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Title: Follicular Lymphoma Evaluation Index (FLEX): A new clinical prognostic model that is superior to existing risk scores for predicting progression-free survival and early treatment failure after frontline immunochemotherapy.
Austin Authors: Mir, Farheen;Mattiello, Federico;Grigg, Andrew P ;Herold, Michael;Hiddemann, Wolfgang;Marcus, Robert;Seymour, John F;Bolen, Christopher R;Knapp, Andrea;Nielsen, Tina;Casulo, Carla
Affiliation: The Royal Marsden NHS Trust Foundation, London, UK
Peter MacCallum Cancer Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
F. Hoffmann-La Roche Ltd, Basel, Switzerland
Austin Health
HELIOS-Klinikum Erfurt, Erfurt, Germany
University Hospital Munich, Munich, Germany
HCA Healthcare, London, UK
Genentech, Inc, South San Francisco, California, USA
F. Hoffmann-La Roche Ltd, Basel, Switzerland
Wilmot Cancer Institute, University of Rochester, New York, New York, USA
Issue Date: Dec-2020 2020-08-20
Publication information: American Journal of Hematology 2020; 95(12): 1503-1510
Abstract: Patients with advanced-stage follicular lymphoma (FL) who progress early after receiving first-line therapy have poor overall survival (OS). Currently applied clinical prognostic models such as FL International Prognostic Index [FLIPI], FLIPI-2 and PRIMA-Prognostic Index [PRIMA-PI] have suboptimal sensitivity and specificity to predict this poor prognosis subgroup. The primary objective was to develop a novel prognostic model, the FL Evaluation Index (FLEX) score, to identify high-risk patients and compare its performance with FLIPI, FLIPI-2 and PRIMA-PI. Progression-free survival (PFS) after first-line immunochemotherapy was the key endpoint, while OS and progression of disease within 24 months (POD24) were also assessed. The model, which includes nine clinical variables, was developed using a cohort of patients with previously untreated advanced-stage FL from the phase 3 GALLIUM trial (NCT01332968). The performance of the model was validated using data from the SABRINA trial (NCT01200758). In GALLIUM (n = 1004; 127 with and 877 without POD24), FLEX increased the intergroup (low-risk/high-risk) difference in 2-year and 3-year PFS rates and demonstrated superior intergroup differences in 2-year and 3-year OS rates compared with FLIPI, FLIPI-2 and PRIMA-PI. Sensitivity for a high-risk score to predict POD24 was 60% using FLEX compared with 53% for FLIPI and FLIPI-2, and 69% for PRIMA-PI, while specificity was 68% for FLEX compared with 58% for FLIPI, 59% for FLIPI-2 and 48% for PRIMA-PI. The prognostic value of FLEX in SABRINA was similar to FLIPI. Therefore, FLEX appears to perform better than existing prognostic models in previously untreated FL, in particular for the newer treatment regimens.
DOI: 10.1002/ajh.25973
ORCID: 0000-0002-7511-8797
PubMed URL: 32815559
Type: Journal Article
Appears in Collections:Journal articles

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