NEWLY DIAGNOSED: Determining prognosis

It's the question everyone has: What's the prognosis?

In 1993, researchers put together an index to try and give every patient with non-Hodgkin's lymphoma as accurate a prognosis as possible. The result was the International Prognostic Index (IPI).

The IPI is a model used to predict the outcome of NHL patients. It uses five pretreatment risk factors to assign patients to one of four risk groups, and it has been found to be the best means of determining prognosis for indolent and aggressive B-cell lymphomas, as well as T-cell lymphomas.

A 'yes' answer to any of the following risk factors amounts to one point, for totals ranging from 0 to 5. Add them up as you go (and remember, answer as of date of diagnosis):

1. Age 60 or older
2. Stage III or Stage IV
3. Elevated LDH levels
4. ECOG/Zubrod performance status 2, 3 or 4 *(see note below)
5. More than one extranodal site

Add up the points, here's what they suggest:
0-1 points: Low risk. 5-year survival, 73%
2 points: Low-intermediate risk. 5-year survival, 51%
3 points: High-intermediate risk. 5-year survival, 43%
4-5 points: High risk. 5-year survival, 26%

Keep in mind that the IPI was established prior to the arrival of Rituxan, which has improved B-cell patient outcomes across the board, so arguably all four percentages would be on the low side if Rituxan were factored in.

There's also the Follicular Lymphoma International Prognostic Index (FLIPI), which you can see at wikidoc.org.

*Note on #4: The ECOG/Zubrod performance status is a 0 to 5 scoring method that attempts to quantify to what degree a patient is symptomatic. For example, 0 means you're entirely asymptomatic, while 2 means you're OK but spend less than half the day in bed. For a more in-depth explanation, Wikipedia's current entry on the ECOG/Zubrod performance status is actually very useful.