Revised IPI (R-IPI)
Prognosis in DLBCL treated with R-CHOP
Sources last checked: 2026-10-13
Revised IPI (R-IPI)
Prognosis in DLBCL treated with R-CHOP
4-year PFS 94 %, OS 94 % (British Columbia R-CHOP cohort).
Retrospective, single-province population-based cohort. No R-IPI group falls below 50 % survival, so it does not identify a clearly very-high-risk group; the NCCN-IPI separates the extremes better.
Interpretation
| 0 — very good | 4-year PFS 94 %, OS 94 % (British Columbia R-CHOP cohort). |
|---|---|
| 1–2 — good | 4-year PFS 80 %, OS 79 %. |
| 3–5 — poor | 4-year PFS 53 %, OS 55 %. |
What is the Revised IPI (R-IPI)?
The revised IPI (R-IPI) regroups the five standard IPI factors into three prognostic groups for diffuse large B-cell lymphoma treated with R-CHOP. It was derived by Sehn and colleagues in 2007 from a population-based British Columbia cohort. In that cohort 4-year overall survival was 94 %, 79 % and 55 % for the very good, good and poor groups.
When to use it
- At diagnosis of DLBCL in patients who will receive rituximab-based chemoimmunotherapy
- When explaining prognosis in the rituximab era
- Alongside the IPI when a trial or local protocol uses R-IPI groups
When not to use it
- In follicular or other indolent lymphomas
- As a substitute for the IPI where a guideline or trial specifies IPI groups
How it is calculated
| Criterion | Points |
|---|---|
| Age > 60 years | +1 |
| Serum LDH above the upper limit of normal | +1 |
| ECOG performance status ≥ 2 | +1 |
| Ann Arbor stage III or IV | +1 |
| More than one extranodal site involved | +1 |
Clinical pearls and limitations
- Retrospective, single-province population-based cohort. No R-IPI group falls below 50 % survival, so it does not identify a clearly very-high-risk group; the NCCN-IPI separates the extremes better.
- The inputs are identical to the IPI — only the grouping changes (0 / 1–2 / 3–5).
- No R-IPI group has survival below 50 %, so it does not pick out a truly very-high-risk group.
- The NCCN-IPI splits age and LDH into more levels and discriminates the extremes better, but is more complex.
Frequently asked questions
What are the R-IPI risk groups?
Very good: 0 factors. Good: 1–2 factors. Poor: 3–5 factors.
Why was the IPI revised?
With R-CHOP, the original four IPI groups collapsed into roughly two distinct outcome groups; regrouping the same factors gave a more useful split.
Is the R-IPI validated outside Canada?
It was derived retrospectively in one Canadian province; later cohorts confirmed its ranking, but the absolute figures vary between populations.
Evidence and guidelines
- Primary source: Sehn LH, Berry B, Chhanabhai M, et al. The revised International Prognostic Index (R-IPI) is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP. Blood 2007;109(5):1857-1861.
- The International Non-Hodgkin's Lymphoma Prognostic Factors Project. N Engl J Med 1993;329(14):987-994 (definition of the five factors).
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