Analysis of Prognosis in Follicular Lymphoma According to the FLIPI.

By the new treatment approaches, such as rituximab, anti-CD20 radioimmunotherapy, high-dose therapy, transplantation, the outcome of treatment for follicular lymphoma has been improved. However, there are wide alternatives in a treatment of follicular lymphoma to stemcell transplantation from watchful waiting, and analysis of prognosis is important in choice of a therapy. The international non-Hodgkin’s lymphoma prognostic index (IPI) has been used for follicular lymphoma. Recently, a new method of the follicular lymphoma international prognostic index (FLIPI) is reported and attracts attention. We apply these two prognostic models for newly diagnosed follicular lymphoma, and reviewed its availability. 5 factors were used, The IPI (age>60, EN≥2, LDH>N, PS≥2, CS≥3), and the FLIPI (age>60, Hb<12.0g/dl, LDH>N, CS≥3, nodal sites>4), respectively. Between 1988 and 2001, 107 patients of newly diagnosed follicular lymphoma (grade I-III) were analyzed. Response rate, overall survival (OS), and progression free survival (PFS) were calculated for each prognostic model. Patients characteristics were male/female 49/58, median age 54yr. (range 21–87yr.), and histological grade I, II/III 103/4. The median follow-up of our series was 84 months (range 40–206 months). CR, PR was 60.7%, 31.8%, and response rate was 92.5%. Median OS at 10 years was 64.4%, and median PFS at 10 years was 28.5%. Patient distribution by the IPI and the FLIPI were the followings; the IPI (L/LI/HI/H 49/41/15/2), the FLIPI (L/I/H 41/29/37). There were few patients equivalent to high risk group in IPI, and it was the patient distribution which was more equal in FLIPI in comparison with IPI.

OS by the IPI and the FLIPI risk group at 10 year were L: 85%, LI: 54%, HI: 44%, H: 50% (p=0.0088), and L: 87%, I: 66%, H: 47% (p<0.0001). PFS by the IPI and the FLIPI risk group at 10 year were L: 36%, LI: 23%, HI: 27%, H: 0% (p=0.0679), and L: 43%, I: 25%, H: 16% (p=0.0003). Correlation with a survival was recognized in FLIPI on OS, PFS more by significantly. As a conclusion, the FLIPI is a promising consequence prediction model. A standard treatment for follicular lymphoma is not established, and the examination that a treatment on the basis of prognosticator is strategic is necessary in future. As for grade 3, there was a little number of patients in this study, but further examination is necessary for adaptation of the FLIPI about this group.