MDCalc

Central Nervous System International Prognostic Index (CNS-IPI)

Predicts relapse in the CNS in patients with diffuse large B-cell lymphoma (DLBCL).

Age >60 years

LDH > normal

The upper limit of normal varies by institution and was not further defined in the original study. Please follow your local lab ranges.

ECOG Performance Status >1

Ann Arbor stages III or IV

>1 extranodal disease site

Disease in bone marrow, CNS, liver/GI tract, or lungs

Kidney and/or adrenal gland involvement

Result:

Please fill out required fields.
Advice

The CNS-IPI should not be the sole determinant of management; it should be used alongside clinical judgment, individual patient factors, and expert consultation to guide decision-making.

Management
  • Low- or intermediate-risk (score <4): Routine CNS prophylaxis and diagnostics are not typically indicated; proceed with standard treatment protocols.
  • High-risk (score ≥4): 
    • Consider incorporating CNS-directed prophylaxis (e.g., intrathecal chemotherapy, high-dose methotrexate) into remission induction therapy.
    • Follow institutional protocols, as CNS prophylaxis strategies vary.
    • CNS imaging or lumbar puncture may be considered to evaluate for subclinical disease.
Critical Actions

Further diagnostic evaluation, including CNS imaging or cerebrospinal fluid analysis, is warranted for patients with abnormal neurologic findings, regardless of CNS-IPI results.

Have feedback about this calculator?