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

Calculators  Oncology
International Prognostic Index to estimate overall survival and progression free survival of diffuse large B-cell lymphoma.
Age
≤60 years 0
>60 years 1
Ann Arbor stage III-IV
III: Involvement on both sides of the diaphragm, IV: Involvement of extranodal sites
No 0
Yes 1
Serum LDH level >1× normal
No 0
Yes 1
>1 extranodal site
Bone marrow, GI tract, liver, lung, CNS, spleen, skin, testes, Waldeyer’s ring
No 0
Yes 1
Result:

Background

Measured Factor
R-IPI score
Measured Factor Disease
  • Diffuse Large B-cell Lymphoma
Measured Factor Detail
International Prognostic Index to find the survival progression based on the age, ann arbor stage III-IV, ECOG performance status > or = 2, serum LDH level, and > 1 extranodal site from bone marrow, liver, GI tract, skin, CNS, lung, Waldeyer's ring or testes. Score 0 indicates no risk with 94% overall and progression free survival of 4 years, Score 1-2 indicates 79 % overall survival and 80 % progression free survival for 4 years, and Score 3-5 indicates high risk with 55 % overall survival and 53 % progression free survival for 4 years.
Speciality
Oncologist
Body System
Oncology
Measured Factor High Impact
  • Score 3-5 indicates high risk with 55 % overall survival and 53 % progression free survival for 4 years.
Process
Ann Arbor staging detected by CT scan, biopsy, positron emission tomography, or gallium scan, diagnosis of extranodal sites, and serum LDH level diagnosed by blood test.

Result Interpretation

Ranges Ranges
  • Critical High: Score > or = 3
  • Normal: Score 0
  • Normal Adult Male: Score 0
  • Normal Adult Female: Score 0
  • Normal Geriatric Male: Score 0
  • Normal Geriatric Female: Score 0
Result High Conditions
  • Diffuse Large B-cell Lymphoma
  • Score > or = 3 indicates high risk of overall and progression free survival for 4 years
Test Limitations
The R-IPI had difficulty in recognizing a high percentage of poor prognosis patients.
References: 3

