High serum carbohydrate antigen-125 (CA-125) level predicts poor outcome in patients with follicular lymphoma independently of the FLIPI score

Carbohydrate antigen-125 (CA-125) was established as a prognostic marker in cancer, especially in ovarian carcinoma. Many recent studies have also reported on the prognostic significance of CA-125 in patients with different types of lymphoma, but only a few studies have been carried out in patients treated with rituximab or high-dose therapy. The prognostic impact of CA-125 on a large cohort of patients with follicular lymphoma (FL) has not been studied. This study analyzed the prognostic significance of CA-125 levels in 116 prospectively enrolled patients with previously untreated FL. It showed that the CA-125 level at the time of treatment initiation correlates with the clinical stage, number of involved nodal areas, bulky disease, hemoglobin level, beta-2 microglobulin level, and lactate dehydrogenase level. Patients with CA-125 >35 U/mL had significantly shorter progression-free (p < 0.001) and overall (p = 0.025) survival rates. Cox regression analysis identified high CA-125 levels as a prognostic factor for overall (HR 3.04, p = 0.05) and progression-free (HR 3.55, p < 0.001) survival rates independent of FLIPI score variables. CA-125 levels may help to refine risk assessment in the modern immunotherapy era.