DLBCL 예후 계산기: IPI 점수와 생존 예측

The International Prognostic Index is the most widely used prognostic tool for aggressive non-Hodgkin lymphoma, originally developed in 1993 from a large international multicentre study. It assigns one point each for age above 60, ECOG performance status ≥ 2, elevated LDH, more than one extranodal site, and Ann Arbor stage III or IV disease. Scores of 0–1 define the Low risk group, 2 the Low-Intermediate group, 3 the High-Intermediate group, and 4–5 the High risk group.

The R-IPI was developed in 2007 using rituximab-containing immunochemotherapy cohorts and identified three rather than four prognostic groups. A score of 0 defines a 'Very Good' group with approximately 94% 4-year overall survival. Scores of 1–2 define a 'Good' group (~79% 4-year OS), and scores of 3–5 define a 'Poor' group (~55%). The R-IPI was designed to better reflect outcomes in the modern rituximab era compared with the original IPI.

Ann Arbor staging classifies lymphoma by the distribution of involved lymph node regions and extranodal sites. Stage I involves a single lymph node region or a single extranodal site. Stage II involves two or more lymph node regions on the same side of the diaphragm. Stage III involves regions on both sides of the diaphragm. Stage IV involves diffuse extranodal involvement or one extranodal site with distant nodal disease. The 'E' modifier is added for contiguous extranodal extension, and 'B' for systemic symptoms.

Double-hit lymphoma (DHL) is defined by concurrent chromosomal translocations involving MYC with either BCL2 or BCL6, identified by FISH. It constitutes 5–10% of newly diagnosed DLBCL but is associated with significantly worse outcomes than IPI score alone predicts — 2-year overall survival rates of 30–50% with standard R-CHOP chemotherapy. This calculator flags double-hit status as a separate adverse finding, and patients with DHL are typically considered for intensified regimens such as DA-EPOCH-R.

ECOG performance status is a standardised scale assessing the functional capacity of cancer patients. Grade 0 is fully active with no restriction. Grade 1 is restricted in physically strenuous activity but ambulatory and able to carry out light work. Grade 2 is ambulatory and capable of self-care but unable to carry out work activities; up and about more than 50% of waking hours. Grade 3 is capable of only limited self-care and confined to bed or chair more than 50% of waking hours. Grade 4 is completely disabled and confined to bed. ECOG ≥ 2 contributes one IPI point.

Yes. The original IPI survival estimates were derived from pre-rituximab cohorts (before 1993). The addition of rituximab to CHOP chemotherapy (R-CHOP) improved outcomes across all IPI groups by approximately 10–15 percentage points. Emerging therapies including CAR-T cell therapy (axicabtagene ciloleucel, lisocabtagene maraleucel), bispecific antibodies (glofitamab, epcoritamab), and polatuzumab vedotin-based combinations continue to improve salvage outcomes. The survival estimates shown are approximate historical benchmarks and should be interpreted in light of current available therapies.