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Annals of Oncology Advance Access published online on June 6, 2005
Annals of Oncology, doi:10.1093/annonc/mdi269
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© 2005 European Society for Medical Oncology
Received February 21, 2005
Revised April 18, 2005
Accepted April 20, 2005

Original article

Prognostic indexes in follicular lymphoma: a comparison of different prognostic systems

G. Perea 1*, A. Altés 1, S. Montoto 2, A. López-Guillermo 2, E. Domingo-Doménech 3, A. Fernández-Sevilla 3, J. M. Ribera 4, J. Grau 4, C. Pedro 5, J. Angel Hernández 6, C. Estany 7, J. Briones 1, R. Martino 1, A. Sureda 1, J. Sierra 1, and E. Montserrat 2

1 Clinical Hematology Division, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
2 Hematology Department, Institut Clínic de Malalties Hemato-oncológiques, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
3 Hematology Department, Hospital Durán i Reynals, Institut Català d'Oncologia, Ciutat Sanitaria i Universitaria de Bellvitge (Hospitalet de Llobregat), Spain
4 Clinical Hematology Division, Hospital Germans Trias i Pujol, Badalona, Spain
5 Clinical Hematology Division, Hospital del Mar, Barcelona, Spain
6 Hematology Department, Hospital de Mataró, Mataró, Spain
7 Hematology Department, Hospital Mútua de Terrassa, Terrassa, Spain

* To whom correspondence should be addressed.
G. Perea, E-mail: gperea{at}hsp.santpau.es


  Abstract

Background: The International Prognostic Index (IPI), initially designed for aggressive lymphomas, is also used in follicular lymphoma (FL) and other indolent lymphomas. Two new prognostic indexes have recently been proposed for FL [the Italian Lymphoma Intergroup (ILI) Index and the Follicular Lymphoma International Prognostic Index (FLIPI)].

Patients and methods: Three indexes, IPI [age >60 years, extranodal involvement two or more sites, elevated lactate dehydrogenase (LDH), Eastern Cooperative Oncology Group performance status ≥2, stage ≥3], ILI (age >60 years, extranodal involvement two or more sites, elevated LDH, male sex, B symptoms, erythrocyte sedimentation rate ≥30 mm first hour) and FLIPI (age >60 years, stage ≥3, elevated LDH, nodal involvement five or more, haemoglobin level ≤12 g/dl) were calculated in 411 patients with FL.

Results: Overall concordance between the three indexes was 54%. A total of 126 (31%) patients were included in the high-risk group according to IPI, 131 (32%) according to ILI and 157 (38%) after FLIPI application. Ten-year overall survival rates after applying the prognostic indexes (IPI, ILI and FLIPI) were, respectively: 72%, 71% and 72%, in the low-risk group; 51%, 60% and 49% in the intermediate-risk group; and 24%, 16% and 31% in the high-risk group.

Conclusions: In this series, all three indexes, IPI, ILI and FLIPI, were useful to classify FL patients into differentiated risk groups, although the FLIPI identified a larger proportion of high-risk patients than the IPI and ILI.

Keywords: follicular lymphoma; prognostic index; survival.
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