Canterbury DHB

Context

Prognosis, Risk Factors, and the Decision to Treat

NHL subtypes have distinct natural histories. As indicated in the classification section, a broad division can be made between indolent or aggressive forms of NHL. Risk factors and the decision to treat vary according to the subtype and will be covered under each disease section. However, a prognostic index (the International Prognostic Index, IPI) has been developed for aggressive NHL and the FLIPI Score for Follicular Lymphoma.

In This Section

International Prognostic Index for Aggressive Lymphoma (IPI)

Revised IPI (RIPI)

Enhanced IPI (Derived by National Comprehensive Cancer Network, NCCN)

FLIPI Score for Follicular Lymphoma

International Prognostic Index for Aggressive Lymphoma (IPI)

Risk factors:

Risk Group

Risk Factors

5 Year OS

Low

= 0-1

73 %

Low Intermediate

= 2

51%

Intermediate High

=3

43%

High

= 4-5

26%

Revised IPI (RIPI)

See Sehn et al, Blood 2007; 109:1857-61.

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. The IPI remains predictive but it identifies only two risk groups. The R-IPI identifies 3 risk groups.

Risk Group

Risk Factors

4 Year OS

Very good

0

92%

Good

1, 2

82%

Poor

3-5

58%

Enhanced IPI (Derived by National Comprehensive Cancer Network, NCCN)

See Zhou et al, Blood 2014; 123:837-42.

The enhanced International Prognostic Index (NCCN-IPI) is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP that better discriminates low- and high-risk DLBCL patients compared with the IPI. It refines categorisation by age and LDH and it identifies disease involvement at specific nodal sites.

Risk factors:

FLIPI Score for Follicular Lymphoma

See Solal Celigny et al. Blood 2004 104 1258-1265.

This prognostic system is based on 5 adverse prognostic features:

Risk Group

Risk Factors

5 Year OS

10 Year OS

Low

0-1

91%

71%

Intermediate

2

78%

51%

High

≥3

53%

36%

The definition of nodal groups is shown in this diagram. Each rectangle corresponds to a nodal area.

About this Canterbury DHB document (5947):

Document Owner:

Peter Ganly (see Who's Who)

Issue Date:

November 2018

Next Review:

November 2021

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 5947