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.

International Prognostic Index for Aggressive Lymphoma (IPI)

Revised IPI (RIPI)

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.

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

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.

FLIPI Score for Follicular Lymphoma

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)
Last Reviewed:	December 2021
Next Review:	December 2024
Keywords:
Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer The Haematology Department Protocols and Guidelines (the Red Book) are intended as a guide for registered health professionals to communicate guidelines and share best practices with supporting health professionals within New Zealand district health boards. They are not intended to be provided to or used as a reference for patients or non-registered health professionals. All health professionals must exercise their own clinical judgement and use pertinent clinical data when treating patients. The authors and editors of this publication have checked with sources believed to be reliable in their effort to provide information that is complete and in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical science, neither the authors, editors, publisher, nor any other party who has been involved in preparing or publishing this work warrants that the information contained in it is accurate or complete in every respect. They therefore have no liability (whether in tort (including negligence) or otherwise) for any loss or damage arising out of any reliance on this information. This publication has been compiled by the staff and contractors of Canterbury District Health Board (CDHB) and as such CDHB has copyright for this book. Amendments must be authorised in accordance with the documented process. No release of part of, or all of, this publication to any other party or organisation is permissible without the prior approval of the designated document owner.
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Risk Group	Risk Factors	5 Year OS
Low	= 0 to 1	73 %
Low Intermediate	= 2	51%
Intermediate High	= 3	43%
High	= 4 to 5	26%

Risk Group	Risk Factors	4 Year OS
Very good	0	92%
Good	1, 2	82%
Poor	3 to 5	58%

Risk Group	Risk Factors	5 Year OS
Low	<1	96%
Low Intermediate	2 or 3	82%
High Intermediate	4 or 5	64%
High	>6	33%

Risk Group	Risk Factors	5 Year OS	10 Year OS
Low	0 to 1	91%	71%
Intermediate	2	78%	51%
High	≥3	53%	36%