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

Nooka, Ajay K.; Nabhan, Chadi; Zhou, Xiaolei; Taylor, Michael D.; Byrtek, Michelle; Miller, Thomas P.; Friedberg, Jonathan W.; Zelenetz, Andrew D.; Link, Brian K.; Cerhan, James R.; Dillon, Hildy; Sinha, Rajni; Shenoy, Pareen J.; Levy, Deborah M.; Dawson, Keith; Hirata, Jamie; Flowers, Christopher R.

doi:10.1093/annonc/mds429

Cited by 81 publications

(59 citation statements)

References 12 publications

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“…31,33 The first large-scale validation of the FLIPI outside of a clinical trial setting was recently reported by the National Lymphocare Study. 34 In this report, approximately 2200 patients from community and academic sites were found to almost evenly fall into low-risk (35%), intermediate-risk (30%), and high-risk (35%) FLIPI groups, with 2-year PFS at 84%, 72%, and 65%, respectively. Although the median OS had not been reached in any group (median follow-up, 57 months), the FLIPI identified differences in outcome irrespective of rituximab-based versus chemoimmunotherapy-based treatment in this registry evaluation, further validating that FLIPI is applicable in routine clinical risk stratification and supporting its incorporation into patient-level discussions.…”

Section: Clinical Prognostic Indicesmentioning

confidence: 74%

“…38 Some have questioned whether the paradigm of "watchful waiting" for low-tumor-burden patients remains relevant in the modern era, particularly because rituximab therapy prolongs PFS and, to a lesser extent, time to chemotherapy initiation in this low-risk population. 34,38,39 However, a retrospective analysis of 120 treatment-naive low-tumor-burden FL patients among more than 1000 patients enrolled in a population-based French registry underwent a watchful waiting strategy. 39 The median time to treatment initiation in this group was 55 months, and their outcome was comparable to 242 patients with similar features receiving frontline rituximab-based therapy.…”

Section: Assessment Of "Tumor Burden"mentioning

confidence: 99%

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Dissecting follicular lymphoma: high versus low risk

Smith

2013

Hematology

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Progress in the management of follicular lymphoma (FL) has translated to improved outcomes, with most patients surviving a decade or more from the time of diagnosis. However, the disease remains quite heterogeneous and a substantial number of patients have more aggressive disease with short responses to therapy and/or transformation to higher-grade lymphomas. Given the lack of a single standard approach, it is important to understand sources of heterogeneity among patients that influence initial management, surveillance strategies, and overall prognosis. Most of the validated tools, such as the Follicular Lymphoma International Prognostic Index (FLIPI) and FLIPI-2, apply to the frontline setting, and there is an unmet need for prognostic tools in relapsed and refractory disease states. In particular, the number of prior treatment regimens may be less important than the duration of response to the most recent regimen and the type of prior therapy received. Furthermore, despite awareness of progressive genetic and epigenetic derangements and a growing appreciation of the microenvironment's role in FL outcomes, there is no validated means of incorporating biologic data into clinical prognostic indices. This review highlights the current state of knowledge regarding risk stratification in FL.

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Section: Clinical Prognostic Indicesmentioning

confidence: 74%

Section: Assessment Of "Tumor Burden"mentioning

confidence: 99%

Dissecting follicular lymphoma: high versus low risk

Smith

2013

Hematology

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“…After enrollment, all clinicopathologic data and treatment were collected, then patients were followed prospectively on their clinical outcome. Since 2009, there have been several publications from NLCS meeting the criteria of CER [16,[63][64][65]. Friedberg and colleagues reported the outcome of FL stage I treated in immunochemotherapy era.…”

