THE CUTANEOUS Lymphoma International Prognostic Index (CLIPI) may improve risk stratification in advanced mycosis fungoides and Sézary syndrome (MF/SS), with higher scores associated with shorter progression-free survival (PFS) and a lower likelihood of treatment response. Findings from an international prospective cohort suggest that CLIPI could provide prognostic information beyond conventional clinical staging.
The study included 277 patients with stage IIB–IVB MF/SS recruited through 46 referral centres between July 2015 and May 2025. Median follow-up was 4.75 years. Researchers evaluated CLIPI scores at diagnosis, which incorporated four factors: age over 60 years, elevated serum lactate dehydrogenase, N3 nodal status, and large-cell transformation in the skin.
Patients were classified as low risk if they had zero or one factor, intermediate risk with two factors, and high risk with three or four factors. Of the cohort, 144 patients (52.0%) were low risk, 93 (33.6%) intermediate risk, and 40 (14.4%) high risk.
Median PFS differed substantially between risk groups. Low-risk patients had a median PFS of 4.64 years, compared with 2.72 years for intermediate-risk patients and 0.89 years for high-risk patients (p<0.001).
Compared with the low-risk group, intermediate-risk patients had a higher hazard of progression or death (hazard ratio [HR]: 1.45; 95% confidence interval [CI]: 1.01–2.08). This association was stronger among high-risk patients (HR: 3.84; 95% CI: 2.21–6.66).
CLIPI also demonstrated an association with treatment response. Each one-point increase in score was associated with lower odds of achieving a better response during follow-up (odds ratio [OR]: 0.62; 95% CI: 0.43–0.89), representing approximately 38% lower odds.
The researchers found that including CLIPI improved the ability to distinguish PFS outcomes compared with a model based on baseline disease stage alone. This addresses a key limitation of tumour, node, metastasis, blood (TNMB) staging, which has limited prognostic value for clinically relevant outcomes in advanced MF/SS.
The findings suggest that CLIPI could help clinicians identify patients at greater risk of progression and support more informed treatment planning. The authors also highlighted its potential role in future clinical trial design.
Although the results support CLIPI as a prognostic tool, the study established associations with outcomes rather than demonstrating that CLIPI-guided treatment improves them. Its integration into clinical decision-making may help refine risk assessment beyond conventional staging.
Reference
Roccuzzo G et al. Cutaneous lymphoma international prognostic index and risk stratification in advanced mycosis fungoides and Sézary Syndrome. JAMA Dermatol. 2026;DOI:10.1001/jamadermatol.2026.3856.
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