EHA 2018 | PRIMA-PI risk assessment tool in patients with FL

On Friday 15^th June an oral abstract session took place at the 23^rd Congress of the European Hematology Association (EHA). Abstract S101 was presented by Marek Trněný, General University Hospital Prague, on the use of the PRIMA-PI tool for risk assessment in patients with follicular lymphoma (FL).

Dr Trněný began his presentation by stating that though the outcomes of patients with FL has significantly improved, it is necessary to understand if it is possible to identify patients who are at high risk of treatment failure with standard therapy or high probability of long-term survival. The study results, presented on behalf of the Czech Lymphoma Study Group, aimed to validate the new PRIMA-PI index for risk assessment. This index was validated by assessing the progression-free survival (PFS) and overall survival (OS) in different subgroups, comparing them to other indexes and its prognostic role in POD24 patients.

Study Overview

• Patients were selected from the NiHiL project (a prospective observation study of newly diagnosed non-Hodgkin lymphoma (NHL) patients in Czech Republic
• Consecutively registered patients with a confirmed diagnosis of FL 1-3A were included in the study who were treated with immunochemotherapy between 2000-2015
• The primary endpoints were PFS and OS
• The final dataset for analysis included 1,179 patients

Key Findings

• According to PRIMA-PI, 39% of the full dataset were considered low risk, 29.2% were intermediate risk and 31.8% were high risk
• After a median follow-up of 6 years, the 8-year OS was 79% and the 8-year PFS was 55.2%
• When comparing the three prognostic indexes, (PRIMA-PI, FLIPI and FLIPI-2), according to PFS, numerically the best one was PRIMA-PI. The probability without progression at 70.4% for low risk, 54% for intermediate risk and 38% for high risk
• The OS according to PRIMA-PI was 86.1% for low risk, 86.9% for intermediate
• Further analysis showed that the 8-year OS of patients without POD24 (n = 970) was 88.6% and patients with POD24 (n = 159) was 47.7%, (95% CI, 4.25–12.01), P < 0.0001, HR 7.145
• 8-year OS with POD24 according to PRIMA-PI for low and intermediate risk (n = 86) was 56.3% and for high risk (n = 73) was 37.9%, P = 0.1018
• 8-year OS without POD24 according to PRIMA-PI for low and intermediate risk (n = 700) was 92.8% and for high risk (n = 270) was 76.9%, P < 0.0001

Dr Trněný concluded that the PRIMA-PI is a very easy and useful tool for PFS risk assessment with a similar stratification as FLIPI or FLIPI-2. The study outcomes showed that high risk patients had significantly worse OS compared to low or intermediate risk. He noted that, “high risk PRIMA-PI patients have 2.6 times higher risk of death, even among late progressors and this finding could influence our treatment choice in those patients who relapse later."