From the Guidelines
I do not recommend using GELF criteria alone for prognosis of follicular lymphoma, as the Follicular Lymphoma International Prognostic Index (FLIPI) or FLIPI-2 are more appropriate tools for prognostic assessment. The GELF criteria, as mentioned in the NCCN guidelines insights: b-cell lymphomas, version 3.2019 1, are useful for determining when to initiate treatment in follicular lymphoma, considering factors such as symptoms attributable to FL, threatened end-organ function, significant cytopenia secondary to lymphoma, bulky disease, splenomegaly, and steady progression over at least 6 months. However, for prognostic assessment, FLIPI or FLIPI-2 are more suitable, as they evaluate factors such as age, hemoglobin level, LDH elevation, nodal involvement, and Ann Arbor stage, which correlate with overall survival and progression-free survival.
Some key points to consider when evaluating prognosis in follicular lymphoma include:
- Progression of disease (POD) within < 24 months of diagnosis and failure to achieve event-free survival at 12 months after initial treatment with chemoimmunotherapy have been identified as prognostic indicators of poor survival 1
- The 5-year overall survival (OS) rate was 50% for patients with POD < 2 years after first-line therapy with R-CHOP (rituximab + cyclophosphamide/doxorubicin/vincristine/prednisone) 1
- Using both FLIPI for prognosis and GELF for treatment decisions provides complementary information to guide clinical care, allowing for a more comprehensive approach to patient management.
In clinical practice, it is essential to prioritize morbidity, mortality, and quality of life when making treatment decisions, and using the most appropriate prognostic tools, such as FLIPI or FLIPI-2, can help guide these decisions.
From the Research
Prognosis of Follicular Lymphoma
- The Follicular Lymphoma International Prognostic Index (FLIPI) is a commonly used prognostic model that uses five independent predictors of inferior survival: age >60 years, hemoglobin <12 g/dL, serum LDH > normal, Ann Arbor stage III/IV, and number of involved nodal areas >4 2, 3.
- Other factors such as time to relapse of less than 2 years from chemoimmunotherapy and specific gene mutations may also be useful for prognosis 2, 3.
- A study found that early relapse of follicular lymphoma after rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone defines patients at high risk for death 4.
Use of GELF for Prognosis
- There is no direct mention of GELF in the provided studies as a prognostic tool for follicular lymphoma.
- However, the GELTAMO study is mentioned in one of the studies, which compared R-Bendamustine vs. R-CHOP plus maintenance therapy as first-line systemic treatment in follicular lymphoma 5.
- The Groupe d'Etude des Lymphomes Folliculaires (GELF) criteria are mentioned in another study as a reference for high tumor burden criteria 6.
Treatment Options
- Chemoimmunotherapy is a common treatment approach for follicular lymphoma, with R-CHOP and R-Bendamustine being two of the most commonly used regimens 2, 3, 5.
- Lenalidomide in combination with R-CHOP has shown promise as a treatment option for high-burden follicular lymphoma 6.
- Maintenance therapy with rituximab has been shown to improve outcomes in patients with follicular lymphoma 2, 3, 5.