MIPI/MIPI-c: Mantle Cell Lymphoma International Prognostic Index
Background
The clinical course of mantle cell lymphoma (MCL) is highly variable. Lower age, better performance status, lower serum lactate-dehydrogenase (LDH) activity, and lower white blood cell (WBC) count at first diagnosis have been shown to be associated with longer progression-free and overall survival in patients with MCL suitable for moderately intensive chemotherapy. Furthermore, the tumour cell proliferation rate Ki-67 index has been identified as strong prognostic marker additional to clinical patient characteristics.
The Mantle Cell Lymphoma International Prognostic Index (MIPI, Hoster et al., Blood 2008) assigns MCL patients to three prognostic groups according to the diagnostic values of the clinical variables age, ECOG performance status, serum LDH activity, and WBC count. When the Ki-67 index evaluated on diagnostic tumour tissue is available, the more refined combined MIPI (MIPI-c, Hoster et al., JCO 2016) can be assessed that classifies MCL patients into four prognostic groups dependent on MIPI group and Ki-67 index. For the assessment of the Ki-67 index, guidelines published by the European MCL Pathology Panel are available (Klapper et al., Journal of Hematopathology, 2009).
Calculator
Please choose whether MIPI or MIPI-c should be calculated. Then enter pre-treatment values of age in years, ECOG performance status, LDH, and WBC count in G/L. For LDH the upper limit of normal (ULN) is also required using the same unit. MIPI assigns a patient to the low, intermediate, or high risk group. For the evaluation of MIPI-c, please additionally enter the Ki-67 index in % assessed on diagnostic tumour tissue. According to MIPI-c a patient is assigned to the low, low-intermediate, high-intermediate, or high risk group.
The values of ECOG performance status (Oken at al. 1982) are defined as follows.
| 0 | Fully active, able to carry on all pre-disease performance without restriction |
| 1 | Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work |
| 2 | Ambulatory and capable of all selfcare but unable to carry out any work activities. Up and about more than 50% of waking hours |
| 3 | Capable of only limited selfcare, confined to bed or chair more than 50% of waking hours |
| 4 | Completely disabled. Cannot carry on any selfcare. Totally confined to bed or chair |
By using this calculator you accept that the European MCL Network does not assume any liability.
(c) 2016 European MCL Network
Follicular lymphoma (FL) is a clinically and genetically heterogeneous disease. We established a clinicogenetic risk model (m7-FLIPI) that improves risk stratification by integrating the mutation status* of seven genes (EZH2, ARID1A, MEF2B, EP300, FOXO1, CREBBP and CARD11), the FL International Prognostic Index (FLIPI) and ECOG performance status.
Note, that this score was established and validated only in patients with follicular lymphoma grade 1, 2, or 3A, advanced stage or bulky disease considered ineligible for curative irradiation, symptomatic disease requiring systemic treatment according to published criteria (Hiddemann et al., Blood 2004), and a lymphoma biopsy obtained less than 12 months prior to therapy initiation. All patients received a combination of rituximab and chemotherapy (either CVP or CHOP) as first-line treatment.
The m7-FLIPI outperformed FLIPI alone, FLIPI combined with ECOG PS, and a model of only gene mutations.
In an independent validation cohort, risk stratification by m7-FLIPI outperformed FLIPI alone, and FLIPI combined with ECOG performance status, and identified a high-risk group (24/107, 22% of patients) with 5-year failure-free survival of 25% versus 68% (HR 3.6, 95% CI 2.0 - 6.4, p<0.0001) in the low-risk group.
The m7-FLIPI was published 2015 in Lancet Oncology by Pastore A et al.
Here you can calculate the m7-FLIPI score and the resulting risk group (high versus low). By using this calculator you accept that GLSG does not assume any liability.
*any somatic or putative somatic non-silent mutation (i.e. missense mutations, nonsense mutations, in-frame or frame-shift insertions/deletions (InDel), translational start site mutations, or splice site mutations).
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Background
Hematological toxicity represents a frequent adverse event after chimeric antigen receptor (CAR) T-cell therapy, and can predispose for severe infectious complications. Determined prior to lymphodepleting chemotherapy (e.g. day -5), the CAR-HEMATOTOX score comprises five markers of hematotoxicity with additional weighting of the baseline platelet count and ferritin levels. The score discriminates between a high (CAR-HEMATOTOX score ≥2) and low (CAR-HEMATOTOX score 0-1) risk for hematotoxicity.
Please note that this score was established and validated only in patients with large B-cell lymphoma receiving Axicabtagene ciloleucel or Tisagenlecleucel in a real-world setting. The model was validated in two independent patient cohorts and discriminated patients with severe neutropenia ≥14 days vs. <14 days (pooled validation: AUC 0.89, sensitivity 89%, specificity 68%).
For details see CAR-HEMATOTOX: a model for CAR T-cell-related hematologic toxicity in relapsed/refractory large B-cell lymphoma. Rejeski et al. Blood (2021) 138 (24): 2499-2513.
In a multi-center follow-up study, the score further identified patients at risk for severe infections and disease progression: The CAR-HEMATOTOX risk-stratifies patients for severe infections and disease progression after CD19 CAR-T for R/R LBCL. Rejeski et al. J Immunother Cancer (2022) May; 10 (5): e004475.
Calculator
Here you can calculate the CAR-HEMATOTOX score and the resulting risk group (high versus low). By using this calculator, you accept that the GLA does not assume any liability.
