CLL-IPI (chronic lymphocytic leukaemia prognostic index)

What is measured: prognosis in chronic lymphocytic leukaemia. How: CLL-IPI (2016) gives 4 points for del(17p) or TP53 mutation, 2 for unmutated IGHV, 2 for serum beta-2 microglobulin above 3.5 mg/L, 1 for Binet B or C (Rai I to IV) and 1 for age over 65, giving low (0 to 1), intermediate (2 to 3), high (4 to 6) and very high (7 to 10) risk with five-year survival of about 93, 79, 63 and 23 percent in the derivation data. Inputs: FISH for del(17p), TP53 sequencing, IGHV sequencing (under 98 percent identity to germline means mutated), serum beta-2 microglobulin and clinical staging. What a result changes: the score does not itself start treatment (the iwCLL criteria do); early-stage high-risk patients have been offered trials (CLL12 tested ibrutinib in early stage and delayed progression without improving survival); del(17p) or TP53 mutation rules out chemo-immunotherapy such as FCR for good, favouring continuous BTK inhibitors or venetoclax with obinutuzumab; unmutated IGHV predicts shorter remissions after fixed-duration therapy and is retested rarely because it does not change. Where it matters: CLL, treatment-naive.