International Prognostic Index (IPI)
Prognosis in aggressive non-Hodgkin lymphoma (DLBCL)
- Onkopedia DLBCL (DGHO)
Sources last checked: 2026-10-13
International Prognostic Index (IPI)
Prognosis in aggressive non-Hodgkin lymphoma (DLBCL)
5-year overall survival 73 % in the 1993 derivation cohort (pre-rituximab).
Survival figures come from patients treated with CHOP-like chemotherapy without rituximab (1982–1987); absolute survival is higher today. For patients ≤ 60 a separate age-adjusted IPI (aaIPI) exists.
Interpretation
| 0–1 — low risk | 5-year overall survival 73 % in the 1993 derivation cohort (pre-rituximab). |
|---|---|
| 2 — low-intermediate risk | 5-year overall survival 51 % in the derivation cohort. |
| 3 — high-intermediate risk | 5-year overall survival 43 % in the derivation cohort. |
| 4–5 — high risk | 5-year overall survival 26 % in the derivation cohort. |
What is the International Prognostic Index (IPI)?
The International Prognostic Index (IPI) predicts survival in aggressive non-Hodgkin lymphoma from five baseline factors: age > 60, raised LDH, ECOG ≥ 2, Ann Arbor stage III/IV and more than one extranodal site. It was derived in 1993 from 2,031 patients treated with doxorubicin-based chemotherapy in the US, Europe and Canada. It remains the reference prognostic index for diffuse large B-cell lymphoma.
When to use it
- At diagnosis of DLBCL or another aggressive B-cell lymphoma, before treatment
- To stratify patients for clinical trials and tumour-board discussions
- When a treatment decision depends on IPI group (e.g. cycle number or regimen choice in Onkopedia/ESMO algorithms)
When not to use it
- In follicular lymphoma — use the FLIPI
- In Hodgkin lymphoma, mantle-cell or T-cell lymphomas, which have their own indices
- To give an individual patient an exact survival figure
How it is calculated
| Criterion | Points |
|---|---|
| Age > 60 years | +1 |
| Serum LDH above the upper limit of normal | +1 |
| ECOG performance status ≥ 2 | +1 |
| Ann Arbor stage III or IV | +1 |
| More than one extranodal site involved | +1 |
Clinical pearls and limitations
- Survival figures come from patients treated with CHOP-like chemotherapy without rituximab (1982–1987); absolute survival is higher today. For patients ≤ 60 a separate age-adjusted IPI (aaIPI) exists.
- The survival figures are from the pre-rituximab era; the risk ranking still holds but absolute survival is better today.
- For patients ≤ 60, the age-adjusted IPI (stage, LDH, performance status) is used instead.
- LDH counts if it is above the local upper limit of normal — not a fixed value.
- The CNS-IPI adds kidney/adrenal involvement to estimate CNS relapse risk.
Frequently asked questions
What are the five IPI risk factors?
Age over 60, LDH above normal, ECOG performance status 2 or more, Ann Arbor stage III or IV, and more than one extranodal site.
What is a high-risk IPI?
4–5 factors. In the 1993 cohort the 5-year overall survival was 26 %, compared with 73 % for 0–1 factors.
IPI or R-IPI?
The R-IPI regroups the same factors for patients treated with R-CHOP into three groups. Many guidelines and trials still use the original four IPI groups.
Evidence and guidelines
- Primary source: The International Non-Hodgkin's Lymphoma Prognostic Factors Project. A predictive model for aggressive non-Hodgkin's lymphoma. N Engl J Med 1993;329(14):987-994.
- Onkopedia (DGHO): Diffuses großzelliges B-Zell-Lymphom — IPI factors and risk groups.
- Sehn LH et al. The revised International Prognostic Index (R-IPI). Blood 2007;109(5):1857-1861.
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