title: Examination of the follicular lymphoma international prognostic index (FLIPI) in the National LymphoCare study (NLCS): a prospective US patient cohort treated predominantly in community practices.
abstract: BACKGROUND
  Because follicular lymphoma (FL) patients have heterogeneous outcomes, the FL international prognostic index (FLIPI) was developed to risk-stratify patients and to predict survival. However, limited data exist regarding the role of FLIPI in the era of routine first-line rituximab (R) and R-chemotherapy regimens and in the setting of community oncology practices.
  
  
  METHODS
  We evaluated the outcome data from the National LymphoCare Study (NLCS), a prospective, observational cohort study, which collects data on patients with FL in the United States (US) community practices.
  
  
  RESULTS
  Among 1068 male and 1124 female patients with FLIPI data, most were treated in US community practices (79%); 35% were FLIPI good risk, 30% intermediate risk, and 35% poor risk. FLIPI risk groups were significant predictors of overall survival (OS) and progression-free survival (PFS) for patients who undergo watchful waiting (WW), and those who receive non-R-containing regimens, R-alone, and R-chemotherapy combinations.
  
  
  CONCLUSIONS
  In the setting of contemporary practice with routine R use, stratifying patients into good, intermediate, and poor FLIPI risk groups predicts distinct outcomes in terms of OS and PFS. FLIPI remains an important prognostic index in the R era and should be used in clinical practices to support discussions about prognosis.
authors.affiliation: Winship Cancer Institute, Division of Hematology and Oncology, Emory University-School of Medicine, Atlanta. Electronic address: anooka@emory.edu.
authors.forename: A K
authors.initials: AK
authors.lastname: Nooka
authors.affiliation: Division of Hematology/Oncology, Advocate Lutheran General Hospital and Oncology Specialists, Park Ridge.
authors.forename: C
authors.initials: C
authors.lastname: Nabhan
authors.affiliation: RTI Health Solutions, Research Triangle Park.
authors.forename: X
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Genentech, South San Francisco.
authors.forename: M D
authors.initials: MD
authors.lastname: Taylor
authors.affiliation: Genentech, South San Francisco.
authors.forename: M
authors.initials: M
authors.lastname: Byrtek
authors.affiliation: Section of Hematology/Oncology, University of Arizona, Tucson.
authors.forename: T P
authors.initials: TP
authors.lastname: Miller
authors.affiliation: Department of Medicine, James P. Wilmont Cancer Center, Rochester.
authors.forename: J W
authors.initials: JW
authors.lastname: Friedberg
authors.affiliation: Department of Medicine, Lymphoma Program, Memorial Sloan-Kettering Cancer Center, New York.
authors.forename: A D
authors.initials: AD
authors.lastname: Zelenetz
authors.affiliation: Oncology and Bone & Marrow Transplantation, Division of Hematology, University of Iowa, Iowa City.
authors.forename: B K
authors.initials: BK
authors.lastname: Link
authors.affiliation: Department of Health Sciences Research, Mayo Clinic-College of Medicine, Rochester.
authors.forename: J R
authors.initials: JR
authors.lastname: Cerhan
authors.affiliation: The Leukemia & Lymphoma Society, White Plains, USA.
authors.forename: H
authors.initials: H
authors.lastname: Dillon
authors.affiliation: Winship Cancer Institute, Division of Hematology and Oncology, Emory University-School of Medicine, Atlanta.
authors.forename: R
authors.initials: R
authors.lastname: Sinha
authors.affiliation: Winship Cancer Institute, Division of Hematology and Oncology, Emory University-School of Medicine, Atlanta.
authors.forename: P J
authors.initials: PJ
authors.lastname: Shenoy
authors.affiliation: Genentech, South San Francisco.
authors.forename: D
authors.initials: D
authors.lastname: Levy
authors.affiliation: Genentech, South San Francisco.
authors.forename: K
authors.initials: K
authors.lastname: Dawson
authors.affiliation: Genentech, South San Francisco.
authors.forename: J H
authors.initials: JH
authors.lastname: Hirata
authors.affiliation: Winship Cancer Institute, Division of Hematology and Oncology, Emory University-School of Medicine, Atlanta.
authors.forename: C R
authors.initials: CR
authors.lastname: Flowers
mesh_terms: D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D015331:Cohort Studies; D003151:Community Health Centers; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008224:Lymphoma, Follicular / Q000145:classification / Q000188:drug therapy* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011446:Prospective Studies; D012307:Risk Factors; D000069283:Rituximab; D016896:Treatment Outcome; D057832:Watchful Waiting
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab