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The International Prognostic Index (IPI) is a clinical tool developed by oncologists to aid in predicting the prognosis
Prognosis

Prognosis is a medicine term denoting the Physician's prediction of how a patient will progress, and whether there is a chance of recovery. This word is often used in medical reports dictating a physician's view on a case....
 of patients with aggressive non-Hodgkin's lymphoma. Prior to 1993, when the IPI was developed, the primary consideration in assessing prognosis was the Ann Arbor stage
Ann Arbor staging

Ann Arbor staging is the Cancer staging system for lymphomas, both in Hodgkin's lymphoma and Non-Hodgkin lymphoma . It was initially developed for Hodgkin's, but has some use in NHL....
 alone, but this was increasingly found to be an inadequate means of predicting survival outcomes, and so other factors were studied.

A retrospective analysis was performed on 2031 patients with aggressive non-Hodgkin's lymphoma, of all ages, treated with a doxorubicin
Doxorubicin

Doxorubicin is a pharmaceutical used in cancer chemotherapy. It is an anthracycline antibiotic, closely related to the natural product daunorubicin, and like all anthracyclines it intercalation DNA....
-based chemotherapy regimen such as CHOP
Chop

Chop can refer to:* CHOP, a chemotherapy treatment for non-Hodgkin's lymphoma* Meat chop, a cut of meat usually containing a rib and served as an individual portion....
 between 1982 and 1987.






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The International Prognostic Index (IPI) is a clinical tool developed by oncologists to aid in predicting the prognosis
Prognosis

Prognosis is a medicine term denoting the Physician's prediction of how a patient will progress, and whether there is a chance of recovery. This word is often used in medical reports dictating a physician's view on a case....
 of patients with aggressive non-Hodgkin's lymphoma. Prior to 1993, when the IPI was developed, the primary consideration in assessing prognosis was the Ann Arbor stage
Ann Arbor staging

Ann Arbor staging is the Cancer staging system for lymphomas, both in Hodgkin's lymphoma and Non-Hodgkin lymphoma . It was initially developed for Hodgkin's, but has some use in NHL....
 alone, but this was increasingly found to be an inadequate means of predicting survival outcomes, and so other factors were studied.

A retrospective analysis was performed on 2031 patients with aggressive non-Hodgkin's lymphoma, of all ages, treated with a doxorubicin
Doxorubicin

Doxorubicin is a pharmaceutical used in cancer chemotherapy. It is an anthracycline antibiotic, closely related to the natural product daunorubicin, and like all anthracyclines it intercalation DNA....
-based chemotherapy regimen such as CHOP
Chop

Chop can refer to:* CHOP, a chemotherapy treatment for non-Hodgkin's lymphoma* Meat chop, a cut of meat usually containing a rib and served as an individual portion....
 between 1982 and 1987. Several patient characteristics were analyzed to determine whether they were associated with differences in survival, and the factors that emerged as significant were, in addition to the Ann Arbor stage: age, elevated serum lactate dehydrogenase
Lactate dehydrogenase

Lactate dehydrogenase is an enzyme present in a wide variety of organisms, including plants and animals....
 (LDH), performance status
Performance status

In medicine , performance status is an attempt to quantify cancer cancer patient general wellbeing. This measure is used to determine whether they can receive chemotherapy, whether dose adjustment is necessary, and as a measure for the required intensity of palliative care....
, and number of extranodal sites of disease.

International Prognostic Index

One point is assigned for each of the following risk factors:

  • Age greater than 60 years
  • Stage
    Cancer staging

    The stage of a cancer is a descriptor of how much the cancer has spread. The stage often takes into account the size of a tumor, how deep it has penetrated, whether it has invaded adjacent organs, how many lymph nodes it has metastasis to , and whether it has spread to distant organs....
     III or IV disease
  • Elevated serum LDH
  • ECOG/Zubrod performance status of 2, 3, or 4
  • More than 1 extranodal site


The sum of the points allotted correlates with the following risk groups:
  • Low risk (0-1 points) - 5-year survival of 73%
  • Low-intermediate risk (2 points) - 5-year survival of 51%
  • High-intermediate risk (3 points) - 5-year survival of 43%
  • High risk (4-5 points) - 5-year survival of 26%


Although the IPI has shown itself to be a useful clinical tool, widely used by oncologists and a mainstay of risk stratification in clinical trials for lymphoma, it should be kept in mind that it was developed prior to the use of rituximab
Rituximab

Rituximab, sold under the trade names Rituxan and MabThera, is a Chimera monoclonal antibody against the protein CD20. Rituximab is used in the treatment of B cell non-Hodgkin's lymphoma, B-cell leukemias, and some autoimmune disorders....
, which is now included with anthracycline-based combination chemotherapy as of the standard of care in B-cell lymphomas (the majority of non-Hodgkin's lymphomas). Rituximab has dramatically improved the outcomes of lymphoma patients, and its effect on the prognostic value of the IPI is uncertain.

Follicular Lymphoma International Prognostic Index (FLIPI)

Given the success of the IPI for intermediate grade lymphomas, an effort was undertaken to develop a similar prognostic index for the most common low-grade lymphoma, follicular lymphoma
Follicular lymphoma

Follicular lymphoma is the most common of the indolent non-Hodgkin's lymphomas. It is defined as a lymphoma of lymph follicle center B-cells , which has at least a partially follicular pattern....
. The prognostic factors that emerged from this were: age, stage, number of lymph node areas involved, serum hemoglobin
Hemoglobin

Hemoglobin is the iron-containing oxygen-transport metalloprotein in the red blood cells of vertebrates, and the tissues of some invertebrates....
 level, and serum LDH.

One point is assigned for each of the following adverse prognostic factors:
  • Age greater than 60 years
  • Stage III or IV disease
  • Greater than 4 lymph node groups involved
  • Serum hemoglobin less than 12 g/dL
  • Elevated serum LDH


The sum of the points allotted correlates with the following risk groups:
  • Low risk (0-1 points) - 5 and 10-year survivals of 91% and 71%, respectively
  • Intermediate risk (2 points) - 5 and 10-year survivals of 78% and 51%, respectively
  • High risk (3-5 points) - 5 and 10-year survivals of 53% and 36%, respectively

Mantle Cell Lymphoma International Prognostic Index (MIPI)


An effort was more recently undertaken to identify a similar prognostic index predictive of outcome in advanced mantle cell lymphoma. There were four factors found to have independent prognostic relevance: age, performance status, LDH, and white blood cell count (WBC).

The point values are assigned as follows:
  • 0 points: Age less than 50 years, ECOG performance status of 0-1, LDH less than 0.67 of the upper limit of normal, or WBC of less than 6,700 cells/mcl
  • 1 point: Age 50-59, LDH 0.67-0.99 of the upper limit of normal, or WBC 6,700 to 9,999 cells/mcl
  • 2 points: Age 60-69, ECOG performance status of 2-4, LDH 1-1.49 times the upper limit of normal, or WBC 10,000-14,000 cells/mcl
  • 3 points: Age 70 or greater, LDH 1.5 times the upper limit of normal or greater, and WBC of 15,000 cells/mcl or greater


The sum of the allotted points correlates with the following risk groups:
  • Low risk (0-3 points) - median survival not yet reached
  • Intermediate risk (4-5 points) - median survival of 51 months
  • High risk (6-11 points) - median survival of 29 months


See also

  • Hodgkin's Lymphoma Prognosis
    Hodgkin's lymphoma

    Hodgkin's lymphoma, also known as Hodgkin's disease is a type of lymphoma . It was named after Thomas Hodgkin, who first described abnormalities in the lymph system in 1832....