Allogeneic Hematopoietic Cell Transplantation (HCT) after Nonmyeloablative Conditioning for Relapsed or Refractory Follicular Lymphoma.

Abstract Forty-five patients (pts) with relapsed or chemotherapy refractory low-grade lymphomas were treated with HLA-matched related (n=22) and unrelated (n=23) HCT after nonmyeloablative conditioning using 2 Gy total body irradiation with or without fludarabine. Postgrafting immunosuppression consisted of cyclosporine and mycophenolate mofetil. Lymphoma histologies included follicular (n=38), small lymphocytic (n=5), and marginal zone (n=2). Seven pts had prior intermediate-grade lymphoma transformation. The median pt age was 54 (range 34–67) years and median time from diagnosis to allogeneic HCT was 4.3 (0.5–18.5) years. Twelve pts had failed and 3 received cytoreductive autologous HCT before nonmyeloablative HCT. Disease status at time of nonmyeloablative HCT included complete remission (CR, n=16), partial remission (PR, n=12), refractory (n=11) and untested relapse (n=6). Prognostic scoring at the time of HCT using the Follicular Lymphoma International Prognostic Index (FLIPI) identified 25 low-risk and 19 intermediate-risk pts and using the International Prognostic Index (IPI) identified 26 low-risk, 13 low-intermediate risk, and 5 intermediate-high risk pts. There were insufficient data to score 1 pt by the FLIPI or by the IPI. All pts received G-CSF mobilzed peripheral blood mononuclear cells. Six of the 23 unrelated donor graft recipients had human leukocyte antigen (HLA) mismatches: one at a single allele, 4 at a single antigen, and one at an antigen and an allele. The median follow up after nonmyeloblative HCT was 23.8 (range 2– 44.9) months. One pt experienced non-fatal graft rejection of a single antigen mismatched unrelated graft. The cumulative probabilities (CP) of acute grades II-IV, III-IV and chronic GVHD were 60%, 18%, and 51%, respectively. Responses [CR (n=14) and PR (n=6)] were seen in 20 of 28 (71%) pts with measurable disease at HCT while 3 had stable and 3 progressive disease, and 2 were not evaluable due to early nonrelapse death. None of the 20 pts who responded and 3 of the 17 transplanted in CR had disease relapse. At 2 years, the CPs of overall relapse/progression, and non-relapse mortality were 15% and 34%, respectively. The 2-year Kaplan-Meier estimates of overall and progression free survival were 58% and 51%, respectively. Higher IPI and FLIPI scores modeled as continuous variables were independently associated with worse PFS (HR 1.55, p=0.05 and HR 1.35, p=0.10 respectively). Use of a HLA mismatched unrelated donor was associated with a trend for worse OS and PFS (HR 3.0, p=0.08 for both). Allogeneic HCT after nonmyeloablative conditioning is a promising salvage strategy for pts with relapsed and refractory indolent lymphoma. The high response and low relapse rates with this approach suggest that relapsed indolent lymphomas are susceptible to graft-versus-tumor responses.

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Serbian lymphoma study group: Demografic characteristics of 257 patients with follicular lymphoma

Vojnosanitetski pregled ◽

10.2298/vsp140115014s ◽

2015 ◽

Vol 72 (6) ◽

pp. 483-488

Author(s):

Olivera Simonovic ◽

Lana Macukanovic-Golubovic ◽

Bosko Andjelic ◽

Darko Antic ◽

Biljana Mihaljevic

Keyword(s):

