EOD Home NCCN International Prognostic Index (IPI) NCCN International Prognostic Index (IPI) Notes **Note 1:** Physician statement of NCCN IPI must be used to This international prognostic index (IPI) score calculator for lymphoma prognosis stratifies survival rates based on risk factors in the original and revised IPI Age adjusted ipi calculator. Stage-adjusted IPI divides the early stage (I or II) patients into low-risk (0 or 1) and high-risk group (2 to 4) through age, ECOG
The CNS-IPI was derived from a population of patients (n=2164) enrolled in the German clinical trials and subsequently validated in a population of 1597 patients The NCCN-IPI outperformed the IPI in both cohorts, with a higher CPE in discrimination (NCCN cohort: 0.80 vs 0.74; BCCA cohort: 0.77 vs 0.74) and better global For patients treated in clinical trials, the simultaneous calculation of NCCN-IPI and IPI may be optimal to allow comparison of outcomes with data acquired from The analysis included a total of 2,124 patients with newly diagnosed DLBCL from whom data were available to calculate the IPI, R-IPI, and NCCN-IPI scoring
In the text below the calculator there is more information about the two versions of the score, the original and the revised one. The international prognostic index FLIPI is designed to be used in patients with follicular lymphoma and to risk stratify patients based on prognosis. This can help guide when and how to treat such
The NCCN-IPI had the greatest absolute difference in OS estimates between the highest- and lowest-risk groups and best discriminated OS (concordance index = 0.632 vs NCCN International Prognostic Index (IPI) Note 1: Physician statement of NCCN IPI must be used to code this data item. Do not calculate points or assign risk Therefore, the NCCN-IPI remains the most important prognostic tool in this disease. Prognostic superiority of the National Comprehensive Cancer Network International NCCN-IPI for more accurate prognostication in the elderly. Albumin and b 2-microglobulin levels are likely to add signiﬁcant information to the NCCN-IPI. Keywords:
The NCCN-IPI includes the same factors as the IPI, but introduces weighted categorization with respect to age and lactate dehydrogenase in serum, and includes
Diffuse Large B-cell Lymphoma Prognosis (NCCN-IPI) DIPSS Plus Score for Prognosis in Myelofibrosis; Multiple Myeloma Prognosis (R-ISS) CLL-IPI; CNS International e19251. Background: NCCN-IPI is a prognostic scoring system that outperforms other risk classification mechanisms in diffuse large B-cell lymphoma (DLBCL) but does not We aimed to establish a predictive prognostic risk-stratification model for diffuse large B-cell lymphoma (DLBCL) in the rituximab era. The data of 1406 primary DLBCL El-Galaly TC et al. Outcome prediction by extranodal involvement, IPI, R-IPI, and NCCN-IPI in the PET/CT and rituximab era: A Danish-Canadian study of 443 patients with diffuse-large B-cell lymphoma. Am J Hematol. 2015; 90(11):1041-6. Other references. 1. Olszewski AJ, Winer ES, Castillo JJ Age adjusted ipi calculator. Stage-adjusted IPI divides the early stage (I or II) patients into low-risk (0 or 1) and high-risk group (2 to 4) through age, ECOG score, LDH and extranodal involvement. However, in 14 patients with adequate data to obtain accurate stage-adjusted IPI, there was no statistical difference in time to progression between the low-risk group and the
. The International Prognostic Index Calculator provides the prognostic scores for individual patients based on risk factors such as age, ECOG performance status, and others. NCCN Guidelines on Diffuse Large B-Cell Lymphoma. This interactive PDF offers a patient-centric breakdown of the NCCN Guidelines for B-Cell Lymphomas, including DLBCL. The. NCCN-IPI was of highly prognostic value in the analyzed group (p<0.0001). Survival analysis showed that ALC>1.1x109/L, EFS was calculate as the time from diagnosis until the last follow up point for event (relapse) for alive patients (January 2015) or death. The treatment response was evaluated according to the previously reported response . NCCN-IPI.
