FLIPI score, number of lines of treatment impact survival in follicular lymphoma patients

Undergoing more lines of treatment and having a higher Follicular Lymphoma International Prognostic Index (FLIPI) score appear to be associated with worse survival in FL patients, a recent study has shown.

The study included 1,088 FL patients (median age, 57 years; 51 percent female), of whom 78 percent had FLIPI scores available upon diagnosis. A total of 208 deaths were observed. The overall survival (OS) rate was 92 percent at 5 years, 80 percent at 10 years, and 65 percent at 15 years. The median OS was not reached.

Stage I, II, and III malignancy had largely comparable 5-year OS rates, at 97 percent, 91 percent, and 88 percent, respectively. FLIPI score at baseline was also important. The 10-year OS rates for those with low, intermediate, and high baseline FLIPI were 91 percent, 77 percent, and 70 percent, respectively.

A total of 922 patients received treatment for FL, the most common of which was rituximab in combination with chemotherapy (52.1 percent) and chemotherapy alone (10.3 percent). Anthracycline was the most popular first-line treatment option, followed by rituximab monotherapy and radiation alone.

Patient outcomes deteriorated with increasing lines of treatment. Those who had received only first-line therapy did not reach median OS, while patients who had undergone second-line therapy showed a median OS of 11.67 years. By the fifth line of therapy, median OS had dropped to 3.13 years. At four or more lines of therapy, progression-free survival was only at 0.9 years.

“Future prospective studies are needed to assess a possible correlation between increased FLIPI score and inferior outcomes,” researchers said.