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Treatment Options for Non-Hodgkin's Lymphoma
Prognosis for Non-Hodgkin's Lymphoma
In 1993, a collaborative group known as The International Non-Hodgkin's Lymphoma Prognostic Factors Project published an important article in The New England Journal of Medicine (Vol. 329; pp. 987-994) entitled "A Predictive Model for Aggressive Non-Hodgkin's Lymphoma". Based on a study of more than 3,000 patients with diffuse large B-cell lymphoma, these researchers developed an index called the International Prognostic Index (IPI) that is useful in determining the prognosis (outlook) for patients with non-Hodgkin's lymphoma (NHL). Since that time, the IPI has been validated by other studies as being an important prognostic indicator for patients with non-Hodgkin's lymphomas.
The International Prognostic Index (IPI) takes into consideration five major factors or variables that, taken as a whole, can be used by doctors to predict the likely outlook for patients with non-Hodgkin's lymphoma. The five major prognostic factors that are evaluated in the IPI include:
Age of the Patient - In general, younger patients (age 60 or below) have a better prognosis than older patients over the age of 60.
Lymphoma Stage - The stage of the lymphoma is an important prognostic indicator because it reflects the extent of spread of the disease. In general, patients with Stage I or II (localized) lymphoma, usually have a more favorable prognosis than those with Stage III or IV (advanced) disease.
Involvement of Extranodal Sites - This is an indication of whether the lymphoma has affected areas of the body outside of the lymph nodes (extranodal sites). Extranodal sites that may be affected include the bone marrow, lung, liver, spleen, and central nervous system. In general, non-Hodgkin's lymphoma patients with no extranodal site involvement have a better outlook than those patients where the lymphoma has affected one or more extranodal sites.
Lactate Dehydrogenase Serum Levels - Lactate dehydrogenase (LDH) is an enzyme that can be measured in the blood (serum) that, if elevated above normal levels, can indicate the presence of an aggressive, fast-growing lymphoma. In general, patients with non-Hodgkin's lymphoma with normal levels of LDH usually have a more favorable prognosis than those with elevated LDH serum levels.
Patient's Performance Status - The term "performance status" refers to the extent of the patient's ability to perform activities of daily living. In other words, the performance status is an indication of the extent to which the disease has affected the patient's lifestyle. Performance status is ranked on a scale from 0 to 4 with a score of "0" or "1" assigned to patients who have good performance status and are capable of maintaining a relatively active lifestyle. In general, non-Hodgkin's lymphoma patients with good performance status have a more favorable prognosis than those with poor performance status.
After evaluating each of the five individual prognostic factors that comprise the IPI, the doctor assigns a score of "1" for each poor prognostic factor. The total IPI score is then determined by adding together all of the poor prognostic factors with a score of "1". The patient is then assigned to one of the following four risk categories:
