This month’s educational theme on the Lymphoma Hub is focusing on prognostic factors. These measurements, collected at the time of diagnosis, help to predict the outcome for individual patients. The most widely used prognostic factors in lymphoma are disease histology, anatomic and clinical stage, presence of systemic symptoms, and tumor burden. Their use allows risk stratification of patients and selection of the most appropriate therapy, which is important in the management of indolent lymphomas, as well as more aggressive types.
One of the most important prognostic factors in cancer is the stage of disease at diagnosis. However, looking at tumor spread alone is not adequate to confidently assign patients to a specific risk group. Therefore, different prognostic factors are often combined into models to improve the accuracy of the prediction. International Prognostic Index (IPI) is used in most lymphoma types excluding follicular, where the Follicular Lymphoma International Prognostic Index (FLIPI) is used instead. Some factors affecting the outcome in patients with non-Hodgkin lymphoma (NHL) such as age, disease stage, or serum LDH, are common between different subtypes. While others, like blood hemoglobin levels, are more subtype specific. 1,2
However, when intermediate-risk is assigned by these models, it can be difficult to interpret with variable outcomes similar to those in the low-risk or high-risk groups. Therefore, researchers are looking to further improve the accuracy of the existing models and reduce their ambiguity by incorporating other clinically relevant factors.
Let us start by recapping some of the relevant articles and video interviews on the topic that were covered on the Lymphoma Hub earlier this year.
This article summarizes an exploratory analysis in patients with non-Hodgkin lymphoma (NHL) from phase III GOYA ( NCT01287741) and GALLIUM (NCT01332968) trials, which sought to investigate the potential prognostic value of natural killer cell count (NKCC) in predicting patient outcomes following anti-CD20 immunochemotherapy. The results indicate that the number of peripheral blood circulating natural killer cells could act as a prognostic biomarker for follicular lymphoma (FL) or diffuse large B-cell lymphoma (DLBCL) patient outcomes and allow the development of novel combination treatment approaches tailored to the number of functional effector cells in NHL.