Non-Hodgkin lymphoma natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Preeti Singh, M.B.B.S.[2]

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%.

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

• 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

• 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%