Follicular lymphoma international prognostic index 2: a new prognostic index for follicular lymphoma developed by the international follicular lymphoma prognostic factor project.
OBJECTIVE
The aim of the F2 study was to verify whether a prospective collection of data would enable the development of a more accurate prognostic index for follicular lymphoma (FL) by using parameters which could not be retrospectively studied before, and by choosing progression-free survival (PFS) as principal end point.


METHODS
Between January 2003 and May 2005, 1,093 patients with a newly diagnosed FL were registered and 942 individuals receiving antilymphoma therapy were selected as the study population. The variables we used for score definition were selected by means of bootstrap resampling procedures on 832 patients with complete data. Procedures to select the model that would minimize errors were also performed.


RESULTS
After a median follow-up of 38 months, 261 events for PFS evaluation were recorded. beta2-microglobulin higher than the upper limit of normal, longest diameter of the largest involved node longer than 6 cm, bone marrow involvement, hemoglobin level lower than 12 g/dL, and age older than 60 years were factors independently predictive for PFS. Using these variables, a prognostic model was devised to identify three groups at different levels of risk. The 3-year PFS rate was 91%, 69%, and 51% for patients at low, intermediate, and high risk, respectively (log-rank = 64.6; P < .00001). The 3-year survival rate was 99%, 96%, and 84% for patients at low, intermediate, and high risk, respectively (P < .0001).


CONCLUSIONS
Follicular Lymphoma International Prognostic Index 2 is a simple prognostic index based on easily available clinical data and may represent a promising new tool for the identification of patients with FL at different risk in the era of immunochemotherapy.
Federico
Massimo
M
Dipartimento di Oncologia ed Ematologia, Università di Modena e Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy. federico@unimore.it
Bellei
Monica
M
Marcheselli
Luigi
L
Luminari
Stefano
S
Lopez-Guillermo
Armando
A
Vitolo
Umberto
U
Pro
Barbara
B
Pileri
Stefano
S
Pulsoni
Alessandro
A
Soubeyran
Pierre
P
Cortelazzo
Sergio
S
Martinelli
Giovanni
G
Martelli
Maurizio
M
Rigacci
Luigi
L
Arcaini
Luca
L
Di Raimondo
Francesco
F
Merli
Francesco
F
Sabattini
Elena
E
McLaughlin
Peter
P
Solal-Céligny
Philippe
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D008224:Lymphoma, Follicular / Q000175:diagnosis* / Q000628:therapy*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D055815:Young Adult