R2-based frontline FL: FLIPI24 flags high-risk patients with lower CR30 and 5-year PFS

FLIPI24 (a prognostic model for newly diagnosed follicular lymphoma) was evaluated in a pooled MD Anderson cohort of first-line, “chemo-free” immunotherapy regimens built around CD20 antibodies plus the immunomodulatory agent lenalidomide: rituximab+lenalidomide (R2; NCT00695786; n=79), ibrutinib (BTK inhibitor)+R2 (NCT02532257; n=38), and obinutuzumab (type II anti-CD20)+lenalidomide (NCT02871219; n=90), totaling 207 patients. Risk groups were 48% low, 39% intermediate, and 13% high; end-of-induction CR was similar (91% vs 90% vs 83%), but high-risk patients had lower CR at 30 months (CR30 59% vs 79% vs 84%; p=0.044) and worse PFS (5-year PFS 58% vs 79% vs 79%; p=0.049) after median 9.1 years’ follow-up, with no OS separation reported. In context, frontline R2 in the randomized Phase 3 RELEVANCE trial delivered broadly comparable long-term disease control to rituximab-chemotherapy (e.g., ~60% PFS at 6 years in both arms), so a 5-year PFS of 58% in FLIPI24 high-risk looks “SOC-range” overall—but FLIPI24 still meaningfully enriches for patients more likely to relapse despite modern R2-based therapy.