nccn ipi dlbcl calculator. September 25, 2020 Kick-off is 3pm at The Hawthorns on Saturday 1st February. Below the text is a list of the direct games. — West Bromwich Albion (@WBA) August 15, 2019. They have won the FA Cup five times, the most recent being 1968. analyse how the website is used and advertising that To do this click on the cookie settings button below. Semi Ajayi (West. For patients treated in clinical trials, the simultaneous calculation of NCCN-IPI and IPI may be optimal to allow comparison of outcomes with data acquired from previous trials in identical risk groups. For all other patients, continued use of the IPI seems acceptable, because differences between the NCCN-IPI and the IPI will not result in differing treatment decisions for the vast majority of. The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 31 leading cancer centers devoted to patient care, research, and education, is dedicated to improving and facilitating quality, effective, efficient, and accessible cancer care so that patients can live better lives. NCCN offers a number of programs to give clinicians access to tools and knowledge that can help. . Aufgrund seiner Komplexität hat er sich bisher nicht allgemein durchgesetzt. 4.4.2 Knochenmarkbefall. Einer retrospektiven Untersuchung zufolge stellt die großzellige (konkordante) Knochenmarkinfiltration einen vom Internationalen Prognostischen Index unabhängigen Risikofaktor dar . Dies gilt.
It's been stressful because I have to worry about still having to help my dad, I have to give him rent money every month, and then I still have to pay off this loan and I don't get that much of a check, you know. dad (plural dads) A lump or piece. birth mother In this regard, advanced age and thrombosis history were used to assess this risk. More recently, JAK2V617F and cardiovascular (CV) risk factors were identified as additional modifiers, leading to the development of a 3-tiered International Prognostic Score of Thrombosis for ET (IPSET-thrombosis): low, intermediate, and high In recent years, the International Prognostic Index (IPI) has been the main prognostic model used for patients with DLBCL. The model incorporates several clinical and demographic parameters, such as age, disease stage, and performance status, to estimate survival and individualize treatment. Adjusted versions, including the National Comprehensive Cancer Network-IPI (NCCN-IPI) and the revised.
NCCN-IPI calculator (QxMD) CNS IPI (QxMD) Key references. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues, revised 4th edition, Swerdlow SH, Campo E, Harris NL, et al. (Eds), International Agency for Research on Cancer (IARC), Lyon 2017; Oken M et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Clinical Problem: Issues with NCCN-IPI § Given that near half of DLBCL patients present with advanced disease (Stage III/IV), a disease specific prognostic model is needed § Older age and ECOG may be a poor prognostic factors as a result of inability to tolerate chemotherapy § Lactate Dehydrogenase (LDH) is a non-specific biomarker § The majority of relapses in DLBCL occur within the first. We applied 4 prognostic indices: IPI, R-IPI, NCCN-IPI and GELTAMO-IPI. Survival was studied using the Kaplan-Meyer method and the survival curves were compared with the Log-Rank test. The Cox method was used to calculate the Hazard ratio. Results. Table 1 shows the main prognostic characteristics at diagnosis in our group of patients PDF | The study included 1848 diffuse large B-cell lymphoma (DLBCL)patients treated with chemotherapy/rituximab. The aims were to validate the National... | Find.
Lies Rezensionen, vergleiche Kundenbewertungen, sieh dir Screenshots an und erfahre mehr über IP Calculator. Lade IP Calculator und genieße die App auf deinem iPhone, iPad und iPod touch Download Calculate by QxMD and enjoy it on your iPhone, iPad, and iPod touch. From the developer of 'Read by QxMD', 'The ECG Guide' and 'Pedi STAT' comes 'Calculate', a next-generation clinical calculator and decision support tool, freely available to the medical community
Independent Prognostic Value of Serum Markers in Diffuse Large B-Cell Lymphoma in the Era of the NCCN-IPI Authors: Thomas Melchardt calculation and Youden index analysis for OS. Results. Patient Characteristics. We included 515 patients consecutively diagnosed with DLBCL treated between 2004 and January 2014 in this retrospective analysis . In detail, the mean age of the whole cohort was. We aimed to establish a predictive prognostic risk-stratification model for diffuse large B-cell lymphoma (DLBCL) in the rituximab era. The data of 1406 primary DLBCL patients from the Sun Yat-Sen. Calculate, ein klinischer Rechner der nächsten Generation. Vom Entwickler von Read by QxMD, The ECG Guide und Pedi STAT kommt Calculate, ein klinischer Rechner der nächsten Generation und ein Entscheidungshilfe-Tool, das der medizinischen Fachwelt kostenlos zur Verfügung steht
