Low-grade stage III-IV follicular lymphoma: Multivariate analysis of prognostic factors in 484 patients - A study of the Groupe d'Etude des Lymphomesde l'Adulte

Purpose: To identify the prognostic factors that influence overall survival (OS) in patients with stage III-IV follicular lymphomas and evaluate the c linical usefulness and the prognostic value of the International Prognostic Index (IPI). Patients and Methods: Four hundred eighty-four patients with Ann Arbor stag e III-IV follicular lymphomas treated in two phase III trials from 1986 to 1995 were screened for this study. All histologic slides were reviewed by t wo hematopathologists. The influence of the initial parameters an survival wets defined by univariate (log-rank test) and multivariate (Cox model) ana lyses. Results: The poor prognostic factors for OS (age > 60 years, "B" symptom(s) , greater than or equal to two extranodal sites, stage IV disease, tumor bu lk > 7 cm, at least three nodal sires > 3 cm,liver involvement, serous effu sion compression or orbital/epidural involvement, and erythrocyte sedimenta tion rate > 30 mm/h) that were significant in univariate analysis were subj ected to multivariate analysis. Three factors remained significant: B sympt om(s) (risk ratio = 1.80), age greater than 60 years (risk ratio = 1.60), a nd at least three nodal sites greater than 3 cm (risk ratio = 1.71). When t he IPI was applied to these patients, the score wets 1, 2, 3, and 4-5 in 49 %, 39%, 11%, and 2%, respectively, and it was significant for progression-f ree survival (P = .002) and OS (P = .0001). Conclusion: Three prognostic factors for poor OS were identified: B symptom s, age greater than 60 years, and at least three nodal sites greater than 3 cm. The IPI was prognostic for OS, bur in this population, a very low numb er of patients belonged to the high-risk groups. (C) 1999 by American Socie ty of Clinical Oncology.