Mantle Cell Lymphoma Prognostic Index (MIPI) Score

Uses independent prognostic factors such as LDH, ECOG score or leukocyte count to stratify malignancy risk.

In the text below the calculator there is comprehensive information on the original MIPI score and the two alternative versions (simplified MIPI and MIPIb).

The mantle cell lymphoma prognostic index (MIPI) score calculator accounts for patient age, LDH, ECOG status, white blood cells and Ki67 (if known) to determine the risk of this type of lymphoma malignancy.

There are three versions of the score that are calculated: the original one, a simplified version and a “biological” version (MIPIb).

These are the three equations for each risk stratification method:

1) Original MIPI score = [0.03535 × Age (years)] + 0.6978 (if ECOG 2-4) + [1.367 × log10(LDH/ULN)] + [0.9393 × log10(WBC)].

2) Simplified MIPI (sMIPI) adds the respective number of points:

 Points Age (years) ECOG performance status LDH/ULN WBC (109 cells/L) 0 <50 0 - 1 <0.670 <6.7 1 50 - 59 n/a 0.670 – 0.999 6.7 – 9,99 2 60 - 69 2 - 4 1.000 – 1.499 10 – 14.999 3 >69 n/a >1.499 >14.999

3) Biological MIPI (MIPIb) formula = [0.03535 × Age (years)] + 0.6978 (if ECOG 2-4) + [1.367 × log10(LDH/ULN)] + [0.9393 × log10(WBC)] + [0.02142 x Ki-67 (%)].

Age
Patient LDH
LDH Upper Limit Normal (IU/L)
ECOG Performance Status
White Blood Cells
Ki67 if known
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Original MIPI explained

The mantle cell lymphoma prognostic index (MIPI) score provides malignancy outcome stratification based on five independent risk factors:

■ Age is considered prognostic factor as it increases the risk of adverse outcome.

■ LDH (lactic acid dehydrogenase) is a marker of cellular damage (higher than normal values) that is used in the diagnosis of lymphoma, anemia, liver and lung disease.

■ ECOG performance status is a functional assessment of cancer patients established by the Eastern Cooperative Oncology Group.

■ White blood cells or leukocyte count is measured in 109 cells/L, 103 cells/microliter or 103 cells/μL.

■ Ki67 is the cellular marker protein associated with cell proliferation. This is presented in percentage (when available, this is used in MIPIb).

MIPI formula = [0.03535 × Age (years)] + 0.6978 (if ECOG 2-4) + [1.367 × log10(LDH/ULN)] + [0.9393 × log10(WBC)].

Where:

ULN = LDH Upper Limit Normal.

WBC = White Blood Cell Count per microliter (x106).

The below table associates the three MIPI score ranges with the low, intermediate and high risk groups.

 MIPI score Disease risk Median overall survival <5.7 Low Not reached 5.7 to <6.2 Intermediate 51 months ≥6.2 High 29 months

Simplified MIPI

The simplified version is aimed for rapid calculation and awards a number of points to the value of the parameter.

Subsequent studies have proved that not only sMIPI has a similar prognostic performance to that of MIPI.

The table below presents the intervals for the parameters used and their correlated number of points:

 Points Age (years) ECOG performance status LDH/ULN WBC (109 cells/L) 0 <50 0 - 1 <0.670 <6.7 1 50 - 59 n/a 0.670 – 0.999 6.7 – 9,99 2 60 - 69 2 - 4 1.000 – 1.499 10 – 14.999 3 >69 n/a >1.499 >14.999

There are three risk categories for the simplified version as well:

■ Low risk – scores of 0 to 3;

■ Intermediate risk – scores of 4 and 5;

■ High risk – scores of 6 to 11.

MIPIb (biological)

Where available, the Ki67 protein can also be considered in the calculation, to provide the MIPIb score. The Ki67 was found to be revelant for prognosis with a κ = 0.79 concordance.

MIPIb formula = [0.03535 × Age (years)] + 0.6978 (if ECOG 2-4) + [1.367 × log10(LDH/ULN)] + [0.9393 × log10(WBC)] + [0.02142 x Ki-67 (%)].

The MIPIb score classifies patients in three risk groups, as follows:

 MIPIb Score Disease risk Median overall survival <5.7 Low Not reached 5.7 to <6.5 Intermediate 58 months ≥6.5 High 37 months

The MIPI was created by Hoster et al. as a specific malignancy risk stratification method for patients with mantle cell lymphoma as the other established prognostic tools (the International Prognostic Index or Follicular Lymphoma International Prognostic Index) only address diffuse large cell and follicular lymphoma cases

The study conducted in 2008 involved 455 advanced stage MCL patients treated within 3 clinical trials and resulted in the development of a new prognostic index of overall survival.

The score classified patient in low risk (44% of patients, median OS not reached), intermediate risk (35%, 51 months), and high risk groups (21%, 29 months).

The original prognostic factors were age, performance status, lactate dehydrogenase (LDH), and leukocyte count. Ki67 (cell proliferation factor) was explored as biological marker.

Original source

Hoster E, Dreyling M, Klapper W, Gisselbrecht C, van Hoof A, Kluin-Nelemans HC, Pfreundschuh M, Reiser M, Metzner B, Einsele H, Peter N, Jung W, Wörmann B, Ludwig WD, Dührsen U, Eimermacher H, Wandt H, Hasford J, Hiddemann W, Unterhalt M; German Low Grade Lymphoma Study Group (GLSG); European Mantle Cell Lymphoma Network. A new prognostic index (MIPI) for patients with advanced-stage mantle cell lymphoma. Blood. 2008; 111(2):558-65.

Other references

1. Hoster E, Klapper W, Hermine O, Kluin-Nelemans HC, Walewski J, van Hoof A, Trneny M, Geisler CH, Di Raimondo F, Szymczyk M, Stilgenbauer S, Thieblemont C, Hallek M, Forstpointner R, Pott C, Ribrag V, Doorduijn J, Hiddemann W, Dreyling MH, Unterhalt M. Confirmation of the mantle-cell lymphoma International Prognostic Index in randomized trials of the European Mantle-Cell Lymphoma Network. J Clin Oncol. 2014; 32(13):1338-46.

2. Lim SY, Horsman JM, Hancock BW. The Mantle Cell Lymphoma International Prognostic Index: Does it work in routine practice? Oncol Lett. 2010; 1(1): 187–188.

Specialty: Oncology

Objective: Risk Stratification

Type: Score

No. Of Variables: 6

Year Of Study: 2008

Abbreviation: MIPI

Article By: Denise Nedea

Published On: May 14, 2017

Last Checked: May 14, 2017

Next Review: May 14, 2023