The age-adjusted international prognostic index 2 (A-FLIPI2) for elderly patients with follicular lymphoma

Follicular lymphoma (FL) is a common B-cell lymphoma and typically affects the elderly population. It is urgently required to enhance our comprehension of disease-specific outcomes in elderly FL patients and identify a reliable predictive indicator to assess patient risk and guide treatment options for them. Therefore, we retrospectively analysed clinical data of 128 elderly patients (aged 60 years or older) with FL treated at Tianjin Medical University Cancer Institute & Hospital from 2002 to 2020. Univariate and multivariate analyses were performed to identify high risk prognostic factors, and we evaluated the predictive capacity of several prognostic scoring models by survival analysis and receiver operating characteristic (ROC) curves. Our analysis revealed that the age ≥70 was a significant independent predictor for both OS and PFS. FLIPI2 model can classify elderly FL patients into two risk groups with different prognoses, but the FLIPI and PRIMA-PI scoring systems may not be as applicable to this specific patient population. Based on the above results, we modified the FLIPI2 scoring system to set age ≥70 years as a risk factor and developed a novel prognostic index called the Age-adjusted FLIPI2 (A-FLIPI2), which effectively classified older FL patients into three distinct groups with significantly different outcomes. Among the four scoring systems evaluated, A-FLIPI2 showed the highest AUC for predicting risk of death (0.793) and disease progression (0.678). And the performance of A-FLIPI2 is validated in an external validation cohort. Thus, A-FLIPI2 is a better prognostic model for elderly FL patients. In conclusion, the newly developed prognostic index A-FLIPI2 in this study offers improved risk stratification for elderly FL patients.