Follicular Lymphoma International Prognostic Index (FLIPI) and FLIPI-2

Follicular Lymphoma International Prognostic Index (FLIPI) and FLIPI-2

 

  • The Follicular Lymphoma International Prognostic Index (FLIPI) was developed prior to the routine use of rituximab and identified five risk factors: age, stage, lactate dehydrogenase, hemoglobin, and number of involved lymph nodes sites. Although it is a useful clinical tool in predicting disease behavior, the FLIPI does not reliably identify highest-risk patients who experience early relapse after up-front therapy. The Follicular Lymphoma International Prognostic Index (FLIPI) derives from a multivariate analysis of survival of 4171 patients diagnosed between 1985 and 1992. (click here for original article)

Risk category and prognosis

FLIPI score Risk category % of patients Median PFS (m)2
0 or 1 Good 36 84
2 Inter­mediate 37 70
3 – 5 Poor 27 42
  • The FLIPI retains prognostic relevance in the era of rituximab. However, a FLIPI-2 scoring system has also been published, incorporating beta 2 microglobulin levels, and applied at the time of first therapy in a cohort that largely received chemoimmunotherapy.

FLIPI 1 VS 2

FLIPI-2 RISK FACTORS
Risk category and prognosis
  • The Follicular Lymphoma International Prognostic Index-2 (FLIPI2) derives from a multivariate analysis of survival of 832 patients receiving first treatment for follicular lymphoma between 2003 and 2005, followed-up for a median of 38 months. (click here for original article)

Important Note > A clinicogenetic model, termed M7FLIPI, consisting of the FLIPI risk factors, Eastern Cooperative Oncology Group performance status, and mutations in seven genes (i.e., EZH2, ARID1A, EP300, FOXO1, MEF2B, CREBBP, and CARD11) was constructed and was more closely associated with outcome compared to the clinical or genetic predictors alone. Two risk groups were identified: a high risk group (28% of patients) with five-year failure-free survival (FFS) of 38 percent, and a low-risk group (72% of patients) with a five-year FFS of 77 percent.

The M7FLIPI is the first prognostic score in lymphoma to incorporate both genetic and clinical factors, resulting in the identification of a high-risk group in patients treated with standard chemoimmunotherapy.