International Prognostic Index for Diffuse Large B-cell Lymphoma (IPI and R-IPI)

IPI / R-IPI for DLBCL

Age >60 years

Ann Arbor Stage III-IV

Serum LDH > normal

ECOG Performance Status ≥2

Extranodal sites >1

Score:–

–

Predicts overall and progression-free survival in DLBCL based on risk factors.

Why Use

Using the same criteria as the older International Prognostic Index (IPI), the revised IPI (R-IPI) discriminates among three different prognostic groups (versus two by IPI), providing more clinical relevance.

When to Use

Use in CD20+ DLBCL patients. Do not use in patients with HIV, secondary malignancies, low grade lymphoproliferative disorders, or comorbidities precluding curative therapy attempt.

Formula

Addition of the selected points: 0 points 1 point Age ≤60 >60 years Ann Arbor stage* Stage I or II (localized disease) Stage III or IV (advanced disease) ECOG performance status 0 or 1 ≥2 Serum LDH ≤1× normal >1× normal Extranodal sites ≤1 >1 *Ann Arbor stages: I Involvement of a single lymph node region or lymphoid structure (e.g. spleen, thymus, Waldeyer’s ring) II Involvement of two or more lymph node regions on the same side of the diaphragm III Involvement of lymph regions or structures on both sides of the diaphragm IV Involvement of extranodal site(s) beyond that designated E (see below) For all stages A No symptoms B Fever (38ºC), drenching sweats, weight loss (10% body weight over 6 months) For stages I to III E Involvement of a single, extranodal site contiguous or proximal to known nodal site

Pearls / Pitfalls

The International Prognostic Index for Diffuse Large B-cell Lymphoma (IPI and R-IPI) estimates 4-year progression-free survival and 4-year overall survival for patients with diffuse large B-cell non-Hodgkin’s lymphoma (DLBCL). The R-IPI provides greater discrimination amongst DLBCL patients with differing survival based on easily obtained factors. Does not identify any risk group with 4-year survival <50%; hence, other molecular or genetic markers are being researched to help select the worst-outcome patients for alternative treatment/clinical trials.

Management

Patients with poor prognosis should be strongly considered for clinical trial enrollment and tertiary center referral for investigational therapy.

Critical Actions

Correct staging and selecting correct performance status are the most potentially difficult factors.

More Information

Interpretation: Risk group 4-year overall survival, % 4-year progression-free survival, % R-IPI 0 Very good 94 94 1–2 Good 79 80 3–5 Poor 55 53 IPI 0–1 Low 82 85 2 Low-intermediate 81 80 3 High-intermediate 49 57 4–5 High 59 51 Note: IPI is listed for historical comparison only.