High Risk ◽

Follicular Lymphoma ◽

International Prognostic Index ◽

Prognostic Index ◽

Treatment Decision ◽

Risk Groups ◽

Low Risk ◽

Intermediate Risk ◽

Prognostic Groups

Background/Aim. Follicular lymphoma (FL) is a B-cell tumor usually with indolent clinical course, yet in some cases the course of the disease can be very aggressive. The aim of the re-search was to determine distribution of patients into prognostic groups based on the International Prognostic Index (IPI) and Folicular Lymphoma International Prognostic Index (FLIPI) criteria, as well as to determine the importance of classifying patients into the prognostic groups, since this could potentially have the influence on selection of the treatment modality. Methods. The retrospective study was performed on 257 patients with follicular lymphoma diagnosed between January 2000 and April 2011. Results. Based on the IPI score, 153 (59.53%) patients had low risk, 57 (22.18%) low intermediate risk, 15 (5.84%) high intermediate risk, 9 (3.50%) high risk, whereas the classification of 23 patients diagnosed with FL remained with unknown risk according to the IPI. Based on the FLIPI prognostic index, 113 (43.97%) patients had low risk, 70 (27.24%) intermediate risk and 51 (19.84%) high risk, whereas the classification of 23 (8.95%) patients remained unknown. On the basis of the FLIPI 2 prognostic index, 48 (18.68%) patients had low risk, 145 (56.42%) intermediate risk and 41 (15.95%) high risk. The classification into prognostic groups for 23 (8.95%) patients remained unknown. According to the IPI, FLIPI and FLIPI 2 there were the patients that required treatment in all the risk groups. Conclusion. The FLIPI and FLIPI 2 effectively identify patients at high risk, thus helping in treatment decision for each single patient.

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Neither the FLIPI Nor the FLIPI2 Accurately Segregates Low- Risk From Intermediate- Risk Follicular Lymphoma Patients in Terms of Progression-Free Survival

Blood ◽

10.1182/blood.v118.21.2663.2663 ◽

2011 ◽

Vol 118 (21) ◽

pp. 2663-2663

Author(s):

Inas El-Najjar ◽

Janet Matthews ◽

John Gribben ◽

Silvia Montoto

Keyword(s):

Follicular Lymphoma ◽

Risk Group ◽

International Prognostic Index ◽

Prognostic Index ◽

Progression Free Survival ◽

Risk Groups ◽

Low Risk ◽

Intermediate Risk ◽

Free Survival ◽

Study Population

Abstract Abstract 2663 Background: Follicular Lymphoma International Prognostic Index (FLIPI) is the most frequently used prognostic index for risk stratification in follicular lymphoma (FL) patients. The FLIPI was designed retrospectively in the pre-rituximab era, with overall survival (OS) as the end-point. Follicular Lymphoma International Prognostic Index 2 (FLIPI2) is a more recent index designed prospectively in the rituximab era to overcome these drawbacks. Aim: To compare the efficacy of the FLIPI and FLIPI2 prognostic indexes in discriminating patients with FL with a distinct outcome in terms of OS and progression-free survival (PFS). Patients: From 1985 to 2007, 302 patients were newly diagnosed with grade 1–3a FL in our institution. The FLIPI could be retrospectively assigned in 220 patients and the FLIPI2 in 149 patients. The 122 patients (47 male/75 female; median age: 56 years –range: 25–87) in whom both the FLIPI and FLIPI2 indexes were assessable constitute the study population. Seventy-five patients (61%) received treatment immediately after diagnosis (of which, 25 patients received rituximab containing regimens), whereas the remainder were managed expectantly. Main characteristics at diagnosis are as follows: age>60 years, 41%; stage III-IV, 70%; Hb<12 g/L, 17%; bone marrow involvement, 45%; largest lymph node diameter>6cm, 26%; B2M>ULN, 20% and LDH>ULN, 17%. The median follow-up for alive patients was 86 months (range: 12– 270). Results: Five-year OS and PFS were 74% (95%CI: 69–79) and 38% (95%CI: 32–44), respectively, for the 302 patients. There were no significant differences in the outcome of these patients in comparison with the 122 patients comprising the study population. The distribution of the 122 patients according to the FLIPI and FLIPI2 as well as the 5-year OS and 5-year PFS are shown in the table. The FLIPI and the FLIPI2 indexes predicted OS (p<0.0001 both for the FLIPI and the FLIPI2), but the FLIPI2 did not accurately separate patients with low-risk from those with intermediate risk in terms of OS (p=0.3). The FLIPI score predicted PFS (p=0.001) but was not able to discriminate patients with low-risk from those with intermediate-risk (p=0.6). There was a trend for the FLIPI2 to predict PFS (p=0.06) but it did not segregate the low-risk group from the intermediate-risk group (p=0.3) Conclusions: The FLIPI separates patients into 3 risk groups, well-balanced in terms of the proportion of patients in each group with a distinct OS. In contrast the, majority of the patients fall into the intermediate risk group according to the FLIPI2, and overlaps with the low risk group in terms of OS. With regards to PFS, both indexes are poor at separating low and intermediate risk groups. In summary, both indexes are good at defining a relatively small high-risk population but do not accurately segregate the rest. FLIPI2 does not appear to be superior to FLIPI for risk stratification. This supports that the future lies in uncovering biological factors that might help in the guidance of treatment, in addition to segregating patients more accurately into specific risk groups. Disclosures: Gribben: Roche: Honoraria; Genentech: Honoraria; GSK: Honoraria; Muundipharma: Honoraria. Montoto:Genentech: Research Funding; Roche: Honoraria.

