Treatment outcomesAs 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.
International Prognostic Indexes
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 completely disappeared after treatment. Patients are especially fond of calling this NED (No Evidence of Disease). Although this does not mean that the disease is cured, 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.
Complete remission unconfirmed (CRu)This term is used when all traditional methods of scanning show a complete remission, but there may still be something that is questionable. For example a lump that is still there, but shows negative by PET scan which means "most" likely scar tissue. Or ambiguous blood work. Or perhaps no follow up bone marrow biopsy to prove clear marrow. This is almost as good as complete remission but just leaves some room for doubt.
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| Risk group | # 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 |
There is a proposal to update the FLIPI with a new index. It has not been adopted yet, but you can read the FLIPI2 proposal at the link below.
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
| Points | Age | 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 | ≥ 15.000 |
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.
- 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%
Proposed International Prognostic Index for Waldenström Macroglobulinemia
- Age > 65 years
- Haemoglobin ≤ 100 x 10^9/L
- ß2 Microglobulin > 3mg/L
- Monoclonal IgM concentration > 7.0 g/dL
- Low risk: Age below 65 and 0 or 1 other risk factors
- Intermediate risk: Age over 65 OR 2 other risk factors with age under 65
- High risk: 3 or more risk factors of any kind
| Risk category | Median survival (months) |
| 1 | 142.5 |
| 2 | 98.6 |
| 3 | 43.5 |
Read the full study proposal here
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