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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 zero to five. When applied to the initial group of 2031 patients with aggressive NHL treated with anthracycline-based regimens that did NOT include rituximab, five-year overall survival (OS) and complete response (CR) rates according to score were as follows:
Score Risk group 5-yr OS, percent CR rate, percent
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-yr EFS 3-yr PFS 3-yr 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 one point, for a score ranging from zero to three. When applied to the group of 761 patients >60 years of age, five-year OS and CR rates according to the adjusted score were as follows:
Score Risk Group 5-yr OS, percent CR rate, percent
0 Low risk 56 91
1 Low-intermediate risk 44 71
2 High-intermediate risk 37 56
3 High risk 21 36
EFS: event-free survival; PFS: progression-free survival.
1. Adapted from: The International Non-Hodgkin's Lymphoma Prognostic Factors Project. N Engl J Med 1993; 329:987.
2. Adapted 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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