BACKGROUND: FLIPI uses five prognostic factors to define 3 risk groups. Limited data exists regarding the role of FLIPI in the era of rituximab (R) and R-chemo as initial therapy
METHODS: NLCS, a prospective, observational cohort study, collected demographic and clinical outcome data. Cox proportional hazards models were constructed to examine FLIPI strata as predictors for PFS, time to next therapy (TTNT) and OS.
RESULTS: Among the 1,069 male and 1,124 female patients (pts) with FL 52% were > 60 years, 69% stage III-IV, 22% had Hb <12 g/dL, 37% >4 nodal areas, and 22% LDH >ULN. Most pts were white (91%), treated in U.S. community practices (79%), had ECOG PS of 0/1 (67%/29%), and treated with single agent R (14%) or a R-containing regimen (54%). 771 pts (35%) were FLIPI low risk (LR), 666 (30%) intermediate (IR), and 756 (35%) high (HR). Statistically significant differences were seen between the 3 risk groups among pts receiving non-R containing regimens in OS, PFS and TTNT concordant with prior studies. FLIPI risk groups were significant predictors of PFS and OS for patients treated with R-alone, R-CHOP, and R-CVP.
CONCLUSIONS: FLIPI remains a useful prognostic index in pts treated in US community practices with non-R and R-containing regimens. Stratifying pts into FLIPI risk groups, generally predicts better outcomes for the LR group > IR > HR in terms of PFS, TTNT and OS.
