International Prognostic Index for Risk Stratification of DLBCL
patients
The International Prognostic Index (IPI) and its revised variant, R-IPI
are widely used clinical prognostication systems for DLBCL (15,16).
These indices use a combination of age, Eastern Cooperative Oncology
Group (ECOG) performance status, tumor stage, lactate dehydrogenase
level, and the number of extra nodal sites of disease to predict the
prognosis of patients with DLBCL (17). Biccler et al showed the poor
performance of the IPI in predicting overall survival in DLBCL patients.
(18) In a study investigating the ability of the IPI and the revised
index to predict outcome, R-IPI identified three distinct prognostic
groups with: (a) very good (4-year progression-free survival [PFS]
94%, overall survival [OS] 94%), (b) good (4-year PFS 80%, OS
79%), and (c) poor (4-year PFS 53%, OS 55%) outcomes, respectively
(P< 0.001) (19). However, neither the R-IPI nor IPI are unable
to predict patients with <50% chance of survival. Such
patients potentially need more potent first lines of therapy. However,
there are no biomarkers that can reliably identify these high risk
patients as of yet.