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International Prognostic Index for Chronic Lymphocytic Leukemia (CLL-IPI)

Calculators  Oncology
International Prognostic Index is used to estimate treatment time and prognosis of chronic lymphocytic leukemia.
Age
≤65 years 0
>65 years 1
Clinical stage
Binet A or Rai 0 0
Binet B-C or Rai I-IV 1
Serum β2 microglobulin
≤3.5 0
>3.5 2
IGHV mutational status
Mutated 0
Unmutated 2
TP53 status
No abnormalities 0
Deletion 17p (FISH) and/or TP53 mutation (sequencing) 4
Result:

Background

Measured Factor
CLL-IPI score
Measured Factor Disease
  • Chronic Lymphocytic Leukemia
Measured Factor Detail
International Prognostic Index indicates points based on the age, clinical stage, serum β2 microglobulin, IGHV mutational status, and TP53 status. Score 0-1 indicates low risk with 93.2% survival of 5 years, Score 2-3 indicates intermediate risk with 79.3% survival of 5 years, Score 4-6 indicates high risk with 63.3 % survival of 5 years, and Score 7-10 indicates very high risk with 23.3 % survival of 5 years.
Speciality
Oncologist
Body System
Oncology
Measured Factor High Impact
  • Higher score indicates the high risk of chronic lymphocytic leukemia with less survival rate
Process
Serum β2 microglobulin diagnose with β2 microglobulin tumor marker, mutation of IGHV and p53 detected by genetic testing.

Result Interpretation

Ranges Ranges
  • Critical High: Score > or = 4
  • Normal: Score 0-1
  • Normal Adult Male: Score 0-1
  • Normal Adult Female: Score 0-1
  • Normal Geriatric Male: Score 0-1
  • Normal Geriatric Female: Score 0-1
Result High Conditions
  • Chronic Lymphocytic Leukemia
Test Limitations
Mutational status of IGHV might not available in all leukemic patients limiting its use.
References: 2

Studies

Study Validation 1
The study aimed to validate the CLL-IPI (the international prognostic index for patients with chronic lymphocytic leukaemia) and compare with the MDACC (MD Anderson Cancer Center) prognostic index in newly diagnosed subjects. Off 858 newly diagnosed and previously untreated CLL patients at least 65 years of age, at around 167 patients died and 304 were treated as 130 patients received chemotherapy and 174 received chemo-immunotherapy. The overall MDACC score showed that 307 patients were classified as low risk, 522 as intermediate risk, and 29 as high risks; respectively, stratification of patients using the MDACC score allowed the prediction of prognosis. The study concluded that this score represents a powerful, easily applicable, and a highly reproducible prognostic tool that can predict both TTFT and OS in newly diagnosed CLL patients.
References: 3
Study Validation 2
An observational study in 337 subjects showed the chronic lymphocytic leukaemia international prognostic index that predicts the TTFT (time to first treatment) in early CLL. It showed that the CLL-IPI score stratified Binet stage A patients into three subgroups with a different outcome. Recursive partitioning analysis identified three subsets with scores of 0 (n = 139), 1 (n = 90), and ≥ 2(n = 108); respectively, the probability of remaining free from therapy after the diagnosis of 5 years was 85%, 67% and 46% in these three categories. The study concluded that the CLL-IPI in the management of early-stage CLL patients should be determined in large, well-designed, prospective clinical trials including randomized trials that evaluated the benefit of early intervention for high-risk early-stage patients.
References: 4
Study Validation 3
The study aimed to describe the evaluation of the validity and reproducibility of the CLL-IPI, the Barcelona-Brno biomarkers only prognostic model, and its comparison with the MDACC in a cohort of Spanish subjects. Off 696 CLL patients, on a median follow-up time of 46 months, 394 subjects were alive and 187 had received treatment as well as the median overall survival (OS) was 173 months and the median time to first therapy (TTFT) was 32 months. The distribution of subjects in the three prognostic groups proposed by the index was 160 patients at low risk, 302 at intermediate risk, and 21 at high-risk. The study concluded that the three PIs (Prognostic indexes) have a great ability to predict the clinical course of patients diagnosed with CLL.
References: 5
Study Additional 1
The study aimed to describe the analyzation whether the International Prognostic Index for CLL (CLL-IPI) is useful to predict Time to First Treatment of patients with early disease. The study model includes 5 independent parameters that predict the overall survival such as age, clinical stage, del(17p) and/or TP53 mutation, IGHV mutation status and β2-microglobulin (B2M) level. It showed that the AUROC increased from 0.646 to 0.720 when moving from MDACC model to CLL-IPI score; respectively, c-statistic of the MDACC model was 0.62 a level below than that of the CLL-IPI. The study concluded or confirmed that the utility of CLL-IPI scores to predict TTFT in a prospective cohort of community-based patients with early CLL at presentation.
References: 6

References

  1. An international prognostic index for patients with chronic lymphocytic leukaemia (CLL-IPI): a meta-analysis of individual patient data. Lancet Oncol. 2016;17(6):779-90.
  2. Chiarugi P, Cirri P, Marra F, et al. The Src and signal transducers and activators of transcription pathways as specific targets for low molecular weight phosphotyrosine-protein phosphatase in platelet-derived growth factor signaling. J Biol Chem. 1998;273(12):6776-85
  3. Gentile M, Shanafelt TD, Rossi D, Laurenti L, Mauro FR, Molica S, et al. Validation of the CLL-IPI and comparison with the MDACC prognostic index in newly diagnosed patients. Blood. 2016;128(16):2093-2095.
  4. Molica S, Shanafelt TD, Giannarelli D, Gentile M, Mirabelli R, Cutrona G, et al. The chronic lymphocytic leukemia international prognostic index predicts time to first treatment in early CLL: Independent validation in a prospective cohort of early stage patients. Am J Hematol. 2016;91(11):1090-1095.
  5. Muñoz-novas C, Poza-santaella M, González-gascón y marín I, Hernández-Sánchez M, Rodríguez-Vicente A, Infante M, et al. The International Prognostic Index for Patients with Chronic Lymphocytic Leukemia Has the Higher Value in Predicting Overall Outcome Compared with the Barcelona-Brno Biomarkers Only Prognostic Model and the MD Anderson Cancer Center Prognostic Index. Biomed Res Int. 2018;2018:9506979.
  6. Molica S, Giannarelli D, Levato L, Mirabelli R, Gentile M, Morabito F. Is the International Prognostic INDEX for CLL (CLL-IPI) Useful to Predict Time to First Treatment of Patients with EARLY Disease? Results of a Prospective Multicenter Analysis. Blood. 2015;126:498.