International Prognostic Index (IPI)

Prognostic scoring system for aggressive non-Hodgkin lymphoma

1. Sum the number of risk factors

Risk factors
Age > 60 years
Raised LDH
Performance status ≥ 2
Ann Arbor stage ≥ 3
Two or more extranodal sites of disease

2. Determine risk category and prognosis

Risk factors (n)Risk categoryDLBCL 3yr OS2PTCL 5yr OS3
0 - 1Low91%50%
2Low-inter­mediate81%33%
3High-inter­mediate65%16%
4 - 5High59%11%

The original International Prognostic Index (IPI) was based upon multivariate analysis of survival of 2031 patients with aggressive non-Hodgkin lymphomas treated between 1982 and 1987.1 Several histological subtypes were included, and patients were treated with various doxorubicin-containing chemotherapy combinations.1

Although the NCCN-IPI and the Revised International Prognostic Index (R-IPI) have been developed for diffuse large B cell lymphoma (DLBCL) in the rituximab era, the original IPI appears to retain some prognostic significance.2 The original IPI is also of prognostic relevance in other aggressive lymphomas, including peripheral T cell lymphoma not otherwise specified (PTCL-NOS)3 and Burkitt lymphoma.4

DLBCL: diffuse large B cell lymphoma
EFS: event-free survival
LDH: Lactate dehydrogenase
OS: overall survival
PTCL: peripheral T cell lymphoma