Blood, Vol. 95 No. 3 (February 1), 2000:
pp. 783-789
Prognosis of follicular lymphoma: a predictive model based on a
retrospective analysis of 987 cases
Massimo Federico,
Umberto Vitolo,
Pier Luigi Zinzani,
Teodoro Chisesi,
Vera Clò,
Giampiero Bellesi,
Massimo Magagnoli,
Marina Liberati,
Carola Boccomini,
Pasquale Niscola,
Vincenzo Pavone,
Antonio Cuneo,
Gino Santini,
Maura Brugiatelli,
Luca Baldini,
Luigi Rigacci, and
Luigi Resegotti for the
Intergruppo Italiano Linfomi
From the Oncologia Medica, Università di Modena, Modena,
Italia; U.O.A. Ematologia, Azienda Ospedaliera San Giovanni Battista,
Torino, Italia; Istituto di Ematologia e Oncologia Medica
Seràgnoli, Università di Bologna, Bologna, Italia;
Divisione di Ematologia, Ospedale Civile Venezia-Mestre;
Cattedra e Divisione di Ematologia, Università di Firenze,
Firenze, Italia; Clinica Medica Generale, Policlinico Monteluce,
Perugia, Italia; Dipartimento di Biotecnologie Cellulari ed
Ematologia, Università La Sapienza, Roma, Italia; Cattedra e
Servizio di Ematologia, Azienda Ospedaliera Policlinico, Bari;
Dipartimento di Scienze Biomediche, Sezione di Ematologia,
Università di Ferrara; Divisione di Ematologia
Ia , Ospedale San Martino, Genova, Italia; and
Dipartimento di Emato-Oncologia, Azienda Ospedaliera
Bianchi-Melacrino-Morelli, Reggio Calabria; Cattedra di Ematologia,
Università di Milano, Ospedale Maggiore, IRCCS, Milano, Italia. A
complete list of the members of the Intergruppo Italiano Linfomi is
given at the end of this article.
Patients (n-987) with a histologically confirmed diagnosis of
follicular lymphoma were studied with the aim of developing a
prognostic model specifically devised for this type of lymphoma. We
collected information on age, sex, Ann Arbor stage, number of
extranodal disease sites, bone marrow (BM) involvement, bulky disease,
B symptom criteria (fever, night sweats, and weight loss), performance
status (PS), serum lactate dehydrogenase (LDH) level, serum albumin
level, hemoglobin level, and erythrocyte sedimentation rate (ESR). In
the training sample of 429 patients with complete data, multivariate
analysis showed that age, sex, number of extranodal sites, B symptoms,
serum LDH level, and ESR were factors predictive for overall survival.
Using these 6 variables, a prognostic model was devised to identify 3 groups at different risk. The 5- and 10-year survival rate was 90% and
65% for patients at low risk, respectively; 75% and 54% for patients
at intermediate risk; and 38% and 11% for those at high risk
(log-rank test, 86.62; P < .0001). The model was also
predictive (P = .0001) in the validation sample of 265 patients with complete data only for the 6 variables used in the
development of the model and even in the group of 210 patients from the
validation sample uniformly treated with doxorubicin-containing
regimens (P = .0001). The prognostic model appears to be
very useful in identifying patients with follicular lymphoma at low,
intermediate, or high risk.
