Design: International prospective cohort (PROCLIPI), 46 centres
Population: 277 patients with stage IIB–IVB mycosis fungoides or Sézary syndrome
Primary outcome: Progression-free survival and best objective response
Effect: Median PFS 4.64, 2.72 and 0.89 years for low, intermediate and high risk; high vs low HR 3.84 (2.21–6.66)

The PROCLIPI cohort followed 277 patients with stage IIB–IVB mycosis fungoides or Sézary syndrome across 46 referral centres for a median of nearly five years. The Cutaneous Lymphoma International Prognostic Index gives one point each for age over 60, raised lactate dehydrogenase, N3 nodal disease and large-cell transformation in the skin.

Median progression-free survival was 4.6 years at low risk (0–1 factors), 2.7 years at intermediate risk and 0.9 years at high risk (3–4 factors; HR 3.84 vs low risk, 95% CI 2.21–6.66). The index added to stage alone, and each extra point lowered the odds of a better treatment response.

The four items are simple and available everywhere, which makes the index usable in Indian centres without specialist assays.

Record age, LDH, nodal stage and large-cell transformation at diagnosis of advanced mycosis fungoides.
Use the four-factor score to discuss prognosis alongside TNMB stage.
Consider early referral to a multidisciplinary lymphoma team for high-risk patients.
Ask the pathologist to report large-cell transformation explicitly.

Why it matters

Stage alone separates outcomes poorly in advanced disease; four bedside items do better.

The statistics, in plain English

A hazard ratio of 3.84 means high-risk patients progressed or died nearly four times as fast as low-risk ones over follow-up. The intermediate-group interval (1.01–2.08) only just excludes no difference.