01.06.2015 | Letter to the Editor | Ausgabe 6/2015 Validation of an enhanced International Prognostic Index (NCCN-IPI) in an Asian cohort of patients with diffuse large B cell lymphom Download Citation | Prognostic prediction of diffuse large-B-cell lymphoma with international index (IPI) and enhanced NCCN-IPI | Purpose: We aimed to evaluate the performance of International. Moreover, the combination of TLG and the NCCN-IPI improved patient risk stratification and might help personalize therapeutic regimens. Will Baseline Total Lesion Glycolysis Play a Role in Improving the Prognostic Value of the NCCN-IPI in Primary Gastric Diffuse Large B-Cell Lymphoma Patients Treated With the R-CHOP Regimen? Clin Nucl Med. 2021 Jan;46(1):1-7. doi: 10.1097/RLU.0000000000003378. The NCCN-IPI is based on the same five parameters that are included in the IPI, the difference being how extranodal sites are regarded: the NCCN-IPI does not include the number of extranodal sites, but selects a group of distinct extranodal involvement sites, such as the bone marrow, central nervous system (CNS), liver, gastrointestinal tract, and lungs * It was impossible to calculate p-value because two cells have more than 20 subjects in the reclassification table. IPI, International Prognostic Index; NCCN, National Comprehensive Cancer Network; GELTAMO, Grupo Español de Linfomas/Trasplante Autólogo de Médula Ósea. Go to: DISCUSSION. In the present study, the NCCN- and GELTAMO-IPI, the revised versions of the IPI that feature enhanced.
Takeaway. A newly developed IPI, known as the IPI24, calculates the probability of an individual patient with diffuse large B-cell lymphoma achieving 24 month's event-free survival with superior discriminatory ability vs the IPI and the NCCN-IPI nach der amerikanischen Stadt Ann Arbor Englisch: Ann Arbor staging. 1 Definition. Die Ann-Arbor-Klassifikation dient der Stadieneinteilung von Hodgkin- und Non-Hodgkin-Lymphomen.Das Tumorstadium bei Diagnosestellung stellt den wichtigsten prognostischen Faktor der Erkrankung dar, denn die Zahl der befallenen Lymphknotenregionen beeinflusst sowohl die Remissionsdauer als auch das Gesamtüberleben e19251. Background: NCCN-IPI is a prognostic scoring system that outperforms other risk classification mechanisms in diffuse large B-cell lymphoma (DLBCL) but does not consider the molecular profile of patients. We evaluated the predictive value of NCCN-IPI and clinically relevant molecular markers on the overall survival (OS) of patients with diagnosed DLBCL in real-world data (RWD)
Comparing survival curves, NCCN‐IPI discriminated better than IPI, separating four risk groups with 5‐year overall survival rates of 93%, 83%, 67% and 49%, but failing to identify a true high‐risk population. For the second aim the series was split into training and validation cohorts: in the former the multivariate model identified age, lactate dehydrogenase, Eastern Cooperative. There were no correlations between tumor necrosis status at CT and the NCCN-IPI factors categorized age ρ (ECOG) performance status score of each patient were recorded, at time of diagnosis, in order to calculate an NCCN-IPI score, as described previously . The four NCCN-IPI risk groups (low [scores 0-1], low-intermediate [scores 2-3], high-intermediate [scores 4-5] and high [scores.
. Thus, the present study aimed to develop a modified prognostic model (M‑PM) to identify high‑risk. Antic et al evaluated the impact of comorbidities on the NCCN-IPI in pateints with diffuse large B-cell lymphoma. The authors are from Clinical Center of Serbia, University of Belgrade, Clinical Center Nis and Clinical Hospital Center Bezanijska Kosa CONCLUSION: MTV and TLG at baseline and in the interim and NCCN-IPI correlate with disease prognosis. SUVmax related parameters hare no significant relationship with prognosis. Besides MTV and TLG during treatment are the independent prognostic risk factors suggesting more predictive value than NCCN-IPI. PMID: 30295248 [Indexed for MEDLINE. NCCN‑IPI, which served as an effective tool for identifying patients with DLBCL at high risk of an adverse prognosis. Introduction Diffuse large B‑cell lymphoma (DLBCL) is one of the most common subtypes of Non‑Hodgkin's lymphoma (NHL) in adults, accounting for ~30% of NHLs (1). DLBCL has significant heterogeneity in clinical manifestations, biological characteristics, and prognosis (2. We have been hosting at Silver Maple House Concerts since September 5, 2009, when Brigitte London brought the house concerts concept into our world. We have..
