Follicular lymphoma (FL) is an indolent, rarely curable B-cell malignancy with a heterogeneous clinical course. While generally treatable, FL is characterized by remissions and relapses, and its clinical presentation varies widely. Rituximab has revolutionized FL treatment, significantly improving overall survival over the past two decades. Risk assessment typically relies on histological grade, tumor burden, and the Follicular Lymphoma International Prognostic Index, which incorporates factors like age, hemoglobin level, and Ann Arbor stage. However, these indices have limitations in fully capturing the clinical variability of FL. Some patients experience indolent disease for extended periods without requiring treatment, while others present with aggressive forms resistant to standard therapies. This review examines various prognostic factors in FL, including the FLIPI, FLIPI2, PRIMA-PI, and m7-FLIPI. The FLIPI, based on five risk factors, stratifies patients into low-, intermediate-, and high-risk groups. The FLIPI2 incorporates beta2-microglobulin and the longest diameter of the largest involved node, offering improved prognostication. The PRIMA-PI, designed for patients receiving rituximab-containing regimens, uses beta2-microglobulin, bone marrow involvement, and the longest diameter of the largest involved node. The m7-FLIPI integrates mutational status with FLIPI2 parameters, further refining risk stratification. The review also discusses clinical parameters like maximum standardized uptake value on PET/CT and lymphocyte/monocyte ratio as prognostic factors. A high SUVmax and low lymphocyte/monocyte ratio identify high-risk patients. While FL remains incurable, advances in immunochemotherapy and targeted therapies have improved outcomes. This review provides a comprehensive overview of prognostic tools in FL, emphasizing the importance of risk stratification for personalized treatment strategies.

Background/Objective: It is known that the duration of response to treatment in patients with follicular lymphoma decreases with advancing lines of treatment. Our current study investigated progression-free survival in patients with follicular lymphoma undergoing different lines of treatment, aiming to understand the factors influencing treatment response and outcomes. Methods: We retrospectively analyzed data from follicular lymphoma patients treated at the University of Debrecen between 2009 and 2023. We collected comprehensive data on patient demographics, disease characteristics, treatment regimens, and outcomes. Results: The analysis included 161 patients with follicular lymphoma. The median follow-up for first-line patients was 51 months (range, 3–204), with a median age of 56 years (range, 25–85). The duration of progression-free survival for the first and second lines coincided, while survival in the third line was indeed an ‘unmet medical need’. Factors that influenced the outcome of the first-line treatment of follicular lymphoma patients have been published before by our working group. A univariate analysis of factors that may have influenced the outcome of second-line treatment was performed. A remarkable impact was found in patients undergoing autologous stem cell transplantations and medium-dose treatment. Another important factor was the presence of B-symptoms at the start of second-line treatment. Conclusions: Our study confirmed the interesting coincidence of the first- and second-line duration of response in follicular lymphoma patients, which can be explained with the high number of patients undergoing stem cell transplantation and medium-dose treatment in the second line.

Introduction: Follicular lymphoma (FL) is a heterogeneous disease, and identifying high-risk patients early is crucial for optimal management. This study aimed to evaluate the prognostic significance of interim positron emission tomography/computed tomography (PET/CT) in newly diagnosed FL patients undergoing first-line treatment. Methods: This single-center, retrospective study included 103 patients with newly diagnosed FL who underwent interim PET/CT. The primary endpoint was progression-free survival (PFS). The prognostic value of positive interim PET/CT, Deauville scores, and maximum standardized uptake values (SUVmax) were analyzed among other clinical features. Results: A total of 30 patients (29.1%) were deemed interim PET/CT-positive. The interim PET/CT-positive group demonstrated a significantly shorter median PFS compared to the interim PET/CT-negative group (17 months vs. not reached, respectively; p < 0.0001). Similarly, patients with Deauville scores of 1–3 had better PFS, with median survival not yet reached, while those with higher Deauville scores exhibited poorer progression-free survival and a median survival of 18 months. Notably, patients with an interim PET/CT SUVmax exceeding 3.365 experienced significantly shorter median survival compared to those with lower values. Discussion: Our findings support the use of interim PET/CT as a prognostic tool in FL. These results are consistent with other studies, although some debate exists regarding the optimal PET/CT metric. Further research is needed to validate these findings and explore personalized treatment strategies based on interim PET/CT results.