{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T16:14:58Z","timestamp":1774282498722,"version":"3.50.1"},"reference-count":24,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2020,9,16]],"date-time":"2020-09-16T00:00:00Z","timestamp":1600214400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["American J Hematol"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Patients with advanced\u2010stage follicular lymphoma (FL) who progress early after receiving first\u2010line therapy have poor overall survival (OS). Currently applied clinical prognostic models such as FL International Prognostic Index [FLIPI], FLIPI\u20102 and PRIMA\u2010Prognostic Index [PRIMA\u2010PI] have suboptimal sensitivity and specificity to predict this poor prognosis subgroup. The primary objective was to develop a novel prognostic model, the FL Evaluation Index (FLEX) score, to identify high\u2010risk patients and compare its performance with FLIPI, FLIPI\u20102 and PRIMA\u2010PI. Progression\u2010free survival (PFS) after first\u2010line immunochemotherapy was the key endpoint, while OS and progression of disease within 24\u2009months (POD24) were also assessed. The model, which includes nine clinical variables, was developed using a cohort of patients with previously untreated advanced\u2010stage FL from the phase 3 GALLIUM trial (NCT01332968). The performance of the model was validated using data from the SABRINA trial (NCT01200758). In GALLIUM (n = 1004; 127 with and 877 without POD24), FLEX increased the intergroup (low\u2010risk\/high\u2010risk) difference in 2\u2010year and 3\u2010year PFS rates and demonstrated superior intergroup differences in 2\u2010year and 3\u2010year OS rates compared with FLIPI, FLIPI\u20102 and PRIMA\u2010PI. Sensitivity for a high\u2010risk score to predict POD24 was 60% using FLEX compared with 53% for FLIPI and FLIPI\u20102, and 69% for PRIMA\u2010PI, while specificity was 68% for FLEX compared with 58% for FLIPI, 59% for FLIPI\u20102 and 48% for PRIMA\u2010PI. The prognostic value of FLEX in SABRINA was similar to FLIPI. Therefore, FLEX appears to perform better than existing prognostic models in previously untreated FL, in particular for the newer treatment regimens.<\/jats:p>","DOI":"10.1002\/ajh.25973","type":"journal-article","created":{"date-parts":[[2020,8,28]],"date-time":"2020-08-28T06:14:44Z","timestamp":1598595284000},"page":"1503-1510","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["Follicular Lymphoma Evaluation Index (<scp>FLEX<\/scp>): A new clinical prognostic model that is superior to existing risk scores for predicting progression\u2010free survival and early treatment failure after frontline immunochemotherapy"],"prefix":"10.1002","volume":"95","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7511-8797","authenticated-orcid":false,"given":"Farheen","family":"Mir","sequence":"first","affiliation":[{"name":"The Royal Marsden NHS Trust Foundation  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federico","family":"Mattiello","sequence":"additional","affiliation":[{"name":"F. Hoffmann\u2010La Roche Ltd  Basel Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Grigg","sequence":"additional","affiliation":[{"name":"Austin Hospital  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Herold","sequence":"additional","affiliation":[{"name":"HELIOS\u2010Klinikum Erfurt  Erfurt Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wolfgang","family":"Hiddemann","sequence":"additional","affiliation":[{"name":"University Hospital Munich  Munich Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Marcus","sequence":"additional","affiliation":[{"name":"HCA Healthcare  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John F.","family":"Seymour","sequence":"additional","affiliation":[{"name":"Peter MacCallum Cancer Centre Royal Melbourne Hospital and University of Melbourne  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher R.","family":"Bolen","sequence":"additional","affiliation":[{"name":"Genentech, Inc  South San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Knapp","sequence":"additional","affiliation":[{"name":"F. Hoffmann\u2010La Roche Ltd  Basel Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tina","family":"Nielsen","sequence":"additional","affiliation":[{"name":"F. Hoffmann\u2010La Roche Ltd  Basel Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carla","family":"Casulo","sequence":"additional","affiliation":[{"name":"Wilmot Cancer Institute University of Rochester  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,9,16]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.59.7534"},{"issue":"1","key":"e_1_2_9_3_1","first-page":"412","article-title":"Validation of POD24 as a robust early clinical endpoint of poor survival in follicular lymphoma: results from the Follicular Lymphoma Analysis of Surrogacy Hypothesis (FLASH) investigation using individual data from 5453 patients on 13 trials","volume":"130","author":"Casulo C","year":"2017","journal-title":"Blood"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2018.209015"},{"key":"e_1_2_9_5_1","first-page":"19","article-title":"High\u2010risk follicular lymphoma patients: identification and treatment","volume":"23","author":"Luminari S","year":"2018","journal-title":"Eur J Oncol"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/hon.2437_85"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/hon.2438_91"},{"issue":"8","key":"e_1_2_9_8_1","doi-asserted-by":"crossref","first-page":"VIII364","DOI":"10.1093\/annonc\/mdy286.014","article-title":"Progression of disease within 2\u2009years (POD24) is a clinically significant endpoint to identify follicular lymphoma patients with high risk of death","volume":"29","author":"Sortais C","year":"2018","journal-title":"Ann Oncol"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdx189"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2003-12-4434"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mds429"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2008.21.3991"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-05-717355"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2017-11-816405"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(15)00169-2"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(18)30102-5"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1614598"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3026(17)30078-9"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2018-99-114620"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2018-99-115167"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v039.i05"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2018-99-114913"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.3109\/10428194.2013.781169"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-18-3270"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/hon.7_2630"}],"container-title":["American Journal of Hematology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ajh.25973","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ajh.25973","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ajh.25973","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T13:17:21Z","timestamp":1693833441000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ajh.25973"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,16]]},"references-count":24,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["10.1002\/ajh.25973"],"URL":"https:\/\/doi.org\/10.1002\/ajh.25973","archive":["Portico"],"relation":{},"ISSN":["0361-8609","1096-8652"],"issn-type":[{"value":"0361-8609","type":"print"},{"value":"1096-8652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,16]]},"assertion":[{"value":"2020-03-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-08-17","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-09-16","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}