Mozas P, Rivero A, Rivas-Delgado A, et al. - Findings demonstrated that molecular and imaging data incorporation will keep on refining the stratification of follicular lymphoma (FL) cases, however, in the rituximab era, FLIPI continues to be the most powerful clinical risk stratification tool, predicting the greatest number of endpoints.

• A single-center analysis of five most widely used clinical scores (IPI, ILI, FLIPI, FLIPI2, PRIMA-PI) for risk stratification in FL.

• Participants included 414 grade 1-3A FL patients diagnosed in the rituximab era.

• Overall concordance was 24%, and time to first treatment was predicted by FLIPI and FLIPI2.

• Response, progression of disease within 24 months of treatment initiation, progression-free, and overall survival (OS) were predicted by all five scores, while only FLIPI was predictive of histological transformation.

• A small subset (7%) of truly high-risk patients (10-year OS of 16%) was revealed by IPI.

• ILI showed utility for prognostication of limited-disease cases, and PRIMA-PI can unveil a high-risk subset of older patients.

• IPI had slightly better performance metrics in terms of calibration (Harrell's c-index 0.73), without major disparities among risk scores concerning other parameters.