Follicular Lymphoma Risk Model

This isn't "new," exactly, but it's kind of "official" now.

At the ASH conference last December, some researchers looked at what is now called the "m7-FLIPI" model, and what it means for clinical oncologists -- the good folks we see when we have an oncologist appointment. 

That research has been written up and published in the journal Blood, in the article "Clinicogenetic Risk Models Predict Early Progression of Follicular Lymphoma After First-Line Immunochemotherapy." That means it has now been peer-reviewed -- looked over by other experts -- and seen as good enough research to be accepted by all.

So what does the article say?

Well, they begin with the idea of POD24 -- Progression of Disease within 24 months after treatment. Researchers have found that POD24 is a good predictor of Overall Survival. That is, if a patient has had immunochemotherapy (Rituxan + Chemo), and then has the disease return (if there was a Complete Response) or get worse (if there was a Partial Response) within 24 months, then there is a good chance that their FL is more aggressive than the usual indolent version. It's not transformation, but something else -- maybe an entirely different type of FL.

The researchers has hoped that the m7-FLIPI model would help them identify that group (which could make up about 20% of Follicular Lymphoma patients). FLIPI indexes are often used in clinical trials to make sure the group of patients in the trial are roughly the same. They look at factors like age, number of lymph node areas involved, etc. to come up with a very general assessment of risk. In other words, a high or low FLIPI score means nothing for an individual patient -- it doesn't predict how long you will live or whether a particular treatment will work for you.

last summer, some researchers proposed the m7-FLIPI model. This takes the standard (and, again, very general) FLIPI model and adds seven gene mutations (EZH2, ARID1A, EP300, FOXO1, MEF2B, CREBBP, and CARD11, if you're interested in knowing), and looks at all of these factors to determine how likely someone is to have this potentially more aggressive version of FL.

The m7-FLIPI has the potential to be more accurate because it is (as the article title puts it) "clinicogenetic." It combines the clinical factors that an oncologist can see (age, stage, LDH level, etc.) with genetic factors that can be seen only through analysis of a patient's genes.

In the article, the researchers looked at two groups of patients and found that the m7-FLIPI did the best job of predicting POD24 -- patients who had problems within 2 years of having immunochemotherapy.

The m7-FLIPI isn't a perfect predictor, however. The researchers recommend more work be done to identify this group of 20% much earlier, so that initial treatment strategies can be developed before that 24 month period.

So how does this affect all of us? At the moment, it might affect those of us who do fall into that POD24 group. More aggressive treatment might be necessary than was thought a while ago.

But as far as our every day lives go, I'm going to recommend that nobody panic, especially if you were diagnosed recently, or had immunochemotherapy less than 2 years ago. The models are not perfect, and no model can predict our individual diseases -- not yet, anyway.

As always, I recommend you live your life as "normally" as a cancer patient can. Hug your loved ones a little more often and little bit longer. Make your small part of the world a little bit better. And if and when the time comes, be informed enough to be able to talk to your doctor in a way that lets you understand what she tells you, and that lets you ask the questions that you need answered.