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The Follicular Lymphoma International Prognostic Index (FLIPI) Predicts Treatment Outcome in Patients with Advanced Stage Follicular Lymphoma Treated Front-Line with Rituximab and the Combination of Cyclophosphamide, Doxorubicin, Vincristine and Prednisone (R-CHOP).

Blood ◽

10.1182/blood.v106.11.925.925 ◽

2005 ◽

Vol 106 (11) ◽

pp. 925-925 ◽

Cited By ~ 1

Author(s):

Christian Buske ◽

Eva Hoster ◽

Martin Dreyling ◽

Joerg Hasford ◽

Michael Unterhalt ◽

...

Keyword(s):

Treatment Outcome ◽

Relative Risk ◽

High Risk ◽

Follicular Lymphoma ◽

Risk Group ◽

International Prognostic Index ◽

Prognostic Index ◽

Intermediate Risk ◽

Advanced Stage ◽

Front Line

Abstract Background: The Follicular Lymphoma International Prognostic Index (FLIPI) has been developed to predict prognosis and to allow risk adapted treatment decisions in patients with follicular lymphoma (FL) before the widely use of Rituximab. However, the addition of Rituximab to standard induction chemotherapy with its long-term beneficial effects has profoundly changed the treatment outcome in patients with advanced stage FL and has become the new standard in the first line therapy of this disease. Therefore, we addressed the question, whether the prognostic value of the FLIPI could be reconfirmed in patients with advanced stage FL treated initially with a rituximab/chemotherapy combination. Methods: The FLIPI index was tested in patients treated with Rituximab and CHOP (Cyclophosphamide, Doxorubicin, Vincristine and Prednisone, R-CHOP) in a prospective multicenter phase 3 trial of the GLSG using the time to treatment failure (TTF) as target parameter. Results: 362 Patients treated with R-CHOP were evaluable for TTF. Of the 338 patients evaluable for all FLIPI risk factors, 14% of patients were classified as low, 41% as intermediate and 45% as high risk. After a median follow-up time of 20 months, patients with low risk and intermediate risk FLIPI had almost identical TTF (2-years TTF 92% vs 90%, 95% C.I., 83% to 100% and 84% to 96%, respectively). In contrast, the TTF was significantly shorter in the high risk FLIPI group (2-years TTF 67%, 95% C.I., 58% to 76%) as compared to the combined low/intermediate risk FLIPI group (relative risk 3.0, 95% C.I., 1.7 to 5.1; p < 0.0001). In addition, responding patients with high risk FLIPI had a significantly shorter progression free survival as compared to the low/intermediate risk group (relative risk 3.3, 95% C.I., 1.8 to 6.0; p < 0.0001). When postremission treatment was taken into account, the FLIPI separated the high risk group from the low/intermediate risk group in 65 patients treated with autologous stem cell transplantation (relative risk 6.0, 95% C.I., 1.4 to 25.2) as well as in 242 patients who had received IFN-α maintenance or no postremission therapy (relative risk 3.2, 95% C.I., 1.8 to 5.8). As the FLIPI was able to separate the high from the low/intermediate risk group in patients with advanced follicular lymphoma treated initially with Rituximab and CHOP we next performed a multivariate analysis to determine the impact of the individual parameters incorporated in the FLIPI on the TTF. The serum LDH level greater than the upper normal limit (relative risk 2.6, 95% C.I., 1.5 to 4.5) and the hemoglobin level below 12 g/dl (relative risk 2.5, 95% C.I., 1.4 to 4.3) were independently associated with a shorter TTF in these patients, whereas the age and the number of nodal areas were not discriminant. Conclusion: Taken together, these data indicate that the FLIPI is a valid prognostic index for identifying high-risk patients in FL, also after front-line combined immuno-chemotherapy. The index will remain an important tool to adjust treatment decisions in individual patients according their risk profile and to design clinical trials for the different risk groups in the era of antibody-based therapy.

