Non-Hodgkin lymphoma natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Preeti Singh, M.B.B.S.[2]
Overview
Common complications of non-Hodgkin lymphoma include lymphadenopathy, disseminated intravascular coagulation, superior vena cava (SVC) syndrome, autoimmune hemolytic anemia and infection. The indolent non-Hodgkin lymphoma types are associated with a relatively good prognosis. The 5-year relative survival rate of patients with NHL is 71.4%.
Natural History
Complications
Common complications of non-Hodgkin lymphoma include:[1]
- Lymphadenopathy especially cervical lymphadenopathy
- Cytopenias such as neutropenia, anemia and thrombocytopenia secondary to bone marrow infiltration
- Autoimmune hemolytic anemia
- Bleeding secondary to thrombocytopenia
- Disseminated intravascular coagulation (DIC)
- Infection secondary to neutropenia
- Cardiac problems secondary to large pericardial effusion
- Cardiac arrhythmias secondary to cardiac metastases
- Respiratory problems secondary to pleural effusion
- Superior vena cava (SVC) syndrome secondary to a large mediastinal tumor
- Spinal cord compression secondary to vertebral metastases
- Neurologic problems secondary to primary CNS lymphoma or lymphomatous meningitis
- Gastrointestinal obstruction, perforation, and bleeding in a patient with MALT lymphoma
- Pain secondary to tumor invasion
- Lymphocytosis in leukemic phase of disease
Prognosis
- The 5-year relative survival rate of patients with NHL is 71.4%.[2]
- The survival rate has steadily improved over the last 2 decades, thanks to improvements in medical and nursing care, the advent of novel therapeutic strategies (ie, monoclonal antibodies), validation of biomarkers of response, and the implementation of tailored treatment.
- The prognosis for patients with NHL depends on the following factors:[2]
- Tumor histology
- Tumor stage
- Patient age
- Tumor bulk
- Performance status
- Serum lactate dehydrogenase (LDH) level
- Beta2-microglobulin level
Prognostic Indexes
International Prognostic Index (IPI)
- The International Prognostic Index (IPI), which was originally designed as a prognostic factor model for aggressive non Hodgkin lymphoma (NHL) appears to be useful for predicting the outcome of patients with low-grade lymphoma and mantle cell lymphoma.[2][3]
- This index is used to identify patients at high risk of relapse, based on specific sites of involvement, including bone marrow, CNS, liver, testis, lung, and spleen.
- Clinical features included in the IPI that are independently predictive of survival include the following:
- Age - Younger than 60 years versus older than 60 years
- LDH level - Within the reference range versus elevated
- Performance status - Eastern Cooperative Oncology Group ( ECOG) grade 0-1 versus 2-4
- Ann Arbor stage - Stage I-II versus III-IV
- Number of extranodal sites - Zero to 1 versus more than 1
- With this model, relapse-free and overall survival rates at 5 years are as follows:
- 0-1 risk factors - 75%
- 2-3 risk factors - 50%
- 4-5 risk factors - 25%
References
- ↑ Dehghani M, Haddadi S, Vojdani R (2015). "Signs, Symptoms and Complications of Non-Hodgkin's Lymphoma According to Grade and Stage in South Iran". Asian Pac J Cancer Prev. 16 (8): 3551–7. PMID 25921177.
- ↑ 2.0 2.1 2.2 Abla O, Weitzman S, Blay JY, O'Neill BP, Abrey LE, Neuwelt E; et al. (2011). "Primary CNS lymphoma in children and adolescents: a descriptive analysis from the International Primary CNS Lymphoma Collaborative Group (IPCG)". Clin Cancer Res. 17 (2): 346–52. doi:10.1158/1078-0432.CCR-10-1161. PMC 4058714. PMID 21224370.
- ↑ Shalabi H, Angiolillo A, Vezina G, Rubenstein JL, Pittaluga S, Raffeld M; et al. (2015). "Prolonged Complete Response in a Pediatric Patient With Primary Peripheral T-Cell Lymphoma of the Central Nervous System". Pediatr Hematol Oncol. 32 (8): 529–34. doi:10.3109/08880018.2015.1074325. PMC 4942274. PMID 26384083.