Original article Predictive value of Follicular Lymphoma International Prognostic Index (FLIPI) in patients with follicular lymphoma at first progression

Background: Different prognostic scores have been proposed to predict the outcome of follicular lymphoma (FL) patients at diagnosis. A new prognostic index specifically addressing FL patients, the Follicular Lymphoma International Prognostic Index (FLIPI), has recently been developed, which might also be useful in patients with progression. Patients and methods: One hundred and three patients (55 male, 48 female; median age 59 years) with FL in first relapse/progression after an initial response to therapy (50 complete responders/ 53 partial responders) were included in the study. Results: Five-year survival from progression (SFP) was 55 % (95 % confidence interval 44%–66%). The distribution according to the FLIPI at relapse was 39 % good prognosis, 24 % intermediate prog-nosis and 37 % poor prognosis. Five-year SFP for these groups were 85%, 79 % and 28%, respect-ively (P < 0.0001). Other variables at relapse with prognostic significance for SFP were age, presence of B symptoms, performance status, bulky disease, number of involved nodal sites, lactate dehydrogenase level, hemoglobin level, histological transformation, the Italian Lymphoma Inter-group prognostic index for FL and the International Prognostic Index for aggressive lymphomas. In the multivariate analysis bulky disease (P = 0.01), presence of B symptoms (P = 0.03) and FLIPI at relapse (P = 0.0003) were the most important variables for predicting SFP. Conclusions: In patients with FL at first relapse/progression, the FLIPI, along with the presence of bulky disease and B symptoms, are features that predict SFP and thus could be useful to select candidates for experimental treatments. Key words: FLIPI, follicular lymphoma, prognosis, progressio