Lies Rezensionen, vergleiche Kundenbewertungen, sieh dir Screenshots an und erfahre mehr über Calculate by QxMD. Lade Calculate by QxMD und genieße die App auf deinem iPhone, iPad und iPod touch Diffuse Large B-cell Lymphoma Prognosis (NCCN-IPI) DIPSS Plus Score for Prognosis in Myelofibrosis; Multiple Myeloma Prognosis (R-ISS) CLL-IPI; CNS International Prognostic Index in Diffuse Large B-Cell Lymphoma (CNS-IPI) MALT Lymphoma prognosis (MALT-IPI) Khorana risk score; CLL BALL Score for Relapsed/Refractory CL
Validation of the NCCN-IPI and the GELTAMO-IPI for Diffuse Large B-Cell Lymphoma Treated With R-CHOP Leukemia and Lymphoma . Save Recommend Share . Facebook Twitter Print Email ×. You must be a member to content. Already Have An Account? Log in Now. Join PracticeUpdate Now. The nomogram showed superior discrimination ability for predicting 5-year PFS and OS rates compared with NCCN-IPI (c index 0.78 vs. 0.75 and 0.79 vs. 0.75, respectively). CONCLUSIONS. High NLR was associated with poor treatment response and worse PFS and OS in DLBCL. The nomogram developed from NCCN-IPI-based variables and NLR may help the clinicians to predict the prognosis individually in. In the current study, the Kaplan-Meier curves for PFS and OS were plotted with 2 subgroup stratification based on IPI and NCCN-IPI, respectively, and patients in the 2 NCCN-IPI groups showed a distinctive clinical outcome (PFS: HR 3.219, P = 0.001; OS: HR 3.515 P = 0.002), whereas patients subcategorized by the IPI exhibited a less discriminatory survival pattern (PFS: HR 2.891, P = 0.002. The International Prognostic Index (IPI) has been used for decades in diffuse large B‐cell lymphoma (DLBCL). A retrospective cancer registry analysis in North America showed significantly improved results when an enhanced IPI, the National Comprehensive Cancer Network (NCCN)‐IPI was applied. This novel score puts more weight on age and high levels of lactate dehydrogenase (LDH)
Voimassa!1.10.2017-31.12.2018;Päivitetty!28.9.2017!SLeppä! 1! Suomen'lymfoomaryhmä' ' Työryhmä:'SirpaLeppä,Anniki'Aromaa8Häyhä,Micaela'Hernberg. Keywords: diffuse large B-cell lymphoma, F-18-fluoro-2-deoxy-d-glucose positron emission tomography, computed tomography, National Comprehensive Cancer Network International Prognostic Index, prognosis, survival, total lesion glycolysis, POSITRON-EMISSION-TOMOGRAPHY, PREDICTOR, IPI, Journal Article, Research Support, Non-U.S. Gov'
'Calculate', uma calculadora clínica de ponta. Da desenvolvedora de 'Read by QxMD', 'The ECG Guide' e 'Pedi STAT' vem 'Calculate', uma calculadora clínica de ponta e ferramenta de suporte a decisões, gratuitamente disponível para a comunidade médica serum albumin is a strong predictor of survival in patients with diffuse large b cell lymphoma treated with r-cho calculate the IPI, R-IPI, and NCCN-IPI. Results: Patients' median age was 58.9 years (range 16-86); 85 (57.8%) were female. According to IPI, risk categories were low (n=41, 28.1%), low-intermediate (n=43, 29.5%), high-intermediate (n=37, 25.3%), and high (n=25, 17.1%). Using R-IPI, risk categories were very good (n=19, 13%), good (n=65, 44.5%), and poor (n=62, 42.5%). According to NCCN-IPI. All FDG-avid lesions in each patient were segmented using semi-automated software to calculate whole-body SUVmax, whole-body MTV, and whole-body TLG values. Cox regression analyses were used to determine the associations of whole-body SUVmax, whole-body MTV, whole-body TLG, and dichotomized National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) risk group (low risk vs. . ASCO develops and publishes clinical practice guidelines, provisional clinical opinions (PCOs), and guideline endorsements, providing evidence-based recommendations to serve as a guide for doctors and outline appropriate methods of treatment and care. The guidelines can also address specific clinical situations.
