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The prognostic index turns a handful of measurable factors into a risk group that helps your team plan treatment. This guide explains the International Prognostic Index (IPI), the FLIPI for follicular lymphoma, and — just as importantly — what the score does and does not tell you.
When you are newly diagnosed with lymphoma, one of the first questions is: what does this mean for my outlook? Doctors answer part of that question with a prognostic index — a simple scoring tool that combines a handful of measurable factors into a risk group. For aggressive non-Hodgkin lymphomas, that tool is the International Prognostic Index (IPI). For follicular lymphoma, a slow-growing type, the equivalent is the FLIPI (Follicular Lymphoma International Prognostic Index).
The idea is straightforward. Each index takes five factors that research has shown to matter, gives one point for each unfavourable factor, and adds them up. The total sorts patients into low, intermediate or high-risk groups. These groups help the care team judge how likely standard treatment is to work and how intensively to treat and monitor. Both NCCN and ESMO reference these indices in their lymphoma guidance.
One thing to hold onto from the start: a prognostic score is a population-level statistic, not a prediction about you as an individual. For the full picture of your diagnosis, see our Lymphoma hub and our Lymphoma Treatment in Hyderabad page.
The International Prognostic Index was first published in 1993 by an international group of investigators, who studied thousands of patients with aggressive non-Hodgkin lymphoma to find the factors that best predicted outcome. Because treatment has improved substantially since then, survival figures from the original index tend to understate what modern therapy can achieve — which is why your team interprets the score in today's context, not by decades-old numbers. (Source: The International Non-Hodgkin's Lymphoma Prognostic Factors Project, as referenced in NCCN and ESMO lymphoma guidelines.)
The IPI adds one point for each of these five adverse factors. A total of 0–1 is low risk, 2 is low-intermediate, 3 is high-intermediate, and 4–5 is high risk.
| Factor | Scores a point when… | Why it matters |
|---|---|---|
| Age | Over 60 years | Older age can affect how treatment is tolerated |
| Stage | Stage III or IV | Disease on both sides of the diaphragm or widely spread |
| Serum LDH | Above the normal range | A blood marker that often rises with more active disease — see what a high LDH means |
| Performance status | Score of 2 or more | Daily activities are noticeably limited |
| Extranodal sites | More than one | Lymphoma outside the lymph nodes in several places |
Risk groups and outcomes vary by individual; this table is a general guide. An age-adjusted version of the IPI is used for younger patients. Scoring follows the framework referenced in NCCN and ESMO guidance.
The right index depends on your lymphoma subtype. Using the tool built for your disease is what makes the risk group meaningful.
The International Prognostic Index is used for aggressive non-Hodgkin lymphomas such as diffuse large B-cell lymphoma. Its five factors are age, stage, LDH, performance status and number of extranodal sites. You can read more about outlook in aggressive disease on our DLBCL survival & prognosis page.
The FLIPI follicular index was built specifically for follicular lymphoma, an indolent (slow-growing) type. Its five factors are age over 60, advanced stage, more than four nodal areas involved, a raised LDH, and low haemoglobin (below 12 g/dL). FLIPI helps weigh active treatment against a period of watch-and-wait monitoring.
A later revision, FLIPI-2, keeps age, low haemoglobin and raised markers but adds bone-marrow involvement and the size of the largest lymph node. It was designed to reflect outcomes with modern treatment. Your team will tell you which version they are using.
Neither IPI nor FLIPI applies to Hodgkin lymphoma, which has its own advanced-stage prognostic score based on factors like age, stage, albumin, haemoglobin and blood counts. The principle — combining measurable factors into a risk group — is the same across all of them.
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Been given an IPI or FLIPI risk group and want to understand what it really means for your treatment? CION's lymphoma team will explain it plainly and review the results behind it.
The prognostic index is worked out after staging is complete but before treatment begins. To calculate it accurately, your team needs several results together:
Because the score depends on accurate staging and lab values, it is calculated by the specialist team — not from a home calculator. If you were given a score elsewhere, CION can review the underlying results as part of a free second opinion.
Understanding the limits of a prognostic index is as important as understanding the score itself.
A higher risk group may prompt your team to consider closer monitoring, a more intensive plan, or a clinical-trial option. But the index does not, on its own, select a specific regimen. Treatment is individualised at CION's multidisciplinary tumour board using your subtype, molecular markers, fitness and preferences. Questions about specific drug regimens are best answered on our treatment page.
Prognostic groups describe averages across many patients. Two people with the same IPI score can have very different journeys. Many people in a high-intermediate or high-risk group still reach complete remission and long-term control. Published series report, for example, Hodgkin lymphoma survival around 80–90% and diffuse large B-cell lymphoma around 60–70% at five years — but these figures vary by individual, subtype and treatment era, and are only a starting point per NCCN and ESMO data.
The score sets a baseline before treatment. As you move through therapy and follow-up, response on scans and blood tests matters more than the original number. Some teams re-apply an index at relapse to help re-plan. Ongoing monitoring is covered in our guides on recurrence risk & monitoring and follow-up & surveillance.
