If you've been diagnosed with lymphoma, you're likely concerned with the disease prognosis. Prognosis refers to the outlook of the disease and the known survival rates. The survival rate is a statistical measure of the percentage of people who are alive after a certain period of time. It is a key factor for determining the prognosis. For Hodgkin lymphoma (HL), it is important to understand what considerations doctors make when estimating disease prognosis.

Factors That Affect Prognosis

Many factors come into play when estimating the prognosis for HL. Many prognostic factors have to do with the growth and spread of cancer, although demographics are also taken into account.

Bulky Disease

Bulky disease refers to a large mass in the chest or a lymph node greater than 10 centimeters. The presence of bulky disease is considered an unfavorable risk factor in HL.

B Symptoms

B symptoms refer to a set of symptoms experienced by people with various forms of lymphoma. B symptoms can include:

• Fever
• Night sweats
• Unexplained weight loss

The presence of B symptoms is considered an unfavorable risk factor in HL.

Extranodal Involvement

Although HL generally originates in the lymph nodes, cancer cells can also be found in or spread to other tissues in the body. This is known as extranodal involvement and can serve as a prognosis factor for HL. Greater extranodal involvement is an indicator of more advanced cancer and is associated with a poorer prognosis.

Disease Stage

The stage of disease is a way of measuring how much cancer is spread throughout the body. For HL, stages range from 1 to 4, and the numbers are sometimes rendered in Roman numerals, e.g., stage 3 as stage III. The higher the stage is, the greater the extent of the spread will be. HL that is at a stage 3 or 4 at the time of diagnosis has a worse prognosis than stage 1 or 2 disease.

Age

A person's age is also an important factor for determining their HL prognosis. People diagnosed with HL when they are younger than 45 tend to have a better prognosis than those diagnosed at 45 or older.

Sex

Being male is considered a risk factor for a worse prognosis in HL.

Red Blood Cell Count

HL can cause low levels of red blood cells, also called anemia. Low red blood cell count is associated with a worse prognosis and can be measured by detecting low levels of proteins called hemoglobin. Low albumin in the blood is also an indication of a poorer prognosis in people with HL.

White Blood Cell Count

Having a high white blood cell count can occur in HL and is associated with a worse prognosis.

Lymphocyte Count

Lymphocytes are a specific kind of white blood cell. A low level of lymphocytes in HL is associated with a worse prognosis.

Measuring Prognosis of Hodgkin Lymphoma

To estimate the outlook of HL, doctors use quantitative methods to measure multiple prognostic factors.

International Prognostic Score

The International Prognostic Score (IPS) is a model developed to predict outcomes of Hodgkin lymphoma. The model takes into account several prognostic variables:

• Age
• Gender
• Disease stage
• Albumin levels
• Hemoglobin levels
• White blood cell count
• Lymphocyte count

A risk factor in each category is assigned a point. For example, a high white blood cell count is a risk factor for poor prognosis and would be assigned a point. The total number of points across all categories serves as an indicator of a person’s overall prognosis — 0 points is the best prognosis and 7 points indicates the worst prognosis.

The IPS can help doctors design an appropriate treatment for the prognosis.

Based on the IPS, a person diagnosed with HL can be categorized into one of the three following risk groups:

• Early-stage favorable
• Early-stage unfavorable
• Advanced stage

Survival Rates

The survival rate is a statistical calculation that measures the likelihood a person diagnosed with cancer will be alive after a certain period of time. The most common time frame used is five years, often referred to as the five-year survival rate. Survival data are tracked over time and are collected by the Surveillance, Epidemiology, and End Results program from the National Institutes of Health. During data collection, the disease stage of HL is categorized as follows:

• Localized, when cancer is present only in the lymph nodes or within the lymphatic system
• Regional, when cancer has spread to a nearby organ
• Distant, when cancer has spread to a distant organ

Each stage has a separately calculated five-year survival rate, and the distant classification has the lowest survival.

Prognosis of Hodgkin Lymphoma

HL is one of the most curable forms of cancer and has a favorable prognosis. Across all forms of HL, the overall five-year survival rate is 87 percent. For people younger than age 45 at the time of diagnosis, the five-year survival rate is even higher: 94.4 percent. These data primarily come from people treated for HL with conventional treatments including radiation therapy and chemotherapy. For newer treatments and targeted therapies, more time and data are needed before their effect on the five-year survival rate can be determined.

HL is broadly classified into two main types: classic Hodgkin lymphoma and nodular lymphocyte-predominant Hodgkin lymphoma. Although both types are considered generally highly curable, disease prognosis varies within each category. The rarest form of classic Hodgkin lymphoma, called lymphocyte-depleted Hodgkin lymphoma, is an aggressive disease with a poor prognosis. A person diagnosed with HL should consult with their physician regarding the treatment options and prognosis for their particular form of cancer.

Connect With Others Who Understand

A new cancer diagnosis can be a lot to handle. It may help to have the support of others who understand what you’re going through as you face new challenges. MyLymphomaTeam is the social network for people with lymphoma and their loved ones. More than 12,000 members understand what it’s like to face lymphoma and can provide support and answers.

Have you or a loved one been newly diagnosed with Hodgkin lymphoma? Share your experience at MyLymphomaTeam or comment below to start a conversation.