This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
What the IPI is
Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive lymphoma in adults. In 1993, the International Non-Hodgkin’s Lymphoma Prognostic Factors Project published the International Prognostic Index (IPI) in the New England Journal of Medicine. It is still the most widely used tool to describe the prognosis of DLBCL at diagnosis.
The five risk factors
Count 1 point for each:
- Age over 60.
- Ann Arbor stage III or IV, meaning lymphoma on both sides of the diaphragm or spread to organs.
- ECOG performance status of 2 or more.
- Serum LDH above the upper limit of normal.
- More than one extranodal site, such as bone marrow, liver or the digestive tract.
Risk groups
| IPI | Risk group | 5-year overall survival, 1993 (before rituximab) |
|---|---|---|
| 0 to 1 | Low | about 73% |
| 2 | Low-intermediate | about 51% |
| 3 | High-intermediate | about 43% |
| 4 to 5 | High | about 26% |
Adding rituximab to CHOP chemotherapy (R-CHOP) improved survival in every group. In 2007, Sehn and colleagues proposed the revised IPI (R-IPI) for patients treated with R-CHOP:
| R-IPI | Factors | 4-year overall survival |
|---|---|---|
| Very good | 0 | about 94% |
| Good | 1 to 2 | about 79% |
| Poor | 3 to 5 | about 55% |
Example
A 68-year-old patient with stage IV disease, high LDH, ECOG 1 and one extranodal site has 3 factors: IPI high-intermediate and R-IPI poor.
Other versions
- The age-adjusted IPI uses only stage, LDH and performance status for patients 60 or younger.
- The NCCN-IPI (2014) splits age and LDH into more levels and counts specific extranodal sites.
Limits
These figures come from groups of patients and cannot predict what will happen to one person. Biological features such as the cell of origin, MYC and BCL2 rearrangements, and the response to treatment on PET scans also shape the prognosis. Discuss the meaning of any score with the hematology team.