At the 64th Annual ASH Meeting, Matthew Maurer, DSc, Department of Quantitative Health Sciences Research, Mayo Clinic, Rochester, MN, discussed a prognostic model, the FLIPI24 model, that can identify a high-risk group of patients with follicular lymphoma who are likely to need novel therapies or should be considered for frontline clinical trials, and those with low-risk disease who are likely need standard of care therapies.

Transcript:

Hi. My name's Matt Maurer. I'm a statistician and lymphoma researcher at the Mayo Clinic in Rochester, Minnesota. At the ASH Annual meeting, I'm presenting research on our study from the FLIPI24 Consortium, looking at developing a prognostic model for patients with follicular lymphoma.

Follicular lymphoma is the most common indolent B-cell lymphoma in the Western world. Most patients with follicular lymphoma can expect to have long lifespans and a lot of patients will die with their disease rather than of their disease. Despite excellent outcomes with available therapies for follicular lymphoma, there's a population of patients who do either progress early on frontline immunochemotherapy or have disease transformation to a more aggressive type of lymphoma, and these patients are at a high risk of lymphoma related mortality and represent an unmet need in treatment of follicular lymphoma. So based on these observations, we developed a frontline prognostic study to try identify at diagnosis the patients who are at high risk of early progression on immunochemotherapy or transformation. This is typically thought of as POD 24, progression of disease within 24 months or early transformation.

So we assembled the FLIPI24 Consortium. This is a collaboration of 10 cohorts across the world with observational studies of patients with follicular lymphoma. We harmonized individual patient data from over 6,000 patients with follicular lymphoma treated with frontline immunochemotherapy. At the ASH Annual Meeting this year, we presented the results of our prognostic model. We identified that five common clinical characteristics that are routinely assessed in patients at diagnosis, patient's age, LDH, beta 2 microglobulin, hemoglobin and white blood cell count. These five variables are highly prognostic in identifying patients at high risk of early relapse to frontline immunochemotherapy. Our prognostic model, called the FLIPI24, containing these five variables did a better job of discerning patients with poor outcomes in our internal validation cohort than existing prognostic models in follicular lymphoma, including the FLIPI and the Prima PI, the two models that are typically used in frontline prognostication.

Not only did our model predict early events to immunochemotherapy as we designed it, it was also highly prognostic for overall survival in our internal validation cohort. We then validate the model in an external cohort of patients in our LEO cohort. So the LEO is the Lymphoma Epidemiology of Outcomes cohort and it is a cohort of newly diagnosed patients enrolled in the eight cancer centers across the United States between 2015 and 2020. The model is highly prognostic in patients in the LEO cohort who are treated with frontline immunochemotherapy.

We also looked at the cohort of all patients with follicular lymphoma as patients receiving immunochemotherapy only represented about a third of the patients in the LEO cohort. When applying the model to all patients with follicular lymphoma diagnosis, the model was highly predictive of overall survival and identified at a population of patients who represent those with high-risk disease. The prognostic model is available in online calculators and can be easily applied to patients at the time of diagnosis. We believe that our FLIPI24 model can identify a high-risk group of patients who are likely to need novel therapies or should be considered for frontline clinical trials, while patients with low-risk disease by the FLIPI24 are likely to be well served by standard of care therapies.