For follicular lymphoma, the FLIPI was created because the original IPI did not separate indolent-lymphoma patients well — most fell into the low-risk category, which was not clinically useful. FLIPI added low haemoglobin and number of nodal areas to better reflect how slow-growing disease behaves. It is a good reminder that a prognostic tool only works when it is matched to the right lymphoma subtype. (Source: FLIPI and FLIPI-2 studies, as referenced in NCCN and ESMO follicular lymphoma guidance.)
A prognostic index is deliberately simple — five factors, five points. But lymphoma outcomes are shaped by much more, and modern care leans heavily on the biology of the tumour:
This is exactly why CION treats the prognostic index as a conversation starter, not the final word. If your lymphoma is advanced or has been hard to control, our guide on living with advanced or hard-to-treat lymphoma may help, and our lymphoma specialists will talk you through your specific situation.
A prognostic score can feel alarming when it is handed over without explanation. A second opinion is especially worthwhile if:
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Start Your Story. Book Free Consultation.The IPI, or International Prognostic Index, is a simple scoring tool that helps estimate the likely outlook for aggressive non-Hodgkin lymphomas such as diffuse large B-cell lymphoma. It adds one point each for five factors: age over 60, an advanced stage (III–IV), a raised LDH level, poor performance status (how well a person copes with daily activities), and lymphoma found at more than one site outside the lymph nodes. The total score, from 0 to 5, sorts patients into low, intermediate or high-risk groups. It is a population-level guide referenced by NCCN and ESMO — not a prediction for any single person. Your care team uses it alongside scans, biopsy and molecular results to plan treatment.
Both are prognostic indices, but they were built for different lymphomas. The IPI (International Prognostic Index) is used for aggressive lymphomas like diffuse large B-cell lymphoma. The FLIPI (Follicular Lymphoma International Prognostic Index) was designed specifically for follicular lymphoma, an indolent (slow-growing) type. FLIPI uses five factors too — age over 60, advanced stage, more than four nodal areas involved, a raised LDH, and low haemoglobin (below 12 g/dL). A later version, FLIPI-2, swaps in factors such as bone-marrow involvement and lymph-node size. Because follicular lymphoma behaves so differently from aggressive disease, using the right index for the right subtype matters. Learn more about our lymphoma treatment approach.
The IPI adds one point for each adverse factor. Age > 60 reflects that older patients often tolerate treatment differently. Stage III–IV means the lymphoma is on both sides of the diaphragm or has spread widely. A raised LDH is a blood marker that often rises when disease is more active — read more about what a high LDH means. Performance status of 2 or more means daily activities are limited. More than one extranodal site means lymphoma outside the lymph nodes in several places. A score of 0–1 is low risk, 2 is low-intermediate, 3 is high-intermediate, and 4–5 is high risk. These groupings guide discussion, not destiny.
The score helps your team judge how likely standard treatment is to control the lymphoma, and whether a more intensive plan or a clinical-trial option should be discussed. For aggressive lymphoma, a higher IPI may prompt closer monitoring and consideration of additional strategies; for follicular lymphoma, FLIPI helps weigh active treatment against a period of watch-and-wait monitoring. Importantly, the score does not, on its own, choose your drugs — treatment is individualised at CION's multidisciplinary tumour board using your stage, subtype, molecular markers, fitness and preferences. NCCN and ESMO both stress the index is one input among many. We explain your score plainly so you understand where you stand.
No. A higher score signals that the lymphoma may be harder to control with standard treatment, but it is a statistic drawn from large groups of patients — it cannot tell you your individual outcome. Many people with a high-intermediate or high IPI still achieve complete remission and long-term disease control. Modern treatment has also improved outcomes well beyond the era when the original index was created, so older survival figures tend to understate today's results. The score is most useful as a planning tool: it helps your team decide how closely to monitor and whether to consider more intensive or trial-based options. Figures always vary by individual.
The index is worked out after staging is complete but before treatment starts, once your team has the results of your biopsy, blood tests (including LDH and, for FLIPI, haemoglobin), a PET-CT or CT scan and, where relevant, a bone-marrow examination. It sets a baseline for the conversation about outlook and intensity of treatment. Some centres also use it at relapse to help re-plan. Because it depends on accurate staging and lab values, it is calculated by the specialist team, not from a home calculator. If you have already been given a score elsewhere, our team can review the underlying results as part of a free second opinion.
Not directly. The classic IPI and FLIPI were developed for non-Hodgkin lymphomas. Hodgkin lymphoma has its own tools — for advanced-stage disease, doctors often use a separate Hodgkin-specific prognostic score based on factors such as age, stage, albumin, haemoglobin, white-cell counts and sex. The principle is the same across all these indices: combine a handful of measurable factors into a risk group that guides how intensively to treat and how closely to monitor. Whichever index applies to your subtype, it is only a starting point for a personalised plan. Explore the full picture on our lymphoma hub or ask about your specific type via a specialist consultation.
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