𧬠DLBCL Prognosis (IPI / R-IPI)
International Prognostic Index for diffuse large B-cell lymphoma.
Educational only. Lymphoma prognosis and treatment belong to your oncology team.
Diffuse large B-cell lymphoma is the commonest aggressive lymphoma, and it is curable in a majority of patients with chemoimmunotherapy. The International Prognostic Index distills five bedside factors into a 0-5 score that has stratified DLBCL outcomes since 1993, updated for the rituximab era as the R-IPI. Enter the five factors above.
How to Use This Calculator
Answer the five IPI factors from the diagnosis workup. Both the original IPI and revised R-IPI appear.
Enter age, LDH, ECOG status, stage, and extranodal site count.
Read the score: 0-1 low, 2 low-intermediate, 3 high-intermediate, 4-5 high.
Use it for what it is: a counseling and trial-stratification tool, discussed with your oncologist, not a personal forecast.
The Five Factors
The International Non-Hodgkin's Lymphoma Prognostic Factors Project derived the IPI in 1993 from over 2,000 patients: each factor independently predicted survival, and the count stratified 5-year overall survival from 73% (low) to 26% (high) in the pre-rituximab era. Rituximab improved every group, so Sehn and colleagues re-calibrated it in 2007 as the R-IPI: 0 factors very good (94% 4-year OS), 1-2 good (79%), 3-5 poor (55%). The factors did not change; the outcomes did, which is the point of re-validation.
Each factor has biologic logic: age captures comorbidity and treatment tolerance, LDH captures tumor burden and turnover, ECOG captures the patient's reserve, stage captures spread, extranodal sites capture sanctuary involvement. None is surprising alone; together they outperform any single one. Newer indices (NCCN-IPI, with finer age and LDH gradations) refine further, but the original IPI remains the lingua franca.
Worked Example
A 68-year-old with raised LDH, ECOG 1, stage III disease, one extranodal site: age 1 + LDH 1 + ECOG 0 + stage 1 + extranodal 0 = 3. High-intermediate IPI; poor R-IPI group (3-5). In the rituximab era that group sees roughly 55% 4-year overall survival, which is precisely why it is called "poor" relatively: it identifies patients for clinical trials of intensified or novel frontline therapy. Contrast a 45-year-old, normal LDH, ECOG 0, stage II, no extranodal disease: 0 points, very good R-IPI, ~94% 4-year OS with standard R-CHOP. Same disease, different numbers, different conversations.
What the Score Changes
High IPI scores route patients toward clinical trials testing intensified regimens (dose-adjusted EPOCH-R, polatuzumab-based combinations) because standard R-CHOP underperforms there. Low scores support standard therapy with confidence and spare patients experimental toxicity. The score also sets surveillance intensity and frames honest counseling: "your group" statistics help patients plan without pretending to predict individuals. It never decides treatment alone; cell-of-origin, MYC/BCL2 rearrangements (double-hit), and comorbidities all modify the plan.
The most important context: DLBCL is curable. Even high-IPI patients achieve durable remissions, and relapsed disease now has CAR-T cell therapy and bispecific antibodies that did not exist when the IPI was born. A "poor" R-IPI group in 2026 faces better options than a "good" group did in 1996. Prognostic scores describe populations in an era; eras change, and this one is changing fast. Bring the number to your oncologist and ask what the current options make of it.
Related Calculators
Keep exploring: try our Charlson comorbidity index and BMI calculator for the next piece of the picture.
For informational purposes only, not medical advice. Consult a healthcare professional.
Frequently Asked Questions
What is the IPI score for lymphoma?
The International Prognostic Index: 5 factors (age >60, raised LDH, ECOG >=2, stage III/IV, >1 extranodal site), each 1 point. It stratifies DLBCL into low (0-1), low-intermediate (2), high-intermediate (3), and high (4-5) risk groups.
What is the R-IPI?
The revised IPI for the rituximab era (Sehn et al., 2007): same 5 factors regrouped as very good (0), good (1-2), and poor (3-5), with 4-year overall survival of ~94%, ~79%, and ~55%. It re-calibrated the original IPI after rituximab improved outcomes.
Is DLBCL curable?
Yes, in a majority of patients with standard chemoimmunotherapy (R-CHOP and newer regimens). Even relapsed DLBCL now has CAR-T and bispecific antibodies. Prognosis scores guide intensity but do not decide curability for any individual.
What does elevated LDH mean in lymphoma?
High tumor burden and rapid cell turnover: LDH leaks from dying tumor cells. It is one of the five IPI factors and a general marker of aggressive disease, though it is nonspecific on its own.
What is double-hit lymphoma?
DLBCL with MYC plus BCL2 and/or BCL6 rearrangements: more aggressive than standard DLBCL, often treated with intensified regimens. It is assessed by FISH testing and modifies the IPI-based plan.
What is the NCCN-IPI?
A refined index using finer age brackets and LDH gradations plus specific extranodal sites. It discriminates high-risk patients better than the original IPI, but the classic IPI remains the most widely used.
Does a high IPI mean treatment will fail?
No. It means the group statistics are worse and trials of intensified therapy are worth discussing. Many high-IPI patients are cured with standard or intensified treatment; the score stratifies populations, not individuals.
What is ECOG performance status?
A 0-5 scale of daily function: 0 fully active, 1 restricted in strenuous activity, 2 up and about >50% of waking hours, 3 confined to bed/chair >50%, 4 completely disabled, 5 dead. IPI counts >= 2 as a risk point.
How is DLBCL treated?
Frontline: chemoimmunotherapy (R-CHOP or polatuzumab-based regimens). Relapsed: salvage chemo plus transplant, CAR-T cell therapy, or bispecific antibodies. Treatment choice incorporates IPI, biology, age, and fitness.
Should IPI guide clinical trial enrollment?
Often yes: high IPI/IPI-high-intermediate patients are the prime candidates for frontline trials of intensified or novel therapy, since standard treatment underperforms in those groups. Ask your oncologist about available trials.