Age
years
ECOG
0-1
Serum LDH
U/l
Upper normal limit of serum LDH
U/l
White Blood Cells
x 1000/µl
MIPI

MIPI Calculator (Mantle Cell Lymphoma International Prognostic Index)

By Łukasz Białek, MD and Dominika Miszewska

This MIPI calculator assesses the survival probability of a patient with advanced stage mantle cell lymphoma, based on the stage of the disease. By estimating a patient's chances of recovery, it is easier to choose the optimal treatment option.

If you have any questions or concerns, stay with us and read the following article, which explains the concepts of mantle cell lymphoma and non-Hodgkin's lymphoma. What causes lymphoma? What are the symptoms of lymphoma? You will find answers to these questions in the following paragraphs.

For more information on lymphomas, the most recent diagnostic methods and treatment, take a look at www.chloniak.org (available only in Polish), or at a research foundation/society based in your country.

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?

MIPI, short for the Mantle Cell Lymphoma International Prognostic Index, is an index created in 2008 based on the results of a study on 455 patients with advanced-stage MCL. This index classifies patients into three risk groups; in each group, there is a difference in their MCL non-Hodgkin's lymphoma survival rate:

  1. Low-risk, where the five-year survival was over 60%.
  2. Intermediate risk, in which the participants had a median survival of 51 months.
  3. High-risk, where the median survival rate was 29 months.

MIPI is a form of prognosis, which allows the optimal treatment method to be chosen for the patient. 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).

Mantle cell lymphoma at a glance

Let's start by explaining what is MCL and who is most affected by this disease? MCL stands for mantle cell lymphoma. It is a type of non-Hodgkin's lymphoma (NHL), which makes it a lymphatic system cancer. It originates in the lymphocytes, a type of blood cell. Mantle cell lymphoma develops when the body creates abnormal B-cells, which normally fight infections. MCL is quite rare, and, according to the American Cancer Society, there is up to 1 new case per 100,000 inhabitants a year.

Colorized scanning electron micrograph of a B cell from a human donor

Human B cell lymphocyte (NIAID, CC BY 2.0, flickr.com)

MCL is more likely to affect men than women (men are three time more likely to be affected by MCL), and is most common in people who are between the ages of 35 and 85. However, the median age of people with newly diagnosed MCL is 68 years. Being of white ethnicity also increases the risk of suffering from this type of lymphoma.

What causes lymphoma? It is not an inherited disease (but you are at a slightly higher risk if anyone in your family has had a lymphoma), and it's not infectious. Currently, doctors don't know the direct causes of MCL. This is unlike lung cancer, where smoking is responsible for as much as 80% of the cases. Yet, we still know some risk factors of MCL, some of which are:

  • Viral infections (such as Epstein-Barr virus, HIV, human T-lymphotropic virus type 1, human herpesvirus 6).
  • Environmental factors (exposure to pesticides, hair dyes).
  • Immunodeficiencies (both primary and secondary).

Non-Hodgkin's lymphoma symptoms

The main changes observed in patients with mantle cell lymphoma are not specific, and vary depending on the part of the body affected. However, there are some non-Hodgkin's lymphoma symptoms common to the whole group of these cancers:

  • Enlarged lymph nodes; may be superficial and palpable, or cause secondary symptoms due to the compression of internal organs, such as a cough or digestive problems.
  • Fever, if there are no other causes of elevated temperature, such as an infection.
  • Night sweats, especially if you need to change your pajamas during the night.
  • Weight loss, more than 10 % of your initial body weight - especially if your diet and appetite have remained unchanged.
  • Itchiness.
  • Fatigue.
  • In the case of MCL, enlarged tonsils, simulating tonsilitis may appear.

Diagram showing the lymph nodes where lymphoma most commonly develops

Diagram showing the lymph nodes lymphoma most commonly develops in (Cancer Research UK, CC BY-SA 4.0, wikimedia.org)

I've got those symptoms. What do I do?

First, keep calm. Make an appointment with you doctor and tell them about all the changes you've observed. There are many reasons for these symptoms - most of them are unrelated to cancer. If you have any past medical history, take the documentation with you too.

The final diagnosis is made by a doctor, usually a hematologist or oncologist, after the pathological evaluation of the suspected lymph node. Usually, you need to have a CT scan, a full blood test, and sometimes a bone marrow biopsy to determine whether or not there are any pathologic cells. Once the diagnosis becomes confirmed and staging is complete, the treatment can begin.

Recently there's been a lot of improvement in lymphoma treatment options. The doctor may suggest different approaches:

  1. Watchful waiting to see if the lymphoma grows slowly and there are no indications that aggressive treatment is required.

  2. Radiotherapy or irradiation, usually as a complement to chemotherapy.

  3. Chemotherapy, generally given intravenously, sometimes orally, as the primary therapy.

  4. Targeted therapies, such as monoclonal antibodies or kinase inhibitors.

MIPI - the basis of our calculator

In this MIPI calculator, you only need to complete five fields to get your result:

  1. Age.
  2. ECOG (Eastern Cooperative Oncology Group Performance Status); based on the performance status of the patient, allows the doctor to determine whether or not the patient will tolerate demanding treatment, such as chemotherapy. Each definition is assigned a score, which can be found in the brackets:
    • Asymptomatic, active without any restrictions (0)
    • Symptomatic but completely ambulatory; able to perform light activities (1)
    • Symptomatic, <50% in bed during the day (2)
    • Symptomatic, >50% in bed, but not bedbound; limited capacity of self-care (3)
    • Bedbound, completely disabled (4)
    • Dead (5)
  3. Serum LDH (lactic acid dehydrogenase); increased levels indicates tissue damage.
  4. The upper limit of local laboratory (ULN), where the blood was analyzed for serum LDH; often the upper limit is 160 U/l.
  5. WBC (white blood cells); for a normal adult these range between 4.3 and 10.8 x 103 cells/µl.

MIPI formula, if ECOG >1: MIPI = 0.03535 * age + 0.6978 + [1.367 * log10(LDH / ULN) + 0.9393 * log10(WBC)]

Otherwise the MIPI formula is: MIPI = 0.03535 * age + [1.367 * log10(LDH / ULN) + 0.9393 * log10(WBC)]

MIPI results interpretation

MIPI Risk Median overall survival
<5.7 Low Not reached (5 year survival: 60%)
5.7 - 6.2 Intermediate 51 months
≥6.2 High 29 months

The median overall survival is the time after which 50% of patients died, and 50% of them survived. Therefore, for the low risk category, the median overall survival was not achieved, as 60% of patients survived in the five following years. The MCL non-Hodgkin's lymphoma survival rate is essential in the prognostic assessment of the patient.

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 does not lack appetite and has not switched to a special diet. His wife took him to a doctor, who, based on his non-Hodgkin's lymphoma symptoms, 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 advanced mantle cell lymphoma. To find out what kind of treatment he qualifies for, and what are his chances in this battle, the physician used the MIPI calculator.

  • Age: 65 years
  • ECOG: Symptomatic but completely ambulatory (1)
  • Serum LDH: 2500 U/l
  • Upper limit at the local laboratory: 160 U/l
  • WBC:20 x 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 the high-risk group, where the median overall survival is 37 months.

Łukasz Białek, MD and Dominika Miszewska

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