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A risk model for relapsed/refractory aggressive NHL integrating clinical risk factors and pretransplant Deauville score

Blood Advances ◽

10.1182/bloodadvances.2020002814 ◽

2020 ◽

Vol 4 (22) ◽

pp. 5762-5771

Author(s):

Ho-Young Yhim ◽

Yael Eshet ◽

Ur Metser ◽

Chae-Hong Lim ◽

Katherine Lajkosz ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

International Prognostic Index ◽

Prognostic Index ◽

Salvage Chemotherapy ◽

Low Risk ◽

Clinical Risk Factors ◽

Intermediate Risk ◽

Clinical Risk ◽

Deauville Score

Abstract There are limited data regarding the combined value of the pretransplant Deauville score (DS) from a positron emission tomography scan and clinical risk factors in patients with relapsed/refractory aggressive non-Hodgkin lymphoma (NHL). We performed a retrospective analysis to assess the prognostic role of pretransplant DS in patients with relapsed/refractory aggressive NHL who underwent salvage chemotherapy and autologous stem cell transplantation (ASCT). We identified 174 eligible patients between January 2013 and March 2019. In multivariable analysis, pretransplant DS, B symptoms, and secondary International Prognostic Index (sIPI) were independent risk factors for event-free survival (EFS). These variables were used to derive an integrated risk score that categorized 166 patients with available information for all risk factors into 3 groups: low (n = 92; 55.4%), intermediate (n = 48; 28.9%), and high (n = 26; 15.7%). The new prognostic index showed a strong association with EFS (low-risk vs intermediate-risk hazard ratio [HR], 3.94; 95% confidence interval [CI], 2.16-7.17; P < .001; low-risk vs high-risk HR, 10.83; 95% CI, 5.81-20.19; P < .001) and outperformed models based on clinical risk factors or DS alone. These results were validated in 60 patients from an independent external cohort (low-risk vs intermediate-risk HR, 4.04; 95% CI, 1.51-10.82; P = .005; low-risk vs high-risk HR, 10.49; 95% CI, 4.11-26.73; P < .001). We propose and validate a new prognostic index that risk-stratifies patients undergoing salvage chemotherapy followed by ASCT, thereby identifying patients at high risk for posttransplant treatment failure.

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Validation of Mantle Cell International Prognostic Index (MIPI) in Mantle Cell Lymphoma (MCL) in a Retrospective Single Institution Series

Blood ◽

10.1182/blood.v112.11.2828.2828 ◽

2008 ◽

Vol 112 (11) ◽

pp. 2828-2828

Author(s):

Annalisa Chiappella ◽

Barbara Botto ◽

Filippo Marmont ◽

Ernesta Audisio ◽

Ileana Baldi ◽

...

Keyword(s):

