Follicular Lymphoma

Retrospective analyses of patients with FL have identified many clinical factors with adverse prognostic significance, including advanced age, high number of nodal sites of involvement, advanced anatomic stage, the presence of tumor bulk, and elevated LDH. The IPI described for aggressive NHL has also been applied to patients with FL, and several studies have shown it to have predictive value. The use of the IPI is limited by the fact that a relatively small number of patients have high-risk disease according to this index, limiting the patient populations for prospective studies in "poor risk" disease. Additionally, clinical factors with prognostic value in indolent lymphoma may differ substantially from those in aggressive NHL because of the biologic difference between these two entities.

The FLIPI has therefore been developed and is now regarded as the standard clinical prognostic tool for patients with low grade FL.36 The risk groups and 5-and 10-year survival rates associated with each of these groups are summarized in Table 66.6.

A recent European study has compared the FLIPI with the IPI and also with an Italian Prognostic Index developed for FL, in a population of 465 patients with low-grade disease.37 They demonstrated that all three indices provided useful prognostic stratification. The FLIPI identified a higher proportion of patients with high-risk disease. However, the concordance between the three indices was only 54%, indicating that as with DLBCL there is substantial biological and clinical heterogeneity within each risk group and emphasizing the need for more accurate predictors of outcome.

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