International Prognostic Index (IPI)—
Institutions in the United States, Canada, and Europe participated in an International Non-Hodgkin's Lymphoma Prognostic Factors Project. Patients with aggressive NHLs were evaluated for pretreatment features which predicted for survival following treatment with doxorubicin-containing chemotherapy regimens. The following factors were found to correlate significantly with shorter overall or relapse-free survival:
• Age >60
•Serum lactate dehydrogenase (LDH) concentration greater than normal
•ECOG performance status 2 (“Tables” )
•Ann Arbor clinical stage III or IV (“Tables” )
•Number of involved extranodal disease sites >1
In this system, one point is given for each of the above characteristics present in the patient, for a total score ranging from zero to five, representing increasing degrees of risk:
5 year survival (%)
-
• Low risk — IPI score of zero or one 73
•Low intermediate risk — IPI score of two 51
•High intermediate risk — IPI score of three 43
•High risk — IPI score of four or five 26
When applied to the initial group of 2031 patients with aggressive NHL, five-year overall survivals for patients with scores of 0 to 1, 2, 3, and 4 to 5 were 73, 51, 43, and 26 percent, respectively.
Revised IPI after CHOP-R
Revised IPI 4-year overall survivals were for:
I. the very good (IPI score of zero) = 94%
II. good (score of 1 or 2) = 79% and
III. poor (score of 3 or more) risk groups = 55%
Blood. 2007 Mar 1;109(5):1857-61. Epub 2006 Nov 14
Assesment of Response for NHL
This reviewed in the Tables sections, linked here:
Follicular Lymphoma International Prognostic Index
Results of the Cox regression analysis in 1795 patients
who exhibited the 5 parameters retained for building the Follicular
Lymphoma International Prognostic Index
Parameter Adverse factor RR 95% CI
Age 60 y 2.38 2.04-2.78
Ann Arbor stage III-IV 2.00 1.56-2.58
Hemoglobin level 120 g/L 1.55 1.30-1.88
Serum LDH level ULN 1.50 1.27-1.77
Number of nodal sites 4 1.39 1.18-1.64
Risk group # pts %5-year OS %10-year OS
Number of factors
Low 0-1 36 90.6 (1.2) 70.7 (2.7) 1.0
Intermediate 2 37 77.6 (1.6) 50.9 (2.7) 2.3 1.9-2.8
High -3 27 52.5 (2.3) 35.5 (2.8) 4.3 3.5-5.3
BLOOD, 1 SEPTEMBER 2004 _ VOLUME 104, NUMBER 5