High Risk ◽

Clinical Course ◽

Prognostic Score ◽

International Prognostic Index ◽

Prognostic Index ◽

Low Risk ◽

Intermediate Risk ◽

Single Institution ◽

Mantle Cell

Abstract Introduction: The clinical course of MCL is characterized by a continuous pattern of relapse and a poor long term outcome with a median Overall Survival (OS) of four years and a 15% of long term survivors. Recently a new clinical prognostic score (MIPI), including performance status, age, LDH level and leukocyte count has been reported. This score allows a more reliable estimation of individual clinical course. We retrospectively applied the MIPI score to patients with MCL. Patients and methods: Between 1999 and 2007, 40 patients with MCL diagnosed and treated in a single institution entered into the study. Clinical characteristics were as follows: median age 56 years (range 37–81), 80% male; 82% stage IV; 78% bone marrow involvement and 15% MCL with blastoid variant. First line treatments were: high dose chemoimmunotherapy including Rituximab (R) with autologous stem cell transplantation (R-HDC) in 26 patients and Rituximab-CHOP like chemotherapy (R-CHOP) in 14. Crude Kaplan-Meier OS and progression-free survival (PFS) curves were estimated both overall and stratified by MIPI and International Prognostic Index (IPI) score. Differences between curves were tested using the 2-tailed log-rank test. In order to quantify the predictive discrimination of MIPI and IPI scores, univariate logistic models (with death and progression event as binary outcomes) were fitted and the area under the receiver operating characteristic (ROC) curves (c index) was estimated. Results: According to MIPI score 17 patients (43%) were at low risk (LR, score 0–3), 13 patients (32%) at intermediate risk (IR, score 4–5) and 10 patients (25%) at high risk (HR, score >5). According to IPI score 14 patients (35%) were at low risk (LR), 16 patients (40%) at low-intermediate risk (LIR) and 10 patients (25%) at intermediate-high and high risk (IH-HR). At the end of the treatment, 30 patients achieved a CR, five a PR and five did not respond. Relapses occurred in 17 patients and seven of them died of lymphoma. With a median follow-up (FU) of 29 months, OS was 85% (95% CI: 66%–93%); with a median FU of 21 months, PFS was 70% (95% CI: 51%–83%). Twenty-nine months OS rates for MIPI score were: LR 100%, IR 81%, HR 66% respectively (p=.07) and for IPI score were: LR 92%, LIR 94%, IH-HR 65% respectively (p=.09). Twenty-one months PFS rates for MIPI score were: LR 92%, IR 59%, HR 45% respectively (p=.006) and for IPI score were: LR 73%, LIR 87%, IH-HR 44% respectively (p=.09). MIPI score was more predictive than IPI score for the death event and for the progression event: the c index was 74% and 73% for MIPI compared to 72% and 69% for IPI respectively. In a subgroup analysis performed on 26 R-HDC patients, OS and PFS rates stratified for MIPI were: for OS, LR 100% vs IR 80% vs HR 69% (p=.4) and for PFS, LR 91% vs IR 80% vs HR 57% (p=.04) respectively. Discussion: in our retrospective series of patients, MIPI prognostic score discriminates among patients with different PFS. Relapses remain the most important issue for all patients affected by MCL, namely in HR group according to MIPI. New therapeutic strategies are warranted to improve the prognosis of MCL.

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Follicular Lymphoma: Design of a Protein-Based Survival Predictor Using Tissue-Microarrays (TMA).

Blood ◽

10.1182/blood.v104.11.2266.2266 ◽

2004 ◽

Vol 104 (11) ◽

pp. 2266-2266

Author(s):

Francisca I. Camacho ◽

Reyes Arranz-Saez ◽

Alessia Caleo ◽

Jimena Cannata ◽

Laura Cereceda ◽

...

Keyword(s):

