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The Non-Hodgkin Lymphoma Pathologic Classification Project: Long-Term Follow-Up of 1153 Patients with Non-Hodgkin Lymphomas

Richard Simon, PhD; Sylvain Durrleman, MD; Richard T. Hoppe, MD; Gianni Bonadonna, MD; Clara D. Bloomfield, MD; Richard A. Rudders, MD; Bruce D. Cheson, MD; and Costan W. Berard, MD
[+] Article, Author, and Disclosure Information

Requests for Reprints: Richard Simon, PhD, National Cancer Institute, Executive Plaza North, Room 739, Bethesda, MD 20892.

Current Author Addresses: Drs. Simon and Durrleman: Executive Plaza North, Room 739, Division of Cancer Treatment, Bethesda, MD 20892.

Dr. Hoppe: Department of Radiation Oncology, Room A091, Stanford University, Stanford, CA 94305.

Dr. Bonadonna: Istituto Nazionale Tumori, Via Venezian, 1, Milan 20133, Italy.

Dr. Bloomfield: Box 277 UMHC, University of Minnesota, Minneapolis, MN 55455.

Dr. Rudders: New England Medical Center and Tufts University School of Medicine, 171 Harrison Avenue, Boston, MA 02111.

Dr. Cheson: NCI, Executive Plaza North, Room 741, Bethesda, MD 20892.

Dr. Berard: 4576 Park Avenue, Memphis, TN 38117.

© 1988 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1988;109(12):939-945. doi:10.7326/0003-4819-109-12-939
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Study Objective: To document the long-term prognosis of patients with non-Hodgkin lymphoma treated between 1971 and 1975 and to determine how the prognosis varies by histologic subtype and stage.

Setting: Three cancer referral centers in the United States and one center in Italy.

Patients: A consecutive sample of 1153 previously untreated patients with non-Hodgkin lymphoma. At the time of analysis, 71% of the patients had died and the median follow-up for patients still alive was 11.2 years.

Measurements and Main Results: The 10-year survival proportions were 45% (CI, 40% to 50%); 26% (CI, 22% to 30%); and 23% (CI, 18% to 30%) for patients with low-, intermediate-, and high-grade lymphomas, respectively. Patients with intermediate- and high-grade lymphomas were curable, but this was not apparent for patients with advanced stage low-grade lymphomas. For the low-grade follicular small cleaved and follicular mixed lymphomas, the Ann Arbor staging system distinguished the prognosis of patients with stage I disease from those with more extensive involvement. For the diffuse large cell and immunoblastic lymphomas, the Ann Arbor staging system distinguished long-term prognosis for patients with stage I disease from patients with stage II disease and those with more disseminated involvement.

Conclusions: The probability of long-term survival for unselected patients with non-Hodgkin lymphoma can be substantial. Long-term prognosis depends on the histologic subtype of the tumor and the extent of dissemination. The Working Formulation for non-Hodgkin lymphomas is a simple and useful nomenclature for selecting treatment and reporting results. The Ann Arbor staging system is a useful but imperfect prognostic indicator.





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