Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr 25;7(8):1606-1614.
doi: 10.1182/bloodadvances.2022007949.

Evaluation of 4 prognostic indices in follicular lymphoma treated in first line with immunochemotherapy

Juan Jose Rodríguez-Sevilla  1   2 , Concepción Fernández-Rodríguez  2   3 , Leyre Bento  4 , Ramón Diez-Feijóo  1   2 , Sergio Pinzón  1   2 , Joan Gibert  2   3 , Lierni Fernández-Ibarrondo  2   3 , Marta Lafuente  2   5 , Ana Ferrer  3   6 , Blanca Sánchez-González  1   2 , Eva Gimeno  1   2 , Juan Sainz  7   8   9 , Rafael Ramos  10 , Juan F García  11 , Lluis Colomo  3   6 , Beatriz Bellosillo  2   3   5 , Antonio Gutiérrez  4 , Antonio Salar  1   2   5
Affiliations

Evaluation of 4 prognostic indices in follicular lymphoma treated in first line with immunochemotherapy

Juan Jose Rodríguez-Sevilla et al. Blood Adv. .

Abstract

Several clinical risk models have been proposed to predict the outcome of follicular lymphoma (FL). The development of next-generation sequencing technologies has allowed the integration of somatic gene mutations into clinical scores to build genotyped-based risk models, such as the m7-Follicular Lymphoma International Prognostic Index (FLIPI). We explored 4 clinical or clinicogenetic-risk models in patients with symptomatic FL who received frontline immunochemotherapy. Of 191 patients with FL grades 1 to 3a, 109 were successfully genotyped. The treatment consisted of rituximab (R) plus cyclophosphamide, vincristine, and prednisone (R-CVP)/cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) (72.5%) or R-bendamustine (R-B) (27.5%). The proportion of cases classified as high risk for FLIPI, FLIPI-2, PRIMA-prognostic index, or m7-FLIPI were 39.3%, 14%, 30.3%, and 22%, respectively. No case with low-intermediate FLIPI was upgraded in the m7-FLIPI, but 18 of the 42 high-risk patients with FLIPI were downgraded to low-risk m7-FLIPI. The sensitivity and specificity for the prediction of POD24 were highest for FLIPI. The discrimination between progression-free survival (PFS) and overall survival (OS) was the best for FLIPI (c-index: 0.644 and 0.727, respectively). When analyzed only in patients treated with R-B, m7-FLIPI showed a higher discrimination between PFS and OS. Thus, the FLIPI remains the clinical risk score with higher discrimination in patients with advanced FL treated with immunochemotherapy; however, the performance of the m7-FLIPI should be further investigated in patients treated with R-B.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest disclosure: A.S. received research funding from Roche, AbbVie, and Gilead Sciences; served on speaker’s bureau for Roche and Janssen Pharmaceuticals; and provided consultancy for Janssen Pharmaceuticals and Bristol Myers Squibb/Celgene. B.B. received research funding from Roche, AstraZeneca, and Novartis; provided consultancy for Thermo Fisher Scientific, Qiagen, Roche, AstraZeneca, Merck-Serono, Novartis, and Bristol Myers Squibb; and served on speaker’s bureau for Thermo Fisher Scientific, Qiagen, Roche, AstraZeneca, Biocartis, Merck-Serono, Novartis, and Bristol Myers Squibb. B.S. provided consultancy for Amgen, Novartis, and Takeda and served on speaker’s bureau for Amgen, Gilead Sciences, Novartis, Shire, and Takeda.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Risk categories among the clinical scores FLIPI, FLIPI-2, and PRIMA-PI compared with the clinicogenetic score m7-FLIPI. Note that FLIPI, FLIPI-2, and PRIMA-PI have 3 categories and m7-FLIPI has only 2 risk categories. Patients are given in percentages. Inter: intermediate.
Figure 2.
Figure 2.
PFS probability according to the 4 prognostics scores.
Figure 3.
Figure 3.
OS probability according to the 4 prognostics scores.
See this image and copyright information in PMC

References

    1. Liu Q, Fayad L, Cabanillas F, et al. Improvement of overall and failure-free survival in stage IV follicular lymphoma: 25 years of treatment experience at the University of Texas M.D. Anderson Cancer Center. J Clin Oncol. 2006;24(10):1582–1589. - PubMed
    1. Tan D, Horning SJ, Hoppe RT, et al. Improvements in observed and relative survival in follicular grade 1-2 lymphoma during 4 decades: the Stanford University experience. Blood. 2013;122(6):981–987. - PMC - PubMed
    1. Casulo C, Byrtek M, Dawson KL, et al. Early relapse of follicular lymphoma after rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone defines patients at high risk for death: an analysis from the National LymphoCare Study. J Clin Oncol. 2015;33(23):2516–2522. - PMC - PubMed
    1. Jurinovic V, Kridel R, Staiger AM, et al. Clinicogenetic risk models predict early progression of follicular lymphoma after first-line immunochemotherapy. Blood. 2016;128(8):1112–1120. - PMC - PubMed
    1. Maurer MJ, Bachy E, Ghesquières H, et al. Early event status informs subsequent outcome in newly diagnosed follicular lymphoma. Am J Hematol. 2016;91(11):1096–1101. - PMC - PubMed

Publication types

MeSH terms