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Lymphoma (DLBCL) Prognosis Panel
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Clinical Context & Background
This panel computes five validated prognostic indices for Diffuse Large B-Cell Lymphoma (DLBCL) to support clinical decision-making at diagnosis:
1. Classic IPI — The original and most widely used prognostic tool (1993). Recommended by ESMO as the standard reference for clinical trials.
2. NCCN-IPI — Enhanced model for the Rituximab era. Better discriminates high-risk (5y OS ~33%) and low-risk (5y OS ~96%) subgroups by refining age/LDH weighting and identifying high-risk extranodal sites. Confirmed as the best-performing clinical scoring system (Ruppert et al., Blood 2020).
3. Age-Adjusted IPI (aaIPI) — Recommended by ESMO and EHA 2025 guidelines. Uses only 3 factors (LDH, Stage, ECOG) enabling within-age-group comparisons and guiding treatment intensity.
4. CNS-IPI — Predicts risk of CNS relapse. EHA 2025 recommends assessment for all LBCL patients [III, A]. Critical for CNS prophylaxis decisions.
5. R-IPI — Simplified 3-tier model for the rituximab era. Included for compatibility with published clinical trial data.
Primary References:
The International NHL Prognostic Factors Project. NEJM 1993;329:987-994.
Zhou Z, Sehn LH, et al. Blood 2014;123(6):837-842.
Schmitz N, et al. JCO 2016;34(26):3150-3156.
Sehn LH, et al. Blood 2007;109(5):1857-1861.
Ruppert A, et al. Blood 2020;135(23):2041-2048.
ESMO Living Guidelines: DLBCL Staging & Risk Assessment.
EHA 2025 CPG: Large B-cell Lymphoma. HemaSphere 2025.
Reference Data
| Risk Group | Classic IPI (5y OS) | NCCN-IPI (5y OS) | aaIPI ≤60y / >60y (5y OS) | R-IPI (4y OS) | CNS-IPI (2y CNS relapse) |
|---|---|---|---|---|---|
| Low | 0-1 (73%) | 0-1 (96%) | 0 (83% / 56%) | 0 (94%) | 0-1 (0.8%) |
| Low-Intermediate | 2 (51%) | 2-3 (82%) | 1 (69% / 44%) | 1-2 (79%) | 2-3 (3.9%) |
| High-Intermediate | 3 (43%) | 4-5 (64%) | 2 (46% / 37%) | — | — |
| High | 4-5 (26%) | 6-8 (33%) | 3 (32% / 21%) | 3-5 (55%) | 4-6 (12%) |
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