Studies

Study Validation 1
This study was performed in 2004 to 2011 to evaluate the We evaluated performance characteristics of the clinically derived International Prognostic Index (IPI) and revised IPI (R-IPI) in patients with in diffuse large B-cell lymphoma (DLBCL). All patients were divided into derivation and validation cohorts. Cox model was utilized to calculate the model-based score Over survival discrimination score was found using both IPI and R-IPI model and it was found that both the clinical models provides good survival discrimination. This study concludes that there can be addition of molecular markers into registry data thus improving the risk stratification.
References: 4
Study Validation 2
This retrospective study was aimed to validate the International Prognostic Index (IPI) and 
International Prognostic Index (R-IPI) model by comparing the before and after score of rituximab in patients with diffuse large B-cell lymphoma (DLBCL). 831 patients were involved in the study. Result showed that R-IPI model had better discriminative value than IPI score but both have difficulty recognizing a high percentage of poor prognosis patients. This study concludes that there is urgent need to develop a novel model to quantify the overall survival in DBCL patients.
References: 3
Study Validation 3
The main aim of this study was to validate and study the prognostic value of the International Prognostic Index (IPI) in a different cohort population with different malignancies. 1,168 patients with non-Hodgkin lymphoma were involved in this study and the main parameters evaluated were age, performance status, stage, extranodal involvement, and LDH. Patients were given score of 0 to 5 according to the working formulation (WF) related to the IPI classes. Survival curves were calculated according to the Kaplan and Meier method; survival analysis was performed using the log-rank test. Patients were divided according to the database i.e. Cancer Centre West (CCCW) and project group. This study concluded that the International Prognostic Index, divided into four categories, is applicable to unselected NHL patients for all three malignancy grades of the WF
"
References: 5
Study Additional 1
This retrospective study of an unselected population of patients with diffuse large B-cell lymphoma (DLBCL) treated with rituximab to CHOP chemotherapy (R-CHOP in the province of British Columbia. More than 10,000 patients were searched using Lymphoid Cancer Database of the Center for Lymphoid Cancer of the BC Cancer Agency. The main aim to this study was to compare the International Prognostic Index (IPI) with revised IPI (R-IPI). This study concludes that using IPI method is restricted as it used only 2 risk groups while R-IPI identifies 3 distinct prognostic groups with a very good (4-year progression-free survival [PFS] 94%, overall survival [OS] 94%), good (4-year PFS 80%, OS 79%), and poor (4-year PFS 53%, OS 55%) outcome respectively. So clinically R-IPI is more clinically effective tool in prediction of outcome in NHL patients treated with rituximab to CHOP chemotherapy
References: 6
Study Additional 2
This study was aimed to assess the involvement of extranodal in the 18F-fluorodeoxyglucose PET/CT (PET/CT) era using current prognostic indices. PET/CT is basically used in diagnosing the stage of diffuse large B-cell lymphoma (DLBCL). Patients that had been diagnosed with PET/CT and treated with rituximab to CHOP chemotherapy (R-CHOP) as 1st line treatment were retrospectively included. Total 443 patients were included in the study. Overall survival (OS) and progression-free survival (PFS) were identified by International Prognostic Index (IPI), revised International Prognostic Index (R-IPI), and NCCN-IPI methods and 69% in all patients. Involvement of Bone/bone marrow was most common cause for extranodal site diagnosed by PET/CT. This study concluded that  PET/CT-ensured involvement of extranodal in DLBCL is common and >2 extranodal sites were associated with a dismal outcome. The prognostic scores IPI, R-IPI, and NCCN-IPI were able to predict outcome with high accuracy
References: 7
Study Additional 3
The aim of this study was to determine the prognostic value of the International Prognostic Index (IPI) at relapse in patients who were presented with intermediate- or high-grade non-Hodgkin's lymphoma (NHL). Study was performed in 215 patients and their IPI score measured. All the patients after receiving 2 courses DHAP regimen (dexamethasone, cisplatin, and cytarabine) were then randomized receive either BEAC (carmustine, etoposide, cytarabine, cyclophosphamide and mesna) followed by autologous bone marrow transplantation (ABMT) or 4 additional courses of DHAP. Overall survival was measured in all cases. Results showed that IPI relapse were highly associated to OS in patients treated in the DHAP arm but not in the BEAC arm. IPI tool very well correlates response and OS in patients with NHL and helps clinicians to identify patients with a significantly different outcome among those treated with conventional chemotherapy alone
References: 8

References

  1. A predictive model for aggressive non-Hodgkin's lymphoma. The International Non-Hodgkin's Lymphoma Prognostic Factors Project. N Engl J Med. 1993;329(14):987-94.
  2. Sehn LH, Berry B, Chhanabhai M, Fitzgerald C, Gill K, Hoskins P, et al. The revised International Prognostic Index (R-IPI) is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP. Blood. 2007;109(5):1857-61.
  3. Bari A, Marcheselli L, Sacchi S, Marcheselli R, Pozzi S, Ferri P, et al. Prognostic models for diffuse large B-cell lymphoma in the rituximab era: a never-ending story. Ann Oncol. 2010;21(7):1486-91.
  4. Olszewski AJ, Winer ES, Castillo JJ. Validation of clinical prognostic indices for diffuse large B-cell lymphoma in the National Cancer Data Base. Cancer Causes Control. 2015;26(8):1163-72.
  5. Hermans J, Krol AD, Van groningen K, Kluin PM, Kluin-Nelemans JC, Kramer MH, et al. International Prognostic Index for aggressive non-Hodgkin's lymphoma is valid for all malignancy grades. Blood. 1995;86(4):1460-3.
  6. Sehn LH, Berry B, Chhanabhai M, Fitzgerald C, Gill K, Hoskins P, et al. The revised International Prognostic Index (R-IPI) is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP. Blood. 2007;109(5):1857-61.
  7. El-galaly TC, Villa D, Alzahrani M, Hansen JW, Sehn LH, Wilson D, et al. Outcome prediction by extranodal involvement, IPI, R-IPI, and NCCN-IPI in the PET/CT and rituximab era: A Danish-Canadian study of 443 patients with diffuse-large B-cell lymphoma. Am J Hematol. 2015;90(11):1041-6.
  8. Blay J, Gomez F, Sebban C, Bachelot T, Biron P, Guglielmi C, et al. The International Prognostic Index correlates to survival in patients with aggressive lymphoma in relapse: analysis of the PARMA trial. Parma Group. Blood. 1998;92(10):3562-8.