The MIPI calculator assesses the risk group of a patient struggling with mantle cell lymphoma (MCL) when diagnosed. The MIPI prognostic index allowed the estimation of the life expectancy of patients treated according to the standard procedure, which was at the time of its creation immunochemotherapy. Currently, targeted therapies or modern methods of immunotherapy have become the most advanced method of treatment, which allowed to improve the prognosis of patients significantly.
Keep in mind that the statistics we used to create this calculator do not apply to individual cases. A patient with a 90% chance of remission can still die from the disease, and a patient with a calculated risk of 90% of not surviving a year will enjoy a long life. However, this calculator allows an initial assessment of the patient's prognosis and basic determination of the severity of the disease.
We try our best to make our Omni Calculators as precise and reliable as possible. However, this tool is never a substitute for a professional medical evaluation. If any health condition bothers you, please consult your doctor.
What is MIPI?
IPI, short for the Mantle Cell Lymphoma International Prognostic Index, based on the results of a study on 455 patients with advanced-stage MCL. MIPI allows to divide patients into three groups depending on the risk factors identified in the diagnosis of the disease:
- Low-risk patients with a five-year survival of over 60%.
- Intermediate risk patients with a median survival of 51 months.
- High-risk patients with the median survival rate of 29 months.
MIPI is a form of a prognosis that allows the patient's optimal treatment method to be chosen. For this index, you need to know four independent variables: age, ECOG (Eastern Cooperative Oncology Group Performance Status), serum LDH levels, and WBC (white blood cells).
What risk factors are part of the MIPI?
To calculate the MIPI, it is necessary to know four independent risk factors:
- Patient Performance Scale by ECOG (Eastern Cooperative Oncology Group Performance Status). It allows us to determine whether the patient will tolerate demanding treatment. EEach definition is assigned a score, which can be found in the brackets:
- Patient has no symptoms of the disease, active without any limitations (0)
- Symptoms of the disease are present but allow light work (1)
- Patient can no longer work, but does not require the care of another person for personal activities, spends less than 50% of the day in bed (2)
- The patient needs temporary assistance from another person, limited ability to perform personal activities, spends more than 50% of the day in bed (3)
- The patient requires constant care of another person, spends the whole day in bed (4)
Serum LDH (lactic acid dehydrogenase); increased activity indicates tissue damage. Due to differences in methods of determining LDH activity, it is also necessary to know the upper limit of the LDH standard in the local laboratory (ULN) where the blood was tested; often, the limit is 160 U/l.
The number of white blood cells (WBC); for a normal adult these range between 4.3 and 10.8 * 10³ cells/µl.
How do you calculate the MIPI?
There are two MIPI formulas.
If the ECOG is greater than 1, use:
MIPI = 0.03535 * age + 0.6978 + [1.367 * log10(LDH / ULN) + 0.9393 * log10(WBC)],
MIPI = 0.03535 * age + [1.367 * log10(LDH / ULN) + 0.9393 * log10(WBC)].
MIPI results interpretation
The median total survival is the time after which 50% of patients died, and 50% of them survived. Therefore, if low-risk is calculated, the median survival rate is not achieved, as 60% of patients survived in the five following years.
The patient also should have calculated the proliferative activity of lymphoma cells. Indirectly, it is determined based on the percentage of Ki67 positive cells, and in such case, the so-called MIPIb is used, which is more accurate than the basic MIPI.
How to use the MIPI calculator?
This MIPI calculator is easy to use; take a look at an example to understand how our calculator works in practice.
Steven is a 65-year-old man who's been having a fever for a few days for no apparent reason. He's also been sweating at night for the past few weeks, to such an extent that he had to change his pajamas. Steven has also lost a lot of weight, even though he doesn't lack appetite and has not switched to a special diet. His wife took him to a doctor, who almost immediately referred him to an oncologist. The specialist ordered several additional blood tests, a bone marrow biopsy, and a CT scan. It turned out that Steven is suffering from mantle cell lymphoma. His risk was calculated according to MIPI:
- Age: 65 years
- ECOG: The symptoms of the disease are present, but Steve can perform light work (1)
- Serum LDH: 2500 U/l
- Upper LDH limit at the local laboratory: 160 U/l
- White blood cells (WBC): 20 * 10³ cells/µl
MIPI = 0.03535 * 65 + 0.6978 + [1.367 * log10(2500 / 160) + 0.9393 * log10(20 x 103)]
MIPI = 7.97
Steven is in a high-risk group. It means that if 100 or 1000 patients with such risk factors were to be assessed, the median survival rate would be 37 months. This result does not apply directly to Steve. In a group of 100 or 1000 patients, some would be in good health after ten years, while some would die in the first months of treatment.
Moreover, the use of targeted therapies, such as Bruton kinase inhibitors (effective in recurrent/resistant cases), would additionally extend the life expectancy.