CITI Calculator

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6T6PDPXSJ5LmtzBWupPE3sVpM

About the CITI Calculator

The CITI (CNS Relapse In T-cell Lymphoma Index) is a prognostic model for central nervous system relapse for patients with mature T- and NK-cell neoplasms (MTNKN) at 1, 5, and 10 years after initial diagnosis. This model was developed using a population of patients with MTNKN enriched for CNS relapse across 19 North American institutions and validated in an independent population-based cohort from the Swedish Lymphoma Registry (Ellin et al. Blood 2015). Primary data used for the development of this calculator can be found here (Bhansali et al. Blood Adv 2024).

Definitions in the CITI Calculator

Definitions of MTNKN were based on the World Health Organization (WHO) classification of hematolymphoid tumors, 5th edition (Alaggio et al. Leukemia 2022). Patients with neoplasms classified by the WHO as "Precursor T-cell neoplasms," "Mature T-cell and NK-cell leukemias," or "Primary cutaneous T-cell lymphomas" were excluded from the development of the CITI model with the exception of subcutaneous panniculitis-like T-cell lymphoma (SPTCL) and primary cutaneous gamma/delta T-cell lymphoma (PCGD-TCL).
Lactate dehydrogenase (LDH) elevation is defined as any value above the upper limit of normal for the reference laboratory.
Staging is based on the Lugano Modification of the Ann Arbor Staging System.
B-symptoms are defined as drenching night sweats, sustained fever over 38°C, and/or unintentional weight loss over 10% of body weight in 6 months.
Extranodal (EN) involvement was confirmed by imaging and/or biopsy. Patients with CNS involvement at diagnosis or prior to receiving frontline therapy were excluded from development of the CITI Calculator.

Using the CITI Calculator

Prediction of CNS relapse is based on clinicopathologic factors at initial diagnosis.
If data are unknown, fields can be left blank, though this limits the utility of predictive modeling.
Select the MTNKN histology. Select "Other" if histology does not fall under the category of PTCL, NOS, ALCL, ALK+, EATL (including EATL and MEITL), or SPTCL (including SPTCL and PCGD-TCL). The CITI Calculator should not be applied to patients with other MTNKN classified as "Precursor T-cell neoplasms," "Mature T-cell and NK-cell leukemias," or "Primary cutaneous T-cell lymphomas" by WHO. The field will default to exclude other histologies.
Select whether or not LDH is elevated.
Select if stage is 1-2 (no) or 3-4 (yes).
Select whether or not the patient has B-symptoms.
Select if patients have 2 or more sites of EN involvement (yes) or not (no). Simultaneous involvement of bone marrow and peripheral blood is considered to be 1 site of EN involvement.
The CITI calculator will calculate a score and risk stratification in real-time upon selection of variable fields.

Risk Factor	Present
MTNKN Histology (Choose 1)
PTCL,NOS	Yes No reset
ALCL, ALK+	Yes No reset
EATL (includes EATL and MEITL)	Yes No reset
SPTCL (includes SPTCL and PCGD-TCL)	Yes No reset
Other	Yes No reset
Elevated LDH	Yes No reset
Stage ≥ III	Yes No reset
B-symptoms	Yes No reset
≥ 2 sites of EN involvement (incl. BM/PB)	Yes No reset

EATL (includes EATL and MEITL)

SPTCL (includes SPTCL and PCGD-TCL)

>=2 sites of EN involvement (incl. BM/PB)

>=2 Sites of EN Involvement (incl. BM/PB) Calc:

CITI Score: 0

Risk	CITI	1 - year risk of CNS relapse	5 - year risk of CNS relapse	10 - year risk of CNS relapse
Low	X ≤ 0.14	1.4%	2.2%	2.2%

CITI Score: 0

Risk	CITI	1 - year risk of CNS relapse	5 - year risk of CNS relapse	10 - year risk of CNS relapse
Intermediate	0.14 < X ≤ 1.11	3.6%	7.4%	7.4%

CITI Score: 0

Risk	CITI	1 - year risk of CNS relapse	5 - year risk of CNS relapse	10 - year risk of CNS relapse
High	1.11 < X	5.6%	11.8%	13.4%

The reverse Kaplan-Meier curve shows cumulative events of CNS relapse after initial diagnosis in the validation cohort from the Swedish Lymphoma Registry. Low, intermediate, and high risk populations are stratified by green, blue, and red lines, respectively with sample size for each group shown in the figure key. Based on the risk group identified by the CITI Calculator, the 95% confidence interval is shown with shading. Hashmarks indicate censored patients. Panel inset shows the comparison of all risk groups.

The CITI Calculator has not been prospectively validated. Additionally, predictive modeling has only been performed in North American and European populations, so predictive modeling needs to be interpreted with caution, particularly outside of these populations.
Predictions derived by the CITI Calculator should not replace evaluation and judgement by a licensed clinician or qualified healthcare provider.
Predictions derived by the CITI Calculator may be informative for patient risk, though it has not been validated for the implementation of CNS sampling (i.e. lumbar puncture) or the use of CNS-directed prophylaxis or other treatment modifications.
The CITI Calculator is a research tool that has not been reviewed by or approved by the United States Food and Drug Administration.

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