This mantle cell lymphoma prognostic index (MIPI) score calculator stratifies patients into low, intermediate and high risk groups based on independent prognostic factors. In the text below the form there is information on the three obtainable results, the MIPI, sMIPI and MIPIb scores.
How does the mantle cell lymphoma prognostic index (MIPI) calculator work?
Mantle cell lymphoma accounts for 3 to 6% of all non Hodgkin lymphoma NHL occurrences.
This health tool provides malignancy risk stratification based on four or five patient parameters which are:
■ Age – is considered prognosis factor, the higher the patient age, the higher the risk of disease and adverse outcome.
■ LDH – lactic acid dehydrogenase – enzyme present in most body tissues with values above normal are marker of cell damage. Used in the diagnosis of lymphoma, anemia, liver and lung disease and in chemotherapy monitoring. Normal range is between 140 to 280 IU/L.
■ ECOG Performance Status – uses the result obtained in the Eastern Cooperative Oncology Group (ECOG) score which assesses the functional status of cancer patients.
■ White Blood Cells – also known as leukocyte count and measured in 109 cells/L, 103 cells/microliter or 103 cells/μL. Normal values vary between 4 and 11 x109 cells/L.
■ Ki67 – cellular marker protein (antigen Ki67) which is associated with cell proliferation. In the form the Ki67 is presented in percentage. This parameter is not compulsory for the MIPI and sMIPI calculations but is used in the MIPIb as explained further in this material.
The mantle cell lymphoma prognostic index calculator provides the MIPI score according to the below formula:
MIPI = [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 (x10^6).
The following table introduces the score ranges for MIPI, their risk groups and occurrence and also the median overall survival in months:
| MIPI Score | Disease risk | Percentage of patients | Median Overall Survival |
| <5.7 | Low | 44% | Not reached |
| 5.7 to <6.2 | Intermediate | 35% | 51 months |
| ≥6.2 | High | 21% | 29 months |
This lymphoma prognosis index is the first of its kind and has been derived from a clinical trial data set of 455 advanced stage MCL patients treated in series of clinical trials in Germany. Patients have been classified into the three risk groups based on the above presented four independent prognostic factors.
Subsequent studies have looked at validating MIPI and its derived scores.
There are also other tools that facilitate prognosis and treatment management in patients diagnosed with lymphoma, such as the FLIPI Calculator for Follicular Lymphoma or the International Prognostic Index (IPI) score.
Simplified MIPI
Beside the original MIPI there is also a simplified version (sMIPI), which appoints individual scores to the four prognostic factors described above. These component scores are summed to provide an overall result. This is used to stratify patient cases in three risk groups: low, intermediate and high, similar to the formula based model.
Subsequent studies have proved that not only s-MIPI facilitates calculation but has a similar prognostic performance to MIPI.
The following table introduces the range of possible patient parameters and the points awarded to each:
| 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 |
The s-MIPI results range between 0 and 11 and correlate with the following risk groups:
| Simplified MIPI | Lymphoma Risk |
| 0 - 3 | Low |
| 4 - 5 | Intermediate |
| 6 - 11 | High |
MIPIb (biological)
For cases in which testing is advanced and the Ki67 protein is known, a more detailed version of MIPI can be calculated, the MIPIb (biological).
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 table below presents the MIPIb scores and their correlated information:
| MIPIb Score | Disease risk | Percentage of patients | Median Overall Survival |
| <5.7 | Low | 28% | Not reached |
| 5.7 to <6.5 | Intermediate | 47% | 58 months |
| ≥6.5 | High | 25% | 37 months |
In the case of MIPIb, the cell proliferation index is also taken into account as a biological marker relevant for prognosis (with a κ=0.79 concordance). Another name of MIPIb is the Combined biologic index.
References
1) 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. (2008) A new prognostic index (MIPI) for patients with advanced-stage mantle cell lymphoma. Blood; 111(2):558-65.
2) 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. (2014) Confirmation of the mantle-cell lymphoma International Prognostic Index in randomized trials of the European Mantle-Cell Lymphoma Network. J Clin Oncol; 32(13):1338-46.
3) Todorovic M, Balint B, Andjelic B, Stanisavljevic D, Kurtovic NK, Radisavljevic Z, Mihaljevic B. (2012) Outcome prediction of advanced mantle cell lymphoma by international prognostic index versus different mantle cell lymphoma indexes: one institution study. Medical Oncology; (29)3, pp 2212–2219.
4) Hoster E, Rosenwald A, Berger F, Bernd HW, Hartmann S, Loddenkemper C, Barth TF, Brousse N, Pileri S, Rymkiewicz G, Kodet R, Stilgenbauer S, Forstpointner R, Thieblemont C, Hallek M, Coiffier B, Vehling-Kaiser U, Bouabdallah R, Kanz L, Pfreundschuh M, Schmidt C, Ribrag V, Hiddemann W, Unterhalt M, Kluin-Nelemans JC, Hermine O, Dreyling MH, Klapper W. (2016) Prognostic Value of Ki-67 Index, Cytology, and Growth Pattern in Mantle-Cell Lymphoma: Results From Randomized Trials of the European Mantle Cell Lymphoma Network. J Clin Oncol; 34(12):1386-94.
5) Lim SY, Horsman JM, Hancock BW. (2010) The Mantle Cell Lymphoma International Prognostic Index: Does it work in routine practice? Oncol Lett; 1(1): 187–188.
6) Hoos A, Stojadinovic A, Mastorides S, Urist MJ, Polsky D, Di Como CJ, Brennan MF, Cordon-Cardo C. (2001) High Ki-67 proliferative index predicts disease specific survival in patients with high-risk soft tissue sarcomas. Cancer; 92(4):869-74.
7) Velders GA, Kluin-Nelemans JC, De Boer CJ, Hermans J, Noordijk EM, Schuuring E, Kramer MH, Van Deijk WA, Rahder JB, Kluin PM, Van Krieken JH. (1996) Mantle-cell lymphoma: a population-based clinical study. J Clin Oncol; 14(4):1269-74.
01 Sep, 2016