DLBCL Prognosis Calculator (IPI and R-IPI)
This calculator scores diffuse large B-cell lymphoma (DLBCL) prognosis using two validated tools: the original International Prognostic Index (IPI) and the Revised IPI (R-IPI) developed for patients receiving rituximab-based therapy. Enter five clinical factors to get a total score, a risk group, and estimated overall and progression-free survival. The result updates as you type.
What is the International Prognostic Index (IPI)?
The International Prognostic Index (IPI) was established in 1993 by an international collaboration to predict outcomes in aggressive non-Hodgkin lymphoma, including DLBCL. It uses five clinical factors that were each independently associated with overall survival in the pre-rituximab era: age above 60, Ann Arbor stage III or IV, elevated serum LDH, ECOG performance status 2 to 4, and more than one extranodal site of disease. Each factor scores 1 point, giving a total from 0 to 5. Patients are then placed into four risk groups: Low (0-1 points), Low-Intermediate (2), High-Intermediate (3), and High (4-5), with 5-year overall survival rates of approximately 73%, 51%, 43%, and 26% respectively in the original dataset.
Why the Revised IPI (R-IPI) is preferred today
The introduction of rituximab transformed DLBCL treatment in the early 2000s, and the original IPI no longer separated patients as cleanly as it did before R-CHOP became standard care. In 2007, Sehn and colleagues re-evaluated the IPI in a cohort of R-CHOP-treated patients and found that the original four-group model collapsed into two indistinguishable groups. They proposed a simplified three-group model - Very Good (score 0), Good (score 1-2), and Poor (score 3-5) - using the same five factors. The R-IPI gives 4-year overall survival estimates of 94%, 79%, and 55% for these groups, providing better discrimination. This calculator offers both models so you can use the one most appropriate to your context.
How to use this calculator
Select R-IPI (recommended for patients planned for rituximab-based therapy) or the original IPI (for historical comparison). Then answer the five yes/no questions about age, Ann Arbor stage, LDH level, ECOG performance status, and number of extranodal sites. The total score, risk group, and estimated overall and progression-free survival update immediately. Use the "Show your work" panel to see how each factor contributes to the score. This tool is intended for educational and research reference only; clinical decisions should always involve a qualified hematologist or oncologist who can weigh the full clinical picture.
IPI factor definitions in detail
Age: patients aged 60 or younger score 0; those over 60 score 1. Ann Arbor stage: stages I and II (disease confined to one side of the diaphragm) score 0; stages III and IV score 1. LDH: a serum LDH at or below the upper limit of the local laboratory normal range scores 0; any elevation scores 1. ECOG performance status: scores 0 (fully active) or 1 (restricted but ambulatory) score 0; scores 2 (capable of self-care but no work), 3 (limited self-care), or 4 (bed-confined) score 1. Extranodal sites: patients with 0 or 1 site of extranodal disease score 0; those with 2 or more sites score 1. Extranodal locations include bone marrow, liver, lung, CNS, skin, gastrointestinal tract, kidney, and testes.
R-IPI and IPI risk groups with estimated survival rates
| Index | Score | Risk group | 4-yr OS (R-IPI) / 5-yr OS (IPI) | 4-yr PFS (R-IPI) |
|---|---|---|---|---|
| R-IPI | 0 | Very Good | 94% | 94% |
| R-IPI | 1-2 | Good | 79% | 80% |
| R-IPI | 3-5 | Poor | 55% | 53% |
| IPI | 0-1 | Low | 73% | N/A |
| IPI | 2 | Low-Intermediate | 51% | N/A |
| IPI | 3 | High-Intermediate | 43% | N/A |
| IPI | 4-5 | High | 26% | N/A |
R-IPI rates are 4-year overall and progression-free survival from Sehn et al. 2007 (R-CHOP cohort). IPI rates are 5-year overall survival from the original 1993 International Non-Hodgkins Lymphoma Prognostic Factors Project.
Frequently asked questions
What is DLBCL and why does prognosis vary so much?
Diffuse large B-cell lymphoma is the most common aggressive lymphoma in adults, accounting for about 25-30% of all non-Hodgkin lymphomas. It arises from mature B lymphocytes and can involve lymph nodes, organs, and other tissues. Despite the same diagnosis, outcomes vary considerably because of differences in tumour biology (such as the germinal centre vs. activated B-cell molecular subtype), stage, the extent of organ involvement, a patient's fitness level, and how well LDH reflects tumour burden. The IPI and R-IPI capture several of these factors in a simple scoring system.
Is the R-IPI better than the IPI?
For patients treated with rituximab plus CHOP (R-CHOP) - the current standard first-line regimen - the R-IPI generally provides better prognostic discrimination because it re-stratifies the original four groups into three that differ more meaningfully in survival outcomes. The NCCN-IPI is a more recently refined version that further separates patients, especially those at very high risk, by using continuous age thresholds and graded LDH values. For most everyday clinical reference, R-IPI is a reasonable and widely validated choice.
What does a Very Good R-IPI score mean?
A score of 0 (no adverse factors) places a patient in the Very Good risk group, which is associated with approximately 94% 4-year overall survival and 94% 4-year progression-free survival in the Sehn et al. 2007 dataset. Only a small minority of DLBCL patients fall into this category. It does not mean cure is guaranteed, but it reflects that modern R-CHOP treatment produces excellent outcomes for this subset.
What is Ann Arbor staging in lymphoma?
The Ann Arbor staging system classifies lymphoma spread. Stage I: disease in a single lymph node region or a single extranodal site. Stage II: two or more lymph node regions on the same side of the diaphragm. Stage III: lymph node regions on both sides of the diaphragm, possibly with the spleen. Stage IV: widespread extranodal involvement (such as bone marrow, liver, or lung). The suffix E (extranodal) or S (spleen) is sometimes added, as is A (no symptoms) or B (fever, night sweats, or significant weight loss).
Can the IPI be used for other lymphomas?
The IPI was designed for aggressive non-Hodgkin lymphoma and is most validated for DLBCL. Variants and adaptations exist for other lymphoma types, such as the Follicular Lymphoma International Prognostic Index (FLIPI) for follicular lymphoma, the Mantle Cell Lymphoma International Prognostic Index (MIPI), and the MALT-IPI for extranodal marginal zone lymphoma. These use some of the same factors but are calibrated to the biology and treatment context of each lymphoma subtype.
Should I use this calculator to make treatment decisions?
No. This tool provides educational and reference information only. The IPI and R-IPI are population-level risk estimates based on group survival data; they do not predict what will happen to any individual patient. Treatment decisions for DLBCL depend on a complete clinical assessment by a specialist hematologist or oncologist, incorporating imaging, pathology (including molecular subtype), complete blood count, full organ function, and the patient's own goals and values.
Sources
- Sehn LH et al. The revised International Prognostic Index (R-IPI) is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP. Blood. 2007.
- The International Non-Hodgkin's Lymphoma Prognostic Factors Project. A predictive model for aggressive non-Hodgkin's lymphoma. N Engl J Med. 1993.