B cell lymphoma is not one disease but a few dozen heterogeneous diseases, or individual cancers, that affect the b-cells in the lymphatic system. However, the most common type of b cell lymphoma is diffuse large b-cell lymphoma (DLBCL), and researchers have come up with a rather handy method of determining prognosis for people with DLBCL known by its initials, the R-IPI, which stands for the Revised International Prognostic Index.
The R-IPI works by identifying a specific patient group—those who have been diagnosed with DLBCL and who are then treated with the R-CHOP chemotherapeutic regimen.
The R-IPI asks five questions, and assigns a point per question when called for.
- Is the patient younger or older than 60? If younger, 0 points. If 60 or older, 1 point.
- What is the patient's ECOG performance status score? [see * below]. If 0-2, 0 points. If 3-4, 1 point.
- Is the patient's LDH normal or elevated? If normal, 0 points. If elevated, 1 point.
- How many extranodal sites are involved? If no more than 1, 0 points. If 2 or more, 1 point.
- What stage disease? If the patient's cancer is stage I or II, 0 points. If III or IV, 1 point.
[*ECOG status: This is a scale to determine how a disease affects a patient's daily life. To see what each score means, refer to this explanation offered by the National Cancer Institute. ]
The R-IPI then identifies three prognostic groups according to points.
- 0 points: Prognosis, Very good (4-year progression-free survival 94%, overall survival, 94%)
- 1-2 points: Prognosis, Good (4-year PFS 80%, OS 79%)
- 3-5 points: Prognosis, Poor (4-year PFS 53%, OS 55%)
The R-IPI doesn't recognize risk groups with a perceived B cell lymphoma survival rate of under 50%.
Researchers are always looking for new methods to determine survival rates, especially among b cell lymphomas, because they are so common, but readers should be aware of the limitations of these indices since each person is different and each person's cancer is also different.