FDG-avid lesions in each patient were segmented to calculate the SUVmax, total metabolic tumor volume (TMTV), and TLG. Progression-free survival (PFS) and overall survival (OS) were used as end points to evaluate prognosis. During the follow-up period of 5 to 108 months (35.3 ± 23.5 months), high TLG and a high NCCN-IPI were significantly associated with poor PFS and OS. Total lesion. FDG-avid lesions in each patient were segmented to calculate the SUV max, total metabolic tumor volume (TMTV), and TLG. Progression-free survival (PFS) and overall survival (OS) were used as end points to evaluate prognosis. Results . During the follow-up period of 5 to 108 months (35.3 ± 23.5 months), high TLG and a high NCCN-IPI were significantly associated with poor PFS and OS. Total. Basic Calculator Developed by the International Working Group for the Prognosis of MDS (IWG-PM) under the aegis of the MDS Foundation, Inc. When entering values into the calculator, note the units given in parentheses. Also note that the usual ranges, given for orientation, are in brackets. These are not normal ranges. Variables (units) [usual range] Value. Hemoglobin (g/dL) [4-20] A possible. Lymphoma (NCCN-IPI, IPI24, R-IPI). Myelodysplastic Syndrome (IPss-R, WPss). Myeloma (Iss, R-Iss). Hemodialysis. COPD (Bode). Pancreatitis (BISAP, Ranson's). Cardiac surgery (Euroscore II. From the developer of 'Read by QxMD', 'The ECG Guide' and 'Pedi STAT' comes 'Calculate', a next-generation clinical calculator and decision support tool, freely available to the medical community. We recommend medical users try the free Calculate by QxMD first... -from iMedicalApps review The best free Medical Calculator apps for the iPhone.
The International Prognostic Index (IPI) and its subsequent revisions [Revised‐IPI (R‐IPI)] and National Comprehensive Cancer Network IPI (NCCN-IPI) remain the most useful prognostications for DLBCL. These scoring systems were based on similar factors: patient age, Eastern Cooperative Oncology Group (ECOG) performance status (PS), Ann Arbor stage, serum lactate dehydrogenase (LDH), and. The most commonly validated models used for prognostication as well as for the comparison with other novel models were IPI, R-IPI, and NCCN-IPI. 24 Among these, NCCN-IPI had the highest performance values, although the performance of models based on nomograms was superior to the NCCN-IPI. However, these models are relatively new and have not been validated in other study populations
Zhou Z, Sehn LH, Rademaker AW, et al. An enhanced International Prognostic Index (NCCN-IPI) for patients with diffuse large B-cell lymphoma treated in the rituximab era. Blood 2014; 123:837. Scott DW, Mottok A, Ennishi D, et al. Prognostic Significance of Diffuse Large B-Cell Lymphoma Cell of Origin Determined by Digital Gene Expression in Formalin-Fixed Paraffin-Embedded Tissue Biopsies. J. A new prognostic model using the NCCN-IPI and neutrophil-to-lymphocyte ratio in diffuse large B-cell lymphoma. Tumori. 2018;104(4):292-299 30. Zhong H, Chen J, Cheng S. et al. Prognostic nomogram incorporating inflammatory cytokines for overall survival in patients with aggressive non-Hodgkin's lymphoma. EBioMedicine. 2019;41:167-174 31
Our NCCI tool provides steps you can take to prevent these NCCI denials: First, know if NCCI edits apply to the services you are submitting. Search for coding pairs by entering your major procedure code. The search results show coding pair lists entitled Column I or Column II. Codes are designated as Column I or Column II codes CNS relapsin riski on keskimäärin 5% luokkaa, IPI 0-2 ryhmässä 1% ja IPI 3-5 taudissa 12%. Korkean IPI:n lisäksi CNS relapsin riski on erityisen suuri potilailla, joilla on BCL2 ja MYC uudelleenjärjestymät (Double hit lymfoomat), kives-, lisämunuais- tai munuaisaffisio [30, 31]. Yhdistämällä kliininen CNS-IPI luokitus [31
Calculate by QxMD APP | 下載安裝蘋果 iOS / 安卓 Android 手機 APP；From the developer of 'Read by QxMD', 'The ECG Guide' and 'Pedi STAT' comes 'Calculate', a next-generation clinical calculator and decision support tool, freely available to the medical community. We recommend medical users try the free Calculate by QxMD first... -from iMedicalApps review The best free Medical. recorded, at time of diagnosis, in order to calculate an NCCN-IPI score, as described previously . The four NCCN-IPI risk groups (low [scores 0-1], low-intermediate [scores 2-3], high-intermediate [scores 4-5] and high [scores 6-8]) were then dichotomized into low risk (including low and low-intermediate risk) and high risk (including high-intermediate and high risk) groups. 2.5.