Cell Cycle ◽

High Risk ◽

Follicular Lymphoma ◽

Univariate Analysis ◽

International Prognostic Index ◽

Control Cell ◽

Low Risk ◽

Low Grade ◽

Frequent Relapses ◽

Survival Predictor

Abstract Follicular lymphoma (FL) is the most common type of low-grade non-Hodgkin’s lymphoma. A subset of FL patients shows a favorable treatment response, and remains in complete remission with long-term follow-up, while another subset of patients has a clinical course characterized by frequent relapses and a shorter survival. Survival predictors for FL are mainly based on clinical data, and they seem to lack accuracy enough predicting survival among patients with advanced stage disease. The aim of this study is to build a survival predictor based on a set of biological markers using Tissue Micro Arrays (TMA). To this purpose, we have retrospectively analysed the expression of a group of 40 selected genes - related with apoptosis control, cell cycle, B-cell differentiation and signaling- in a series of 192 FLs using TMA. The association of these molecules with survival, and their usefulness to discriminate among FLIPI groups was evaluated. Results were quantified using different tools; singularly nuclear markers were scanned using the Bliss system and the quantitative expression was measured using the TMAscore v.1.0 image analysis software (Bacus Laboratories, Inc.). The mean overall survival (OS) was 74 months, and 38 months for progression-free survival (PFS). Statistically significant differences in OS were found with the Follicular Lymphoma International Prognostic Index (FLIPI) score (p < 0.01). No significant OS or PFS differences were observed between FL grades 1–3, between grades 3a and 3b, or using Ki67 expression. Univariate analysis revealed several TMA markers with capacity to predict OS and PFS. After multivariate analysis, a set of 4 apoptosis and cell-cycle markers was integrated into a FLIPI-independent clinical predictor, with the capacity to recognize two groups of FL patients with statistically significant differences in OS (83% versus 43% of OS at 120 months; p< 0.001). Then, patients were classified into low-risk (FLIPI: 0–2) and high-risk groups (FLIPI: 3–5), and the protein-based predictor model was used in both groups. High-risk FLIPI patients were stratified by the protein-based predictor into two groups with OS probability of 79,3% versus 14,2% at 120 months, p < 0.001, and low-risk FLIPI patients were also separated into two groups with OS probability of 100% versus 60,4% at 120 months, p < 0.01. The model is now being validated in a blind set. These results suggest that an integrated use of the FLIPI and the protein-based model could reach a higher accuracy predicting survival in FL.

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Response to Rituximab, Cyclophosphamide and Dexamethasone as Initial or Salvage Therapy in Low Grade Lymphoma and Immune Hemolytic Anemia.

Blood ◽

10.1182/blood.v108.11.4726.4726 ◽

2006 ◽

Vol 108 (11) ◽

pp. 4726-4726

Author(s):

Neetu Radhakrishnan ◽

Rajasree Roy ◽

Reuven Yakubov ◽

Matthew Kaufman ◽

Kanti Rai ◽

...

Keyword(s):

Side Effects ◽

Follicular Lymphoma ◽

Hemolytic Anemia ◽

Salvage Therapy ◽

International Prognostic Index ◽

Prognostic Index ◽

Lymphoproliferative Disorders ◽

Low Grade ◽

Immune Hemolytic Anemia ◽

Heavily Pretreated

Abstract BACKGROUND: The combination of dexamethasone, cyclophosphamide, and rituximab (RCD) have documented activity in lymphoproliferative disorders without severe side effects and shows significant results in the setting of AIHA (auto immune hemolytic anemia) in CLL (chronic lymphocytic leukemia). We conducted a retrospective study of the response to RCD in low grade lymphoproliferative disorders and in AIHA at our institution. METHODS: Between December 1998 and June 2006, 17 patients completed therapy after a median of 6 cycles of RCD (rituximab 375 mg/m2 i.v. on Day 1, dexamethasone 40 mg intravenously [i.v.] or [p.o.] on Days 1–4, cyclophosphamide at a dose of 750 mg/m2 i.v. on Day 2). Data regarding patient characteristics, disease pathology, stage, IPI scores, prior treatments, response using standard disease response criteria and flow cytometric and/or molecular studies where appropriate, and any recurrences were recorded. Stage IV responders with undocumented post treatment bone marrows were classified as PR (partial response). RESULTS: The median age of the patients was 63 years (range: 28 – 80 years), 42% were male; (9/17) 52% had previously untreated disease; and (9/17) 52% had follicular lymphoma, 35% had other indolent lymphomas or CLL (2 marginal zone lymphoma (1 salvage), 1 mantle zone lymphoma, 1 waldenstroms macroglobulinemia requiring frequent plasmapheresis, 1 small cell lymphocytic lymphoma and 1 CLL) and 2 had steroid resistant AIHA. Median international prognostic index/follicular lymphoma international prognostic index (IPI/FLIPI) score for the malignant lymphomas was 2 (range: 0–3). Objective responses (OR) and complete responses (CR) were observed in (16/17) 94% and (11/17) 64%, respectively. For patients with follicular lymphoma, the respective OR and CR ratios were 5/5 (100%) and 3/5 (60%) as first line therapy, and 4/4 (100%)and 2/4 (50%) as salvage therapy. Both patients with heavily pretreated AIHA responded completely and have not relapsed. The median progression free survival (PFS) was 18 months (range: 1–58 months) and median overall survival (OS) was 28 months (range: 1 – 78 months). The PFS for follicular lymphomas was a median of 19months (range: 6 – 55months), with median OS of 45 months (range: 6 – 78 months). Both patients with heavily pretreated AIHA achieved CR without relapse. Recurrence of disease did not correlate with the FLIPI/IPI. Side effects were minimal and included grade II – III neutropenia, hyperglycemia and steroid induced insomnia. CONCLUSIONS: RCD is active as initial or salvage therapy in patients with low grade lymphoproliferative disorders and is highly effective in steroid refractory AIHA with minimal side effects. Addition of rituximab prior to moderate doses of cytoxan and dexamethasone significantly enhances the response rates. This chemotherapeutic combination with a low side effect profile appears to produce significant responses for low grade lymphomas and may translate into better long term outcomes compared to previously utililized regimens. Further studies are needed to evaluate whether this regimen may improve the outcome of patients with low grade lymphomas. Summary of data Pathology (no: of pts) OR (pt no:) CR(pt no:) PFS (months) Recurrence(pt no:) Untreated follicular lymphoma (5) 5 3 19 1 Pre treated follicular (4) 4 2 12 3 Other indolent lymphoma (6) 5 4 23 0 AIHA(2) 2 2 14.5 0

