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When using the International Prognostic Index (IPI), initially designed for aggressive non-Hodgkin's lymphoma, 10-15% of patients with follicular lymphoma are classified in the poor-risk category. Because of this, IPI is not appropriate for identifying patients in whom intensive therapy must be tested. An international cooperative study was thus designed to collect the data on initial characteristics of a large number of patients with follicular lymphoma and to propose a prognostic index for it. The cooperative study culminated in a proposal for a Follicular Lymphoma International Prognostic Index (FLIPI). This would be a simple and reproducible prognostic index and a useful tool for improving the prognostic assessement of patients with follicular lymphoma. It can also be of help to select the most appropriate treatment in individual patients and to stratify patients in prospective trials.

Risk factors for the Definition of the International Prognostic Index (IPI)

Parameter

Risk Factor

Score

RR

95% CI

Age

< 60

1

2.38

2.04 - 2.78

Ann Harbor Stage

3-4

1

2.00

1.56 - 2.58

Hemoglobin

< 12 g/dl

1

1.55

1.30 - 1.88

Serum LDH

> ULN

1

1.50

1.27 - 1.77

Number of nodal sites

> 4

1

1.39

1.18 - 1.64

Maximum score is 5

Risk Groups of the International Prognostic Index

FLIPI Group

Score

% Pat

% 5-J OAS

% 10-J OAS

RR

95% CI

1 = low

0 - 1

36

90.6

70.7

1.0

-

2 = low intermediate

2

37

77.6

50.9

2.3

1.9-2.8

4 = high

< 3

27

52.5

35.5

4.3

3.5-5.3

International Prognostic Index for Aggressive Lymphoma (General IPI)

flipi-survival_02

Age adjusted International prognostic Index

flipi-nodalsites_02

Copyright ©2008 Massachusetts Medical Society. All rights reserved. The International Non-Hodgkin's Lymphoma Prognostic Factors Project. A Predictive Model for Aggressive Non-Hodgkin's Lymphoma.NEJM 1993, Sept 30, 329(14): 987-994.

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