Determining The Survival Rate of Follicular Lymphoma

This article looks at the survival rate for Follicular lymphoma (FL), an indolent cancer that typically strikes people in their 50s and older.

It is the second most commonly diagnosed B-cell non-Hodgkin's lymphoma, after diffuse large B-cell lymphoma. FL is regarded as a manageable disease that may or may not require treatment. Although manageable, FL is not considered curable.

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Determining the Survival Rate

Follicular lymphoma is rarely a fatal disease; patients are far more likely to survive their lymphoma than succumb to it. However, FL can sometimes progress into a more aggressive form of lymphoma that will require more aggressive treatment.

In an effort to give patients and doctors alike a better idea of the prognosis of any one FL patient, a prognostic index was developed known as the Follicular Lymphoma International Prognostic Index (FLIPI).

The FLIPI index presents the following five adverse risk factors; a point is added for each factor if true:

  • Patient age is 60 or older
  • Patient's disease stage is III or IV
  • Patient's hemoglobin level is less than 12 g/dL
  • Patient's serum LDH level is greater than the ULN (upper limit of normal)
  • Patient's number of affected nodal sites is equal to or greater than 5

The following point groups are then used to determine risk groups and the survival rate:

[Number of factors: Risk group: Est. overall lymphoma survival]

  • 0-1: Low risk: Estimated overall lymphoma survival at 10 years: 70%
  • 2: Intermediate risk: Estimated overall lymphoma survival at 10 years: 50%
  • 3 or more: High risk: Estimated overall lymphoma survival at 10 years: 35%

Since first being introduced several years ago, the FLIPI risk groups and overall lymphoma survival rates have been validated by subsequent studies. However, it does have its limitations, and really should only be used by patients and doctors together in improving the treatment choices they make.

Sources

  • Solal-Celigny P et al. Follicular lymphoma international prognostic index. Blood. 2004 Sep 1;104(5):1258-65
  • Buske C et al. The Follicular Lymphoma International Prognostic Index (FLIPI) separates high-risk from intermediate- or low- risk patients with advanced-stage follicular lymphoma treated front-line with rituximab and the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) with respect to treatment outcome. Blood. 2006 Sep 1;108(5):1504-8
  • Formica V et al. Utility of the Follicular Lymphoma International Prognostic Index and the International Prognostic Index in assessing prognosis and predicting first-line treatment efficacy in follicular lymphoma patients. Acta Haematol. 2009;122(4):193-9

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