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The Follicular Lymphoma International Prognostic Index (FLIPI) separates high-risk from intermediate- or low-risk patients with advanced-stage follicular lymphoma treated front-line with rituximab and the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) with respect to treatment outcome

Blood ◽

10.1182/blood-2006-01-013367 ◽

2006 ◽

Vol 108 (5) ◽

pp. 1504-1508 ◽

Cited By ~ 155

Author(s):

Christian Buske ◽

Eva Hoster ◽

Martin Dreyling ◽

Joerg Hasford ◽

Michael Unterhalt ◽

...

Keyword(s):

Treatment Outcome ◽

High Risk ◽

Follicular Lymphoma ◽

International Prognostic Index ◽

Prognostic Index ◽

Intermediate Risk ◽

Advanced Stage ◽

Front Line ◽

High Risk Patients ◽

Risk Patients

The Follicular Lymphoma International Prognostic Index (FLIPI) was developed to predict prognosis of patients with follicular lymphoma (FL). However, it was based on different protocols, none of which included rituximab. The current analysis aimed at evaluating the predictive value of the FLIPI for treatment outcome in 362 patients with advanced-stage FL treated front-line with rituximab/CHOP in a prospective trial of the German Low Grade Lymphoma Study Group. According to the FLIPI, 14% of the patients were classified as low-risk, 41% as intermediate-risk, and 45% as high-risk patients. With a 2-year time to treatment failure (TTF) of 67%, high-risk patients had a significantly shorter TTF as compared with low- or intermediate-risk patients (2-year TTF of 92% and 90%, respectively; P < .001). Our data demonstrate that the FLIPI is able to identify high-risk patients with advanced-stage FL after first-line treatment with rituximab/chemotherapy.

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Retrospective Study of the Utility of Follicular Lymphoma International Prognostic Index (FLIPI) and FLIPI2 In Patients with Follicular Lymphoma Uniformly Treated with Rituximab, Cyclophosphamide, Doxorubicin, Vincristin, and Prednisone

Blood ◽

10.1182/blood.v116.21.3100.3100 ◽

2010 ◽

Vol 116 (21) ◽

pp. 3100-3100

Author(s):

Ayumi Numata ◽

Katsumichi Fujimaki ◽

Naoto Tomita ◽

Masatsugu Tanaka ◽

Chizuko Hashimoto ◽

...

