What are the five IPI risk factors?

Age > 60 years, serum LDH above the upper limit of normal, ECOG performance status ≥ 2, Ann Arbor stage III or IV, and more than one extranodal site involved. Each factor scores one point for a maximum of five.

What do the IPI risk groups mean?

Score 0–1 = Low risk (~73% 5-year OS); score 2 = Low-Intermediate risk (~51%); score 3 = High-Intermediate risk (~43%); score 4–5 = High risk (~26%). These figures are from the original 1993 pre-rituximab cohort; outcomes with modern R-CHOP are meaningfully better.

Is the IPI still valid for DLBCL patients receiving R-CHOP?

Yes, the IPI retains prognostic discrimination in the rituximab era, though absolute survival rates are higher than the original pre-rituximab cohort. The revised IPI (R-IPI) and NCCN-IPI were developed specifically for R-CHOP-treated DLBCL and may offer finer risk separation for that population.

Does this calculator apply to Hodgkin lymphoma?

No. The IPI was designed for aggressive non-Hodgkin lymphomas (e.g., DLBCL, Burkitt, peripheral T-cell lymphoma). Hodgkin lymphoma uses the International Prognostic Score (IPS), a separate tool.

How is ECOG performance status scored?

ECOG 0 = fully active; 1 = restricted in strenuous activity, ambulatory and able to carry out light work; 2 = ambulatory and capable of self-care but unable to work, up and about >50% of waking hours; 3 = capable of limited self-care, confined to bed or chair >50% of waking hours; 4 = completely disabled. For IPI, score ≥ 2 is an adverse factor.

Is this a substitute for clinical judgment?

No. This calculator is for educational and informational purposes only. Clinical treatment decisions for lymphoma require comprehensive evaluation by qualified hematology/oncology specialists. Never use a risk score as the sole basis for treatment planning or prognosis communication.

IPI Lymphoma Score

Enter five clinical factors to calculate the IPI score and five-year overall survival estimate for aggressive non-Hodgkin lymphoma.

For educational use only. Clinical decisions require evaluation by a qualified hematology/oncology specialist.

IPI Risk Factors

Age

≤ 60 years 0 pts > 60 years 1 pt

Serum LDH

Normal 0 pts Elevated 1 pt

ECOG Performance Status

ECOG ≥ 2 = adverse factor (1 point)

Ann Arbor Stage

I or II 0 pts III or IV 1 pt

Extranodal Sites Involved

> 1 extranodal site = adverse factor (1 point)

Select values on the left and click Calculate to see the IPI score and risk group.

IPI Risk Groups

Score	Risk	5-yr OS
0–1	Low	~73%
2	Low-Intermediate	~51%
3	High-Intermediate	~43%
4–5	High	~26%

Summary

The International Prognostic Index (IPI) is the standard validated risk-stratification tool for aggressive non-Hodgkin lymphoma, originally published in the New England Journal of Medicine in 1993. It assigns one point each for five adverse clinical features: age over 60, high serum LDH, ECOG performance status of 2 or higher, Ann Arbor stage III or IV, and more than one extranodal site of disease. Total scores 0–5 map to four risk groups (Low, Low-Intermediate, High-Intermediate, High) with corresponding five-year overall survival rates derived from the original cohort. The IPI remains relevant in the rituximab era and has spawned variants such as the R-IPI and NCCN-IPI that refine predictions for DLBCL patients receiving modern chemoimmunotherapy.

How it works

Enter the patient's age and select whether it exceeds 60 years.
Indicate whether serum LDH is elevated above the institutional upper limit of normal.
Select the ECOG performance status (0–4) — score ≥ 2 counts as an adverse factor.
Choose the Ann Arbor stage — stage III or IV counts as an adverse factor.
Enter the number of extranodal sites involved — more than one counts as an adverse factor.
Click Calculate to see the IPI score, risk group, and five-year overall survival estimate.

Use cases

Stratify newly diagnosed aggressive NHL patients into risk groups before treatment planning.
Estimate five-year overall survival to guide goals-of-care conversations with patients and families.
Support eligibility assessment for clinical trials that use IPI as an inclusion criterion.
Benchmark individual patient risk against published cohort data.
Educate medical students, residents, and oncology fellows on lymphoma prognostication.
Communicate prognosis objectively between referring oncologists and tertiary hematology teams.

Frequently Asked Questions

Last updated: 2026-06-15 · Reviewed by Nham Vu