Section: Nlcs Databasementioning

confidence: 99%

“…The data suggested the importance of complete staging when predicting survival outcome of FL stage I patients and challenged the existing paradigm of RT as the preferred therapy by demonstrating comparable excellent survival outcome of FL stage I treated with different strategies [63]. Nooka et al highlighted the relevance of FLIPI prognostics in the era of immunochemotherapy treatment [64], while Nabhan et al led the effort to highlight in differences in presentation and management of FL across ethnic groups [65]. Recently Martin et al presented the data from NLCS regarding lymphoma treatment delivery, showing that most FL patients who received immuno chemotherapy in the NLCS completed ≥5 cycles of treatment.…”

Section: Nlcs Databasementioning

confidence: 99%

Comparative effectiveness research in follicular lymphoma: current and future perspectives and challenges

Wudhikarn

Link

2014

J. Compar. Effect. Res.

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Follicular lymphoma (FL) is the most common indolent non-Hodgkin's lymphoma in northern America. FL is an incurable disease with relapsing-remitting courses requiring serial intermittent treatments. Duration of remission will often become progressively shorter and most patients will die from refractory disease or transformation to aggressive lymphoma. Given the incurable nature of FL, current goals of treatment are focused on improving symptoms and survival by a variety of available treatment options, while considering potential adverse events. Although randomized controlled trials are universally perceived as the gold standard of clinical research, randomized controlled trials are not always practical and have several limitations. Therapeutic and diagnostic options of FLs are expanding faster than randomized controlled trials can test them, so employing comparative effectiveness research on other research designs are needed to efficiently improve global FL care. Implementing comparative effectiveness research with judicious use of appropriate research designs will hopefully fill current knowledge gaps and provide insights for FL managements.

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“…Clinical prognostic scores: baseline FLIPI (Follicular Lymphoma International Prognostic Index) and FLIPI2 are validated as prognostic risk factors for early and advanced FL in clinical trial settings and outside of clinical trials, irrespectively to CT, R-based and immuno-chemotherapy-based treatment 10. More recently, the m7-FLIPI score, combining clinical parameters (FLIPI and Performance status according to ECOG score) with gene mutations (EZH2, ARID1A, MEF2B, EP300, FOXO1, CREBBP, and CARD11), demonstrated a prognostic value in FL patients receiving first-line immuno-chemotherapy (ICT) 11.…”

Section: Introductionmentioning

confidence: 99%

Systemic Front Line Therapy of Follicular Lymphoma: When, to Whom and How

Pavanello

Steffanoni

Ghielmini

et al. 2016

Mediterr J Hematol Infect Dis

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The natural history of follicular lymphoma is usually characterized by an indolent course with a high response rate to the first line therapy followed by recurrent relapses, with a time to next treatment becoming shorter after each subsequent treatment line. More than 80% of patients have advanced stage disease at diagnosis. The time of initiation and the nature of the treatment is mainly conditioned by symptoms, tumor burden, lymphoma grading, co-morbidities and patients preference. A number of clinical and biological factors have been determined to be prognostic in this disease, but the majority of them could not show to be predictive of response to treatment, and therefore can’t be used to guide the treatment choice. CD20 expression is the only predictive factor recognized in the treatment of FL and justifies the use of “naked” or “conjugated” anti-CD20 monoclonal antibodies as a single agent or in combination with chemo- or targeted therapy. Nevertheless, as this marker is almost universally found in FL, it has little role in the choice of treatment. The outcome of patients with FL improved significantly in the last years, mainly due to the widespread use of rituximab, autologous and allogeneic transplantation in young and fit relapsed patients, the introduction of new drugs and the improvement in diagnostic accuracy and management of side effects. Agents as new monoclonal antibodies, immuno-modulating drugs, and target therapy have recently been developed and approved for the relapsed setting, while studies to evaluate their role in first line treatment are still ongoing. Here we report our considerations on first line treatment approach and on the potential factors which could help in the choice of therapy.

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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

Cited by 81 publications

References 12 publications

Dissecting follicular lymphoma: high versus low risk

Dissecting follicular lymphoma: high versus low risk

Comparative effectiveness research in follicular lymphoma: current and future perspectives and challenges

Systemic Front Line Therapy of Follicular Lymphoma: When, to Whom and How

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