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Prognostic factors
Source: Aggressive B-Cell Non-Hodgkin Lymphoma Treatment (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: May 12, 2025 · Captured 2026-09-09.
Selected source text with whitespace normalised. This Triangle page is not an NCI PDQ summary. Independent clinical review is pending.
The National Comprehensive Cancer Network International Prognostic Index (IPI) for aggressive NHL (diffuse large cell lymphoma) identifies the following five significant risk factors prognostic of overall survival (OS) and their associated risk scores:[32]
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Age.
Age.
<40 years: 0.
Age.
41–60 years: 1.
Age.
61–75 years: 2.
Age.
>75 years: 3.
Stage III/IV: 1.
Performance status (PS) 2/3/4: 1.
Serum lactate dehydrogenase (LDH).
Serum lactate dehydrogenase (LDH).
Normalized: 0.
Serum lactate dehydrogenase (LDH).
>1x–3x: 1.
Serum lactate dehydrogenase (LDH).
>3x: 2.
Number of extranodal sites ≥2: 1.
Risk scores:
Low (0 or 1): 5-year OS rate, 96%; progression-free survival (PFS) rate, 91%.
Low intermediate (2 or 3): 5-year OS rate, 82%; PFS rate, 74%.
High intermediate (4 or 5): 5-year OS rate, 64%; PFS rate, 51%.
High (>6): 5-year OS rate, 33%; PFS rate, 30%.
Age-adjusted and stage-adjusted modifications of this IPI are used for younger patients with localized disease.[33] Shorter intervals of time between diagnosis and treatment appear to be a surrogate for poor prognostic biological factors.[34]
The BCL2 gene and rearrangement of the MYC gene or dual overexpression of the MYC gene, or both, confer a particularly poor prognosis.[35-38] Patients at high risk of relapse may be considered for clinical trials.[39] Molecular profiles of gene expression using DNA microarrays may help to stratify patients in the future for therapies directed at specific targets and to better predict survival after standard chemotherapy.[40]
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Preserved source evidence · Independent clinical review pending · Not medical advice