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    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
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    Patent Pending

    International Prognostic Index for Chronic Lymphocytic Leukemia (CLL-IPI)

    Stratifies patients with chronic lymphocytic leukemia into four risk categories.
    When to Use
    Pearls/Pitfalls
    Why Use

    Patients with new diagnosis of chronic lymphocytic leukemia (CLL), to estimate prognosis and time to first treatment.

    • Developed using patient data from before use of targeted agents such as ibrutinib and venetoclax, which are known to have greater efficacy in patients with TP53 alterations.
    • While treatment type was not an independent factor in the CLL-IPI, TP53 status was, and thus the use of novel agents may have an effect not currently measured in the CLL-IPI.

    Many patients with CLL will have an indolent course and not require treatment for many years, while others will have a shorter time to first treatment. The CLL-IPI combines clinical, laboratory and genetic risk factors into a single score that can be used to help estimate time to first treatment as well as overall survival.

    ≤65 years
    0
    >65 years
    +1
    Binet A or Rai 0
    0
    Binet B-C or Rai I-IV
    +1
    ≤3.5
    0
    >3.5
    +2
    Mutated
    0
    Unmutated
    +2
    No abnormalities
    0
    Deletion 17p (FISH) and/or TP53 mutation (sequencing)
    +4

    Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. Michael Hallek

    From the Creator

    Why did you develop the CLL-IPI? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?

    We developed the CLL-IPI because we realized that the clinical staging systems did not separate high risk patients well enough in the era of new therapies (chemoimmunotherapies) (Pflug et al, Blood 2014).

    What pearls, pitfalls and/or tips do you have for users of the CLL-IPI? Do you know of cases when it has been applied, interpreted, or used inappropriately?

    The score should be applied for prognostication but not for determining treatment indication. As of today, indication for treatment is determined by symptoms of disease (and sometimes clinical staging).

    What recommendations do you have for doctors once they have applied the CLL-IPI? Are there any adjustments or updates you would make to the score based on new data or practice changes?

    The CLL-IPI will be evaluated in the era of novel targeted agents to see whether it applies for patients treated with agents such as ibrutinib, idelalisib, or venetoclax.

    How do you use the CLL-IPI in your own clinical practice? Can you give an example of a scenario in which you use it?

    I use it for all CLL patients.

    Any other research in the pipeline that you’re particularly excited about?

    I am excited about the potent therapeutic efficacy of novel agents in CLL, and by studies of clonal evolution of CLL under targeted therapies, as well as strategies to prevent it.

    About the Creator

    Michael Hallek, MD, is an internist specializing in hematology and oncology in Cologne, Germany. He also serves as chair of the internal medicine department at the University of Cologne and director of the Center for Integrated Oncology. Dr. Hallek's primary research interests include the development of specific molecular therapies for leukemia.

    To view Dr. Michael Hallek's publications, visit PubMed

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    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
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