Should PRIMA Prognostic Index Be Widely Applied Instead of FLIPI2 in the Prognosis of Follicular Lymphoma?

Recent studies have suggested that PRIMA-PI (Prognostic Index) is a simple tool for predicting patients with follicular lymphoma (FL). With the desire to contribute some experience in the prognosis of FL, we conducted a study to analyze the value of PRIMA-PI versus FLIPI2 (Follicular Lymphoma International Prognostic Index) in the prognosis of FL. Forty-five patients diagnosed with newly follicular lymphoma who received chemotherapy were retrospectively analyzed. All patients underwent bone marrow biopsy to detect bone marrow involvement. Based on histology, the grade was defined according to WHO. The Kapplan-Meyer method and the Cox proportion hazards model were used in the OS (overall survival) analysis to evaluate prognostic indices such as FLIPI2, PRIMA-PI, and the histological classification of FL (grade). According to FLIPI2, the 9-year OS rate of the low-risk group, the intermediate-risk group, and the high-risk group was 100%, 52.9%, and 49.5%; respectively. According to PRIMA-PI, the OS rate for the low-risk group, the intermediate-risk group, and the high-risk group at 9 years was 83.9%, 68.2%, and 43.3%; respectively. According to grade, the 9-year OS rate for grades 1, 2, 3a, and 3b was 83.3%, 73%, 59.3%, and 25%; respectively. Univariate and multivariate analysis showed that only FLIPI2 and grade were truly independent prognostic factors for OS with P=0.03, and 0.012; respectively. On the contrary, we had not yet found the significance of PRIMA-PI in the prognosis of OS, (P=0.056). Caution should be exercised when planning to apply PRIMA-PI widely instead of FLIPI2 in the prognosis of follicular lymphoma.