Evaluation of four prognostic indices in follicular lymphoma treated in first line with immunochemotherapy

Several clinical risk models have been proposed to predict outcome in follicular lymphoma (FL). The development of Next Generation Sequencing (NGS) technologies has allowed the integration of somatic gene mutations in clinical scores to build genotyped-based risk models, such as m7-FLIPI. We explored four clinical or clinicogenetic risk models in patients with symptomatic FL who received frontline immunochemotherapy. Out of 191 patients with FL grade 1-3a, 109 were successfully genotyped. Treatment consisted on rituximab (R) plus CVP/CHOP (72.5%) or R-bendamustine (R-B) (27.5%). The proportion of cases classified as high-risk in FLIPI, FLIPI-2, PRIMA-PI or m7-FLIPI were 39.3%, 14%, 30.3%, 22%, respectively. No case with low-intermediate FLIPI was upgraded in m7-FLIPI, but 18 out of 42 higher-risk patients in FLIPI were downgraded to low-risk m7-FLIPI. Sensitivity and specificity for the prediction of POD24 was highest for FLIPI. The discrimination for progression free survival (PFS) and overall survival (OS) was best for FLIPI (c-index: 0.644 and 0.727, respectively). When analyzed only R-B patients, m7-FLIPI had higher discrimination for PFS and OS. Thus, FLIPI remains as the clinical risk score with higher discrimination in advanced FL patients treated with immunochemotherapy, but the performance of m7-FLIPI should be further investigated in patients treated with R-B.