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International Prognostic Index for non-Hodgkin lymphoma

International Prognostic Index for non-Hodgkin lymphoma
International Prognostic Index[1]
Age >60
Serum lactate dehydrogenase concentration above normal
ECOG performance status ≥2
Ann Arbor stage III or IV
Number of extranodal disease sites >1

One point is given for each of the above characteristics present in the patient, for a total score ranging from 0 to 5.

When applied to the initial group of 2031 patients with aggressive NHL treated with anthracycline-based regimens that did not include rituximab, 5-year OS and CR rates according to score were as follows:
Score Risk group 5-year OS (%) CR rate (%)
0 to 1 Low risk 73 87
2 Low-intermediate risk 51 67
3 High-intermediate risk 43 55
4 to 5 High risk 26 44
This same score applied to 1063 patients with CD20-positive aggressive lymphoma treated with rituximab plus CHOP or CHOP-like chemotherapy predicted the following[2]:
Score 3-year EFS 3-year PFS 3-year OS
0 to 1 81 87 91
2 69 75 81
3 53 59 65
4 to 5 50 50 59
Age-adjusted International Prognostic Index[1]

For this score, all of the prognostic factors listed above, with the exception of age and number of extranodal sites, are given 1 point, for a score ranging from 0 to 3.

When applied to the group of 761 patients >60 years of age, 5-year OS and CR rates according to the adjusted score were as follows:
Score Risk group 5-year OS (%) CR rate (%)
0 Low risk 56 91
1 Low-intermediate risk 44 71
2 High-intermediate risk 37 56
3 High risk 21 36
CHOP: cyclophosphamide, doxorubicin, vincristine, prednisone; CR: complete response; ECOG: Eastern Cooperative Oncology Group; EFS: event-free survival; NHL: non-Hodgkin lymphoma; OS: overall survival; PFS: progression-free survival.
Sources:
  1. Adapted from: International Non-Hodgkin's Lymphoma Prognostic Factors Project. A predictive model for aggressive non-Hodgkin's lymphoma. N Engl J Med 1993; 329:987.
  2. Additional data from: Ziepert, M, Hasenclever, D, Kuhnt, E, et al. Standard International Prognostic Index remains a valid predictor of outcome for patients with aggressive CD20+ B-cell lymphoma in the rituximab era. J Clin Oncol 2010; 28:2373.
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