In follicular lymphoma (FL), no prognostic index has been built based solely on a cohort of patients treated with initial immunochemotherapy. There is currently a need to define parsimonious clinical models for trial stratification and to add on biomolecular factors. Here, we confirmed the validity of both the follicular lymphoma international prognostic index (FLIPI) and the FLIPI2 in the large prospective PRIMA trial cohort of 1135 patients treated with initial R-chemotherapy ± R maintenance. Furthermore, we developed a new prognostic tool comprising only 2 simple parameters (bone marrow involvement and β2-microglobulin [β2m]) to predict progression-free survival (PFS). The final simplified score, called the PRIMA-PI (PRIMA-prognostic index), comprised 3 risk categories: high (β2m > 3 mg/L), low (β2m ≤ 3 mg/L without bone marrow involvement), and intermediate (β2m ≤ 3 mg/L with bone marrow involvement). Five-year PFS rates were 69%, 55%, and 37% in the low-, intermediate-, and high-risk groups, respectively (P < .0001). In addition, achieving event-free survival (EFS) or not at 24 months (EFS24) was a strong posttreatment prognostic parameter for subsequent overall survival, and the PRIMA-PI was correlated with EFS24. The results were confirmed in a pooled external validation cohort of 479 patients from the FL2000 LYSA trial and the University of Iowa/Mayo Clinic Lymphoma Specialized Program of Research Excellence Molecular Epidemiology Resource. Five-year EFS in the validation cohort was 77%, 57%, and 44% in the PRIMA-PI low-, intermediate-, and high-risk groups, respectively (P < .0001). The PRIMA-PI is a novel and easy-to-compute prognostic index for patients initially treated with immunochemotherapy. This could serve as a basis for building more sophisticated and integrated biomolecular scores.

4th Department of Internal Medicine Hematology University Hospital Hradec Kralove Czech Republic

Centre Hospitalier de la Roche sur Yon Roche sur Yon France

Centre Hospitalier Pontchaillou Rennes France

CHU de Reims and Université Reims Champagne Ardenne Reims France

Chulalongkorn University Bangkok Thailand

CNRS Unité Mixte de Recherche 5558 Laboratoire de Biométrie et Biologie Evolutive Equipe Biostatistique Santé Villeurbanne France

Deparment of Biostatistics Lysarc Lyon France

Department of Haematology Concord Repatriation General Hospital Concord Sydney NSW Australia

Department of Health Sciences Research Mayo Clinic Rochester MN

Department of Hematology Centre Hospitalier Universitaire de Tours Tours France

Department of Hematology Hospices Civils de Lyon and Université Claude Bernard Université de Lyon INSERM102 Centre National de la Recherche Scientifique 5286 Pierre Bénite France

Department of Internal Medicine University of Iowa College of Medicine Iowa City IA; and

Department of Laboratory Medicine and Pathology Mayo Clinic Rochester MN

Division of Hematology Mayo Clinic Rochester MN

Faculty of Medicine Charles University Prague Hradec Kralove Czech Republic

Hematology Department Cliniques Universitaires UCL Saint Luc Brussels Belgium

Hospices Civils de Lyon Service de Biostatistique et Bioinformatique and Université Lyon 1 Lyon France

Hospital Son Llàtzer Palma de Mallorca Spain

Institut Gustave Roussy Villejuif France

Institut Paoli Calmettes Marseille France

Peter MacCallum Cancer Centre and University of Melbourne Melbourne VIC Australia

Polyclinique Bordeaux Nord Aquitaine Bordeaux France

Portuguese Institute of Oncology Lisbon Portugal

Sydney Medical School University of Sydney Sydney NSW Australia

Blood. 2018 Jul 5;132(1):3-4. doi: 10.1182/blood-2018-05-847558. PubMed

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The EHA Research Roadmap: Malignant Lymphoid Diseases

Rituximab maintenance significantly reduces early follicular lymphoma progressions in patients treated with frontline R-CHOP