80% progression free survival @ 5 years
3-5 risk factors, poor - 50% progression free survival @ 5 years
The
International Prognostic Index for Follicular NHL
This one
has been proposed
by an international cooperative group in 2004, and it pertains to follicular
lymphoma, and perhaps to other low grade types as well.
Click here to read the abstract from the Journal Blood about this new index.
Age (< 60 years of age versus >60 years of age)
Ann Arbor Stage III or IV
Elevated LDH
Greater than 4 nodal sites
Note OS means Overall Survival
| Risk Group | Number of Factors | % 5 year OS | % 10 year OS |
| Low | 0-1 | 90.6 | 70.7 |
| Intermediate | 2 | 77.6 | 50.9 |
| High | 3 or higher | 52.5 | 35.5 |
Mantle Cell Lymphoma International Prognostic Index
The MIPI identifies four risk factors for overall survival. For each factor your get points from zero up to 3. The maximum score is 11
| Points | Age years) | ECOG PS | LDH (ULN) | WBC, 10^9/L |
| 0 | < 50 | 0-1 | <0.67 | <6.700 |
| 1 | 50-59 | - | 0.67-0.99 | 6.700-9.999 |
| 2 | 60-69 | 2-4 | 1.0-1.49 | 10.000-14.999 |
| 3 | ≥ 70 | - | ≥1.5 | ≥15.00 |
ECOG PS = Eastern Cooperative Oncology Group performance status
LDHULN = lactic acid dehydrogenase institutional upper limit of normal
WBC = white blood cell count from the complete blood count
- Low risk (0-3 points)
- Intermediate risk (4-5 points)
- High risk (6-11 points)
When the MIPI was applied to the
455 cases:
44% were low risk (median OS, not reached)
35% intermediate risk (median OS, 51 months)
21% high risk (median OS, 29 months).
Source: Bloodjournal article "Vol 111, No. 2, pp.558-565"
Prognostic Index for peripheral T-cell lymphoma
unspecified
This index identifies 4 significant risk factors for
overall survival.
Read the published paper here
-
Age > 60, relative risk 1.732
-
Performance status >=2, relative risk 1.719
-
Elevated LDH, relative risk 1.905
-
Bone marrow involvement, relative risk 1.454
0 adverse factors 5 year survival 62.3%, 10 year survival 54.9%
1 adverse factor, 5 year survival 52.9%, 10 year survival 38.8%
2 adverse risk factors, 5 year survival 32.9%, 10 year survival 18%
3 or 4 adverse risk factors, 5 year survival 18.3%, 10 year survival 12.6%
Performance status
Performance status in the aggressive IPI is defined as
Grade Description 0 Fully active, able to carry on all pre-disease performance without restriction 1 Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work 2 Ambulatory and capable of all selfcare but unable to carry out any work activities. Up and about more than 50% of waking hours 3 Capable of only limited selfcare, confined to bed or chair more than 50% of waking hours 4 Completely disabled. Cannot carry on any selfcare. Totally confined to bed or chair 5 Dead
So if you are 2-4 on this scale then you get one point on the IPI scale. If you are 0-1 on the Performance scale you get zero on the IPI. As you can see the goal is to have a low IPI score.
You may also hear of the Karnofsky score. It is a similar scoring system used to evaluate a patients overall performance. However it goes into more detail in an effort to more accurately evaluate a patient for general medical purposes. It is not used when calculating the IPI score above.
Click here to read the Karnofsky performace scale
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