Keyword(s):

Follicular Lymphoma ◽

Conflicts Of Interest ◽

Risk Group ◽

International Prognostic Index ◽

Prognostic Index ◽

High Risk Group ◽

Retrospective Data ◽

Time To Failure ◽

Intermediate Risk

Abstract Abstract 3100 The Follicular Lymphoma International Prognostic Index (FLIPI) is the most useful prognostic index for follicular lymphoma (FL). FLIPI was developed from retrospective data, which was based on treatment without rituximab (R) therapy and did not contain β2-microglobulin data of some cases. Recently the working group that had suggested FLIPI proposed FLIPI2, based on prospectively collected data. However, FLIPI2 contains data on several different treatment methods, such as treatment with or without R therapy. The present study aimed to retrospectively analyze the prognosis of FL uniformly treated with the combination of R, cyclophosphamide, doxorubicin, vincristin, and prednisone (R-CHOP). This study involved 114 patients consecutively diagnosed with FL who were treated with R-CHOP and were registered in the data-base of the Yokohama City University Hematology Group between January 2001 and October 2009. All the parameters required for FLIPI and FLIPI2 calculation were present in 108 patients (men, 53; women, 55, median age; 57 years [34- 78 years]). The median follow-up period was 31.7 months (0.8- 97.5 months). According to the FLIPI score, 50 patients (46.3%) were in the high-risk group (HR); 31 patients (28.7%), the intermediate-risk group (IR); and 27 patients (25.0%), the low-risk group (LR). On the basis of the FLIPI2 score, 45 patients (41.7%) were in HR; 52 patients (48.1%), IR; and 11 patients (10.2%), LR. According to FLIPI, the 5-year overall survival (5yOS) was 74.1% (95% CI, 58.1– 94.4%) for HR, 89.5% (95%, CI, 76.6– 100%) for IR, and 100% for LR (p = 0.0049); the 5-year time to failure (5yTTF) was 42.3% (95% CI, 26.0– 68.9%) for HR, 39.1% (95% CI, 22.7– 67.3%) for IR, 66.4% (95% CI, 47.2– 93.4%) for LR (p = 0.244). According to the FLIPI2 score, 5yOS was 71.3% (95% CI, 53.2– 95.6%) for HR, 85.6 % (95% CI, 72.0– 100%) for IR, and 100% for LR (p = 0.197), the 5yTTF was 35.8% (95% CI, 20.0– 64.2%) for HR, 46.7% (95% CI, 31.1– 70.3%) for IR, and 76.2% (95% CI, 52.1– 100%) for LR (p = 0.075). In conclusion, in FL patients treated with R-CHOP, FLIPI provided a more accurate OS than that provided by FLIPI2; however, FLIPI2 provided a more accurate TTF than that provided by FLIPI. Disclosures: No relevant conflicts of interest to declare.

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Efficacy of Idelalisib as Bridge to Allogeneic Stem Cell Transplant in Relapsed Follicular Lymphoma: A Case Report

Tumori Journal ◽

10.5301/tj.5000679 ◽

2017 ◽

Vol 103 (1_suppl) ◽

pp. S41-S43 ◽

Cited By ~ 3

Author(s):

Miriam Marangon ◽

Cinzia Pellegrini ◽

Lisa Argnani ◽

Pier Luigi Zinzani

Keyword(s):

Stem Cell ◽

Case Report ◽

Follicular Lymphoma ◽

Stem Cell Transplant ◽

International Prognostic Index ◽

Prognostic Index ◽

Unrelated Donor ◽

Cell Transplant ◽

Allogeneic Stem Cell Transplant ◽

Effective Treatment Option

Purpose A large number of new therapeutic agents have been studied for patients with relapsed/refractory follicular lymphoma (FL). Among new therapies, idelalisib, a novel PI3K inhibitor, shows promising results in the management of this disease. Case report We describe the case of a 39-year-old patient with a diagnosis of grade 3a FL and a Follicular Lymphoma International Prognostic Index score of 2, who underwent several lines of therapy (including autologous stem cell transplant) with transient responses or no response at all. The patient was subsequently treated with 5 courses of idelalisib monotherapy, achieving a partial response. No relevant toxicities occurred. The patient underwent allogeneic stem cell transplant (allo-SCT) from an unrelated donor and obtained a complete response, which was confirmed after 3, 6, 9, and 12 months, and is still ongoing. Conclusions As previously reported, the achievement of a good response is predictive for a better outcome after allo-SCT: idelalisib represents an effective treatment option for patients with relapsed/refractory FL, which can also be adopted as a bridge to allo-SCT.

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