Rituximab (R) plus doxorubicin, cyclophosphamide, vincristine, and prednisolone (CHOP) chemotherapy (R-CHOP) is widely accepted as standard care for diffuse large B-cell lymphoma (DLBCL) patients. The revised International Prognostic Index (R-IPI) was established in 2007 after the addition of rituximab to standard DLBCL treatment. To reassess the utility of R-IPI, we carried out a retrospective analysis of patients with DLBCL uniformly treated with standard R-CHOP. Progression-free survival (PFS) curves in "very good" and "good" risk groups as defined by the R-IPI showed no statistical difference. We added soluble interleukin-2 receptor (sIL-2R) level to the factors comprising the R-IPI. Five levels of sIL-2R were weighed with respect to their impact on PFS. sIL-2R of >2500 U/mL was determined as the most appropriate threshold. We developed a new prognostic SIL index, which includes three independent prognostic risk factors: clinical stage (S); sIL-2R level over 2500 U/mL (I); and elevated lactate dehydrogenase level (L). This index indicates standard risk (0 or 1 risk factors, 4-year PFS 83%, 4-year overall survival 91%) and high risk (2 or 3 risk factors, 4-year PFS 52%, 4-year overall survival 67%) outcomes. The SIL index is a simple and objective prognostic index for DLBCL patients to identify candidates for experimental therapy other than R-CHOP. (Cancer Sci 2012; 103: 1518-1523 T he prognosis for patients with DLBCL has dramatically improved since the introduction of rituximab, an anti-CD20 mAb. Although R-CHOP chemotherapy is regarded as the standard care for patients with DLBCL, approximately 30% of patients are unlikely to be cured by this treatment. To identify patients with a poor prognosis, who might be candidates for experimental therapy, the IPI was proposed in 1993, during the pre-R era.(1) The IPI depends on five negative prognostic factors: age over 60 years; advanced stage; elevated LDH level; performance status >1; and an extranodal disease number >1. Based on the number of risk factors, patients are classified into four risk groups. The IPI was based on data from patients with histologically varying, aggressive lymphomas, treated with combination chemotherapy regimens containing doxorubicin. In the R era, the R-IPI was proposed in 2007 for patients with DLBCL who underwent R-CHOP therapy. (2) In this R-IPI, three risk groups were identified by the redistribution of the IPI factors. Thus, the prognostic factors should be re-evaluated under new therapeutic strategies.Expression of sIL-2R is induced by mononuclear cell activation.(3,4) Activated T cells, activated B cells, and some tumor cells are also known to induce sIL-2R expression. Soluble interleukin-2 receptor exists in healthy individuals at low levels; the upper limit of the normal range is approximately 500 U/mL. The level of sIL-2R is elevated in most patients with B-cell lymphoma, but the sIL-2R-producing cells have not been identified. The level of sIL-2R is not of diagnostic value. It is usually measured in follow-up patients with...