DLBCL Prognosis Calculator — IPI & R-IPI Score

Formula

How this is calculated

The International Prognostic Index (IPI), described by Shipp et al. (NEJM 1993), is the standard tool for risk-stratifying newly diagnosed aggressive lymphomas including DLBCL. It assigns one point each for five independent adverse prognostic factors: age over 60, serum LDH above the local upper limit of normal, ECOG performance status of 2 or higher, Ann Arbor stage III or IV, and more than one extranodal site of disease. Scores range from 0 to 5 and map to four risk groups with 5-year overall survival estimates derived from the original pre-rituximab cohort (Low: ~73%, Low-intermediate: ~51%, High-intermediate: ~43%, High: ~26%).

The Revised IPI (R-IPI), published by Sehn et al. (Blood 2007), re-validated the same five factors in patients treated with R-CHOP (rituximab plus chemotherapy) and found that three groups better captured prognosis in the modern era: very good (IPI 0, ~94% 5-year OS), good (IPI 1–2, ~79% 5-year OS), and poor (IPI 3–5, ~55% 5-year OS). Survival estimates are substantially higher across all groups with rituximab-based therapy compared to the original IPI cohort.

Both the IPI and R-IPI provide population-level risk estimates and cannot predict individual patient outcomes. Actual prognosis depends on additional factors including cell-of-origin subtype (GCB vs. ABC), MYC/BCL2/BCL6 rearrangements (double- or triple-hit lymphoma), and treatment regimen. Always interpret in the context of full clinical assessment by a haematologist or oncologist.