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IPI, R-IPI and NCCN-IPI scores for DLBCL

The original IPI, revised IPI (R-IPI) and NCCN-IPI are prognostic tools used to predict survival in patients with DLBCL.
1. Select score:


IPI / R-IPI IPI: Original IPI (International Prognostic Index) score developed before the Rituximab era

R-IPI: Revised IPI score re-validated the original IPI score based on patients who received Rituximab based chemotherapy (RCHOP).

NCCN-IPI Based on data from the National Comprehensive Cancer Network database of patients with DLBCL treated during the Rituximab era.

Age (years):
≤60
>60
ECOG Performance status: 0: Fully active, able to carry out all pre-disease activities.

1: Restricted in strenuous activity but ambulatory and able to do light work.

2: Capable of self-care, but no work related activities, out of bed >50% of the day.

3: Capable of limited self-care, confined to bed or chair >50% of the day.

4: Incapable of any self-care, confined to bed or chair.
0-1
2-4
Ann-Arbor stage: Stage I:
Nodal involvement in a single lymph node region OR a single localized extranodal site.

Stage II:
Nodal involvement in two or more lymph node regions OR localized extranodal involvement on one side of the diaphragm.

Stage III:
Nodal involvement or extranodal involvement on both sides of the diaphragm.

Stage IV:
Diffuse or disseminated involvement of one or more extralymphatic organs OR
involvement of liver, bone marrow, lungs or cerebrospinal fluid.
I-II
III-IV
Elevated LDH: Greater than upper limit of normal.
No
Yes
Extranodal sites: Any tumor spread involving tissue outside of the lymph nodes, spleen, thymus, Waldeyer’s tonsillar ring, appendix and Peyer’s patches.
≤1
>1
Age (years):
≤40
>40 to ≤60
>60 to ≤75
>75
LDH normalised to upper limit of normal (ULN):
≤1 x ULN
>1 to ≤3 x ULN
>3 times
Ann-Arbor stage: Stage I:
Nodal involvement in a single lymph node region OR a single localized extranodal site.

Stage II:
Nodal involvement in two or more lymph node regions OR localized extranodal involvement on one side of the diaphragm.

Stage III:
Nodal involvement or extranodal involvement on both sides of the diaphragm.

Stage IV:
Diffuse or disseminated involvement of one or more extralymphatic organs OR
involvement of liver, bone marrow, lungs or cerebrospinal fluid.
I or II
III or IV
Extra-nodal disease Disease in bone marrow, CNS, liver, GI tract or lung.
Absent
Present
ECOG Performance status: 0: Fully active, able to carry out all pre-disease activities.

1: Restricted in strenuous activity but ambulatory and able to do light work.

2: Capable of self-care, but no work related activities, out of bed >50% of the day.

3: Capable of limited self-care, confined to bed or chair >50% of the day.

4: Incapable of any self-care, confined to bed or chair.
0-1
≥ 2
Score:

IPI (International Prognostic Index), R-IPI (revised IPI), NCCN-IPI prognostic scores for predicting overall survival in DLBCL


IPI score (International Prognostic Index)

The international prognostic index (IPI) was developed as a prognostic tool to predict long term survival in patients with DLBCL.

Original IPI score

The original IPI was developed from a population of 2031 patients with aggressive non-Hodgkin lymphoma treated with anthracycline based chemotherapy which did not include rituximab(1).

A model based on age≤60, stage≥3, LDH, performance status≥2 and presence of more than 1 extranodal site of disease emerged as independently significant in predicting survival.

The model identifies 4 prognostic risk groups: low (73% 5-year OS), low intermediate (51% 5-year OS), high intermediate (43% 5-year OS) and high (5-year OS 26%).

Revised IPI (R-IPI) score

The addition of rituximab to CHOP (cyclophosphamide, doxorubicin, vincristine and prednisolone) chemotherapy has significantly improved survival in DLBCL.

The original IPI score was therefore revalidated in 1063 patients with DLBCL who received RCHOP(2).

The revised IPI score uses the same prognostic variables but re-distributes the stratification into 3 prognostic groups: very good (94% 4-year OS), good (79% 4-year OS) and poor (55% 4-year OS).

NCCN-IPI

The NCCN-IPI score was developed to improve risk stratification of patients with DLBCL treated in the rituximab era.

The score was developed based on 1650 patients diagnosed with DLBCL between 2000-2010 at 7 NCCN cancer centers(3).

Five variables (age, LDH, stage, extra-nodal disease and performance status) were found to significantly associate with prognosis.

The score stratifies patients into four risk groups: low (0-1), low-intermediate (2-3), high-intermediate (4-5) and high (6-8).

The NCCN-IPI was found to better discriminate between low and high risk groups (5-year OS 96% vs 33%) than the IPI (5-year OS 90% vs 54%)

The NCCN-IPI has been validated in a cohort of 1138 patients from the British Columbia Cancer Agency treated with RCHOP and again demonstrated enhanced discrimination for high and low risk patients as compared to the IPI.

References:
  1. A predictive model for aggressive non-Hodgkin’s lymphoma. N Engl J Med. 1993;329(14):987-994. doi:10.1056/NEJM199309303291402
  2. Sehn LH, Berry B, Chhanabhai M, 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):1857-1861. doi:10.1182/blood-2006-08-038257
  3. Zhou Z, Sehn LH, Rademaker AW, et al. An enhanced International Prognostic Index (NCCN-IPI) for patients with diffuse large B-cell lymphoma treated in the rituximab era. Blood. 2014;123(6):837-842. doi:10.1182/blood-2013-09-524108