The NCCN‐IPI identified a group of patients with a 2‐year OS <50%, but this was not the case for the IPI and R‐IPI (Fig. 1). Figure 1. Estimated survival probability over the first 7.5 years postdiagnosis shown as Kaplan-Meier curves for the different risk groups defined by the International Prognostic Index (IPI), Revised IPI (R‐ IPI), and National Comprehensive Cancer Network IPI. The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN . Calculation of International Prognostic Index (IPI) USEFUL IN SELECTED CASES: Neck CT, head CT, or MRI Discussion of fertility issues and sperm banking HIV Lumbar puncture, consider if paranasal sinus, testicular, epidural, bone marrow with large cell lymphoma, HIV. NCCN-IPI (p = 0.004; likelihood ratio). Median overall survival was not reached. Survival rates at 1 and 2 years were 75.8% and 73.2%, respectively. Using multivariate analysis, higher NCCN-IPI score was significantly associ-ated with higher risk of death. Adjusted hazard ratio of NCCN-IPI score was 10.44 (95%CI: 1.27-86.06) for hig Aplikácie pre smartphones a i. Calculate by QxMD. Epocrates - liekové interakcie, kalkulačky, prevody jednotiek, a i. (prístup sčasti zadarmo) e-Anatomy by IMAIOS (pre radiačných onkológov a radiológov), aj on-line web atlas, prístup k celému obsahu je spoplatnený (cca 70e/ročne) Mediately Databáza liekov
In addition, in some Italian centers normal values have changed over time and for this reason we have not been able to calculate the NCCN-IPI score. Following your suggestion, we have added in the Introduction the following sentences and reference: Using National Comprehensive Cancer Network (NCCN) database, an enhanced International Prognostic Index (NCCN-IPI) for patients with diffuse large. No related calculators found for Diffuse Large B-cell Lymphoma Prognosis (NCCN-IPI), No related articles found for Diffuse Large B-cell Lymphoma Prognosis (NCCN-IPI). Bari A, Marcheselli L, Sacchi S, et al. Examples of drugs that may be used in various combinations for Burkitt lymphoma include: Other treatments for Burkitt lymphoma may include intensive chemotherapy in combination with: In. of the recently developed R-IPI nor NCCN-IPI prognos-tic score including the two factors and the role of RDW and PLT count in their scores, also, their roles as independent prognostic factors in DLBCL has never been fully explored. Therefore, this study seeks to evalu-ate the prognostic significance of RDW and PLT in a large cohort of DLBCL patients, and to test whether they can significantly. NCCN-IPI is currently recognized as a prognostic indicator for DLBCL, which we also found in this study. However, it has limitations when used to predict the prognosis of patients with DEL. Therefore, in this study we examined potential prognostic factors other than NCCN-IPI Current ESMO / NCCN recommendations. Prognostication. Variable Adverse factor Grading TP53 (17p) Deleted and/or mutated 4 IGHV Unmutated 2 B2M, mg/L > 3.5 2 Age > 65 years 1 Stage Binet B/C or Rai I-IV 1 Total Score 0 -10 Score Risk Group 0 -1 Low risk 2 -3 Intermediate risk 4 -6 High risk 7 -10 Very high risk CLL-IPI: integrated model The International CLL-IPI Working Group Lancet.