From the Guidelines
The Follicular Lymphoma International Prognostic Index (FLIPI) is the recommended prognostic scoring system for follicular lymphoma, as it specifically evaluates key factors relevant to this disease and guides treatment decisions. FLIPI evaluates five key factors: age over 60 years, Ann Arbor stage III-IV, hemoglobin level less than 12 g/dL, more than 4 nodal areas involved, and elevated serum LDH, categorizing patients into three risk groups: low risk (0-1 factors), intermediate risk (2 factors), and high risk (3-5 factors) 1. An updated version, FLIPI-2, incorporates additional factors such as beta-2 microglobulin levels, lymph node diameter, bone marrow involvement, and hemoglobin less than 12 g/dL, and age over 60 years, providing a more comprehensive assessment of patient risk 1.
Key Factors in FLIPI
- Age over 60 years
- Ann Arbor stage III-IV
- Hemoglobin level less than 12 g/dL
- More than 4 nodal areas involved
- Elevated serum LDH
Updated FLIPI-2 Factors
- Beta-2 microglobulin levels
- Lymph node diameter greater than 6 cm
- Bone marrow involvement
- Hemoglobin less than 12 g/dL
- Age over 60 years
The use of FLIPI or FLIPI-2 is supported by recent guidelines, which emphasize the importance of accurate prognostic assessment in guiding treatment decisions for follicular lymphoma patients 1. By using FLIPI or FLIPI-2, clinicians can determine the most appropriate treatment intensity and follow-up strategies for their patients, potentially improving outcomes and quality of life.
From the Research
Prognostic Scores for Follicular Lymphoma
The following prognostic scores can be used for follicular lymphoma:
Characteristics of FLIPI
The FLIPI uses five independent predictors of inferior survival:
- Age >60 years
- Hemoglobin <12 g/dL
- Serum LDH > normal
- Ann Arbor stage III/IV
- Number of involved nodal areas >4 5
Risk Stratification using FLIPI
The presence of 0-1,2, and ≥3 adverse factors defines low, intermediate, and high-risk disease, respectively 5
Validation of FLIPI
Studies have validated the FLIPI as a prognostic index in various settings, including the use of rituximab and R-chemotherapy regimens 3, 4, 6
Clinical Application of FLIPI
The FLIPI can be used to support discussions about prognosis and treatment outcomes in clinical practice 6