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Is the follicular lymphoma international prognostic index better than the international prognostic index to identify high-risk follicular lymphoma patients?

The aims of this study are to validate follicular lymphoma international prognostic index (FLIPI) prognostic score and to compare it with the international prognostic index (IPI) in a cohort of 57 Brazilian patients. According to IPI, 24 patients (42%) were in the low-risk, 28 (49%) in the intermediate-risk, and 4 (7%) in the high-risk group. The distribution according to FLIPI was: 20 (35%) in the low-risk, 8 (14%) in the intermediate-risk, and 29 (51%) in the high-risk group. According to IPI score, median OS was not reached for the low-risk, it was 45 months for the intermediate-risk and 25 months for the high-risk group (p < 0.001). When FLIPI score was applied, median OS was not reached for the low and intermediate-risk, and was 42 months for the high-risk group (p = 0.0064). These findings suggest that: (1) FLIPI score could be validated in a Brazilian population; (2) FLIPI is more accurate than IPI to identify FL patients having worse prognosis (51%); (3) IPI seems to be a better tool for clinical decisions because it selected a smaller high-risk group (7%) having worse prognosis. In our opinion, IPI high-risk patients are the real candidates for more aggressive therapies, avoiding unnecessary over-treatment.