What are the NCCN and ESMO recommendations for risk stratification of patients with diffuse large B-cell lymphoma (DLBCL)?

Updated: Aug 20, 2020
  • Author: Shipra Gandhi, MBBS; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

The NCCN and ESMO recommend use of the International prognostic index (IPI) for all patients. Age-adjusted International Prognostic Index (aa-IPI) should be used for risk stratification of patients aged 60 years and younger. [3, 154]

The IPI includes the following risk factors:

  • Age > 60 years
  • Elevated serum lactate dehydrogenase (LDH) level
  • Eastern Cooperative Oncology Group (ECOG) performance status ≥2
  • Stage III or IV disease
  • Extranodal involvement > 1 site

Each risk factor is worth 1 point. On the basis of the IPI score, patients can be categorized as follows:

  • Low risk (0-1 point)
  • Low-intermediate risk (2 points)
  • High-intermediate risk (3 points)
  • High risk (4-5 points)

The aa-IPI includes the following risk factors (1 point is allotted for each factor):

  • Elevated LDH level
  • Stage III or IV disease
  • ECOG performance status ≥2

Based on the aa-IPI score, patients can be categorized as follows:

  • Low risk (0 points)
  • Low-intermediate risk (1 point)
  • High-intermediate risk (2 points)
  • High risk (3 points)

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