A simplified scoring system in de novo follicular lymphoma treated initially with immunochemotherapy
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- 5 July 2018
- journal article
- research article
- Published by American Society of Hematology in Blood
- Vol. 132 (1), 49-58
- https://doi.org/10.1182/blood-2017-11-816405
Abstract
In follicular lymphoma (FL), no prognostic index has been built based solely on a cohort of patients treated with initial immunochemotherapy. There is currently a need to define parsimonious clinical models for trial stratification and to add on biomolecular factors. Here, we confirmed the validity of both the FLIPI and the FLIPI2 in the large prospective PRIMA trial cohort of 1,135 patients treated with initial R-chemotherapy +/- R maintenance. Furthermore, we developed a new prognostic tool comprising only 2 simple parameters (bone marrow involvement and β2-microglobulin (β2m)) to predict progression-free survival (PFS). The final simplified score called the PRIMA-PI (PRIMA-prognostic index) comprised 3 risk categories: high (β2m > 3 mg/L), low (β2m ≤ 3 mg/L without bone marrow involvement) and intermediate (β2m ≤ 3 mg/L with bone marrow involvement). Five-year PFS rates were 69%, 55% and 37% in the low-, intermediate- and high-risk groups, respectively (P<.0001). In addition, achieving or not event-free survival (EFS) at 24 months (EFS24) was a strong post-treatment prognostic parameter for subsequent OS and the PRIMA-PI was correlated with EFS24. The results were confirmed in a pooled external validation cohort of 479 patients from the FL2000 LYSA trial and the University of Iowa/Mayo Clinic Lymphoma SPORE Molecular Epidemiology Resource. Five-year EFS in the validation cohort were 77%, 57% and 44% in the PRIMA-PI low-, intermediate- and high-risk groups respectively (P<.0001). The PRIMA-PI is a novel and easy-to-compute prognostic index for patients initially treated with immunochemotherapy. This could serve as a basis for building more sophisticated and integrated biomolecular scores.This publication has 40 references indexed in Scilit:
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