Vojnosanitetski pregled 2015 Volume 72, Issue 1, Pages: 26-32
https://doi.org/10.2298/VSP1501026A
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Follicular lymphoma patients with a high FLIPI score and a high tumor burden: A risk stratification model
Anđelić Boško (Clinical Center of Serbia, Clinic for Hematology, Belgrade)
Todorović-Balint Milena (Clinical Center of Serbia, Clinic for Hematology, Belgrade + Faculty of Medicine, Belgrade)
Antić Darko (Clinical Center of Serbia, Clinic for Hematology, Belgrade + Faculty of Medicine, Belgrade)
Bila Jelena (Clinical Center of Serbia, Clinic for Hematology, Belgrade + Faculty of Medicine, Belgrade)
Đurašinović Vladislava (Clinical Center of Serbia, Clinic for Hematology, Belgrade)
Mihaljević Biljana (Clinical Center of Serbia, Clinic for Hematology, Belgrade + Faculty of Medicine, Belgrade)
Background/Aim. The widely accepted Follicular Lymphoma International
Prognostic Index (FLIPI) divides patients into three risk groups based on the
score of adverse prognostic factors. The estimated 5-year survival in
patients with a high FLIPI score is around 50%. The aim of this study was to
analyse the prognostic value of clinical and laboratory parameters that are
not included in the FLIPI and the New Prognostic Index for Follicular
Lymphoma developed by the International Follicular Lymphoma Prognostic Factor
Project (FLIPI2) indices, in follicular lymphoma (FL) patients with a high
FLIPI score and high tumor burden. Methods. The retrospective analysis
included 57 newly diagnosed patients with FL, a high FLIPI score and a high
tumor burden. All the patients were diagnosed and treated between April 2000
and June 2007 at the Clinic for Hematology, Clinical Center of Serbia,
Belgrade. Results. The patients with a histological grade > 1, erythrocyte
sedimentation rate (ESR) ± 45 mm/h and hypoalbuminemia had a significantly
worse overall survival (p = 0.015; p = 0.001; p = 0.008, respectively), while
there was a tendency toward worse overall survival in the patients with an
Eastern Cooperative Oncology Group (ECOG) > 1 (p = 0.075). Multivariate Cox
regression analysis identified a histological grade > 1, ESR ± 45 mm/h and
hypoalbuminemia as independent risk factors for a poor outcome. Based on a
cumulative score of unfavourable prognostic factors, patients who had 0 or 1
unfavourable factors had a significantly better 5-year overall survival
compared to patients with 2 or 3 risk factors (75% vs 24.1%, p = 0.000).
Conclusion. The obtained results suggest that from the examined prognostic
parameters histological grade > 1, ESR ± 45 mm/h and hypoalbuminemia can
contribute in defining patients who need more aggressive initial treatment
approach, if two or three of these parameters are present on presentation.
Keywords: lymphoma, follicular, antineoplastic combined chemotherapy protocols, prognosis