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International Prognostic Index (IPI) for Aggressive Lymphoma

The IPI scores 5 adverse factors in aggressive non-Hodgkin lymphoma: age >60, stage III–IV, elevated LDH, ECOG ≥2 and >1 extranodal site. 0–1 is low risk (5-year OS 73%), 2 low-intermediate (51%), 3 high-intermediate (43%) and 4–5 high (26%) in the pre-rituximab era.

  • Age (years)
  • Ann Arbor stage: Stage I; Stage II; Stage III; Stage IV
  • LDH above upper limit of normal (yes/no, +1)
  • ECOG performance status: ECOG 0; ECOG 1; ECOG 2; ECOG 3; ECOG 4
  • Number of extranodal sites
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Interpretation

ResultMeaning
0–1Low (5-y OS 73%)
2Low-intermediate (51%)
3High-intermediate (43%)
4–5High (26%)

Formula

1 point each: age >60 y · Ann Arbor stage III or IV · LDH > upper limit of normal · ECOG ≥2 · >1 extranodal site

Clinical pearls

  • Survival figures predate rituximab; for R-CHOP-treated DLBCL use the R-IPI or NCCN-IPI.
  • The age-adjusted IPI (patients ≤60) uses only stage, LDH and ECOG.

Examples

ipi 65 yo stage III dlbcl high ldh ecog 1 no extranodalinternational prognostic index age 55 stage 2 normal ldh ps 0 one extranodal sitelymphoma prognosis 72M stage IV ldh elevated ecog 2 with 3 extranodal sites

FAQ

What are the 5 IPI factors?

Age over 60, stage III or IV, elevated LDH, ECOG performance status 2 or more, and more than one extranodal site.

Is the IPI still valid with rituximab?

It remains prognostic but separates fewer groups; the R-IPI and NCCN-IPI were developed for the rituximab era.

Evidence

  1. International Non-Hodgkin's Lymphoma Prognostic Factors Project. A predictive model for aggressive non-Hodgkin's lymphoma. N Engl J Med 1993;329:987–94.

Hematology & Oncology · Reviewed 2026-10-14 · Methodology