Recent clinical advances in<unk>  <unk>  have seen standard‐of‐care treatment algorithms transformed. Frontline rituximab combination therapy, high dose cytarabine‐based induction in younger patients and, more recently, Bruton Tyrosine Kinase (BTK) inhibitors in the relapse setting have all demonstrated survival advantage in clinical trials (Wang et al, 2013; Eskelund et al, 2016; Rule et al, 2016). Over the last 15 years these practices have gradually become embedded in clinical practice and real‐world data has observed corresponding improvements in patient survival (Abrahamsson et al, 2014; Leux et al, 2014). The overall 5-year survival rate for<unk>  is generally 50% (advanced stage<unk>  to 70% (for limited-stage<unk> . Prognosis for individuals with<unk>  is problematic and indexes do not work as well due to patients presenting with advanced stage disease. Staging is used but is not very informative, since the malignant B-cells can travel freely though the lymphatic system and therefore most patients are at stage III or IV at diagnosis. Prognosis is not strongly affected by staging in<unk>  and the concept of metastasis does not really apply. The<unk>  International Prognostic Index (MIPI) was derived from a data set of 455 advanced stage<unk>  patients treated in series of clinical trials in Germany/Europe. Of the evaluable population, approximately 18% were treated with high-dose therapy and stem cell transplantation in first remission. The MIPI is able to classify patients into three risk groups: low risk (median survival not reached after median 32 months follow-up and 5-year OS rate of 60%), intermediate risk (median survival 51 months) and high risk (median survival 29 months). In addition to the 4 independent prognostic factors included in the model, the cell proliferation index (Ki-67) was also shown to have additional prognostic relevance. When the Ki67 is available, a biologic MIPI can be calculated.<unk>  is one of the few NHLs that can cross the boundary into the brain, yet it can be treated in that event. There are a number of prognostic indicators that have been studied. There is not universal agreement on their importance or usefulness in prognosis. Ki-67 is an indicator of how fast cells mature and is expressed in a range from about 10% to 90%. The lower the percentage, the lower the speed of maturity, and the more indolent the disease. Katzenberger et al. Blood 2006;107:3407 graphs survival versus time for subsets of patients with varying Ki-67 indices. He shows median survival times of about one year for 61-90% Ki-67 and nearly 4 years for 5-20% Ki-67 index.<unk>  cell types can aid in prognosis in a subjective way. Blastic is a larger cell type. Diffuse is spread through the node. Nodular are small groups of collected cells spread through the node. Diffuse and nodular are similar in behavior. Blastic is faster growing and it is harder to get long remissions. Some thought is that given a long time, some non-blastic<unk>  transforms to blastic. Although survival of most blastic patients is shorter, some data shows that 25% of blastic<unk>  patients survive to 5 years. That is longer than diffuse type and almost as long as nodular (almost 7 yrs). Beta-2 microglobulin is another risk factor in<unk>  used primarily for transplant patients. Values less than three have yielded 95% overall survival to six years for auto SCT where over three yields a median of 44 most overall survival for auto SCT (Khouri 03). This is not yet fully validated. Testing for high levels of Lactate dehydrogenase (LDH) in NHL patients is useful because LDH is released when body tissues break down for any reason. While it cannot be used as a sole means of diagnosing NHL, it is a surrogate for tracking tumor burden in those diagnosed by other means. The normal range is approximately 100-190.
Mantle cell lymphoma
Mature T-cell lymphoma
Mixed-cell lymphoma
Diffuse large B-cell lymphoma
Anaplastic large-cell lymphoma
Aggressive lymphoma
Marginal zone B-cell lymphoma
Nodal marginal zone B cell lymphoma