# IPS-E (early-stage asymptomatic CLL)

IPS-E

Status: LIVE
Price: $0.005 USDC
`GET /api/calc/ips_e`
HTML: https://magentlab.com/docs/ips-e
Markdown: https://magentlab.com/docs/ips-e.md

Not a medical device. Not a diagnosis, dose, or listing recommendation.

## What it computes

Sum the 2020 IPS-E (international prognostic score for asymptomatic early-stage chronic lymphocytic leukemia) and return low (0), intermediate (1), or high (2–3).

## When to use

When an agent needs the published IPS-E point total and risk band for early-stage asymptomatic CLL and must not invent a treatment start order, and must not substitute CLL-IPI, Rai, or Binet.

## When not to use

- Not a medical device and not a CLL diagnosis or treatment start order. magent does not examine the patient.
- This is Condoluci 2020 IPS-E (time to first treatment in early-stage asymptomatic CLL), not CLL-IPI, not Rai, and not Binet.
- magent does not assay IGHV, count lymphocytes, or palpate lymph nodes. ighv_unmutated and palpable_lymph_nodes are caller-assigned flags; alc_k_ul is caller-supplied ALC.

## Formula

```
IPS-E = ighv_unmutated 1 + alc_gt_15 1 + palpable_lymph_nodes 1; Condoluci 2020; max 3; low 0, intermediate 1, high 2-3
```

## Citation

[International prognostic score for asymptomatic early-stage chronic lymphocytic leukemia](https://doi.org/10.1182/blood.2019003453)
Condoluci A, Terzi di Bergamo L, Langerbeins P, Hoechstetter MA, Herling CD, et al.
Blood. 2020;135(21):1859-1869
DOI: [10.1182/blood.2019003453](https://doi.org/10.1182/blood.2019003453)

## Worked example

### No IPS-E factors

Given: `alc_k_ul=10, ighv_unmutated=false, palpable_lymph_nodes=false`

1. ighv_unmutated false → 0; alc_k_ul 10 is not >15 → 0; palpable_lymph_nodes false → 0
2. Score = 0 (max 3); ips_e_risk = low


### All three IPS-E factors

Given: `alc_k_ul=20, ighv_unmutated=true, palpable_lymph_nodes=true`

1. ighv_unmutated → 1; alc_k_ul 20 >15 → 1; palpable_lymph_nodes → 1
2. Score = 3 (max 3); ips_e_risk = high (2–3)


## Also searched as

- IPS-E
- international prognostic score early-stage CLL
- Condoluci IPS-E
- asymptomatic early-stage CLL score
- CLL time to first treatment score
- IPS E CLL
- early CLL prognostic score

## Parameters

- `ighv_unmutated` (boolean, required): Unmutated IGHV as assigned by the caller (Condoluci 2020 IPS-E). true scores 1. magent does not sequence IGHV.
- `alc_k_ul` (number, required): Absolute lymphocyte count in ×10^9/L (0.1-500). >15 scores 1 (Condoluci 2020 IPS-E). 15.0 is the ≤15 arm and scores 0. magent does not count lymphocytes.
- `palpable_lymph_nodes` (boolean, required): Palpable lymph nodes as assigned by the caller (Condoluci 2020 IPS-E). true scores 1. magent does not palpate lymph nodes.

## Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

Method: `POST /api/calc/ips_e`
Max items: 25
Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic)
Status: PREVIEW

- 1 to 25 items. Each item uses the same keys as the GET query parameters.
- POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
- The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
- HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
- Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
- x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request:

```json
{
  "items": [
    {
      "alc_k_ul": "10",
      "ighv_unmutated": "false",
      "palpable_lymph_nodes": "false"
    },
    {
      "alc_k_ul": "10",
      "ighv_unmutated": "false",
      "palpable_lymph_nodes": "false"
    }
  ]
}
```

Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/ips-e

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/ips_e",
  "items": [
    {
      "components": [
        {
          "factor": "ighv_unmutated",
          "points": 0,
          "present": false
        },
        {
          "value": 10.0,
          "factor": "alc_gt_15",
          "points": 0,
          "present": false
        },
        {
          "factor": "palpable_lymph_nodes",
          "points": 0,
          "present": false
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Condoluci A, Terzi di Bergamo L, Langerbeins P, Hoechstetter MA, Herling CD, et al.",
        "doi": "10.1182/blood.2019003453",
        "id": "condoluci-2020",
        "pmid": "32267500",
        "source": "Blood. 2020;135(21):1859-1869",
        "title": "International prognostic score for asymptomatic early-stage chronic lymphocytic leukemia"
      },
      "formula": "ips_e",
      "formula_expression": "IPS-E = ighv_unmutated 1 + alc_gt_15 1 + palpable_lymph_nodes 1; Condoluci 2020; max 3; low 0, intermediate 1, high 2-3",
      "max_score": 3,
      "score": 0,
      "alc_k_ul": 10.0,
      "ighv_unmutated": false,
      "ips_e_risk": "low",
      "palpable_lymph_nodes": false
    },
    {
      "components": [
        {
          "factor": "ighv_unmutated",
          "points": 0,
          "present": false
        },
        {
          "value": 10.0,
          "factor": "alc_gt_15",
          "points": 0,
          "present": false
        },
        {
          "factor": "palpable_lymph_nodes",
          "points": 0,
          "present": false
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Condoluci A, Terzi di Bergamo L, Langerbeins P, Hoechstetter MA, Herling CD, et al.",
        "doi": "10.1182/blood.2019003453",
        "id": "condoluci-2020",
        "pmid": "32267500",
        "source": "Blood. 2020;135(21):1859-1869",
        "title": "International prognostic score for asymptomatic early-stage chronic lymphocytic leukemia"
      },
      "formula": "ips_e",
      "formula_expression": "IPS-E = ighv_unmutated 1 + alc_gt_15 1 + palpable_lymph_nodes 1; Condoluci 2020; max 3; low 0, intermediate 1, high 2-3",
      "max_score": 3,
      "score": 0,
      "alc_k_ul": 10.0,
      "ighv_unmutated": false,
      "ips_e_risk": "low",
      "palpable_lymph_nodes": false
    }
  ]
}
```

## Response fields

- `formula` (string): ips_e
- `formula_expression` (string): Exact expression used
- `score` (integer): IPS-E points 0-3
- `max_score` (integer): Always 3
- `ips_e_risk` (string): low when score is 0, intermediate when 1, high when 2-3 (Condoluci 2020 IPS-E). Not a CLL diagnosis. Not CLL-IPI. Not Rai. Not Binet. Not a treatment start order.
- `alc_k_ul` (number): Absolute lymphocyte count in ×10^9/L used for the >15 criterion
- `ighv_unmutated` (boolean): Caller-assigned unmutated IGHV flag used for the 1-point criterion
- `palpable_lymph_nodes` (boolean): Caller-assigned palpable lymph-node flag used for the 1-point criterion
- `components` (array): Per-factor points
- `citation` (object): Condoluci et al. Blood 2020 IPS-E citation
- `disclaimer` (string): Not-a-device notice

## Example JSON

Frozen fixture. Not a live lookup.

```json
{
  "components": [
    {
      "factor": "ighv_unmutated",
      "points": 0,
      "present": false
    },
    {
      "value": 10.0,
      "factor": "alc_gt_15",
      "points": 0,
      "present": false
    },
    {
      "factor": "palpable_lymph_nodes",
      "points": 0,
      "present": false
    }
  ],
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Condoluci A, Terzi di Bergamo L, Langerbeins P, Hoechstetter MA, Herling CD, et al.",
    "doi": "10.1182/blood.2019003453",
    "id": "condoluci-2020",
    "pmid": "32267500",
    "source": "Blood. 2020;135(21):1859-1869",
    "title": "International prognostic score for asymptomatic early-stage chronic lymphocytic leukemia"
  },
  "formula": "ips_e",
  "formula_expression": "IPS-E = ighv_unmutated 1 + alc_gt_15 1 + palpable_lymph_nodes 1; Condoluci 2020; max 3; low 0, intermediate 1, high 2-3",
  "max_score": 3,
  "score": 0,
  "alc_k_ul": 10.0,
  "ighv_unmutated": false,
  "ips_e_risk": "low",
  "palpable_lymph_nodes": false
}
```

## Errors

- HTTP 400 `invalid_flag`: boolean clinical flags must be true or false Returned before settlement; you are not charged.
- HTTP 400 `invalid_alc`: alc_k_ul must be a number from 0.1 to 500 (absolute lymphocyte count ×10^9/L; Condoluci 2020 IPS-E). Returned before settlement; you are not charged.
- HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
- HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
- HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged.

Shared HTTP 402 and 503: https://magentlab.com/docs/payments

## Related tools

- [CLL-IPI](https://magentlab.com/docs/cll-ipi) — Sum the 2016 CLL-IPI (chronic lymphocytic leukaemia international prognostic index) and return low (0–1), intermediate (2–3), high (4–6), or very_high (7–10).
- [Rai](https://magentlab.com/docs/rai) — Apply Rai 1975 original clinical staging of chronic lymphocytic leukemia and return rai_stage 0-4 from four caller-assigned flags.
- [Binet](https://magentlab.com/docs/binet) — Apply Binet 1981 chronic lymphocytic leukemia staging and return stage A, B, or C from caller-assigned anemia (Hb <10 g/dL), thrombocytopenia (platelets <100×10^9/L), and involved lymphoid areas (0-5).

## Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s.

- GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall).
- HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote.
- Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering.
- Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional.
- Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402.

- offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront.
- offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization.

- not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search.

Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers).

Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments

Stdio MCP (one process per host): https://magentlab.com/docs/mcp

## Guarantees

- HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON.
- exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
- HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
- Execution is timeout-bounded and concurrency-capped.
- Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.