Groupe d'Etude des Lymphomes Folliculaires (GELF) Criteria
Determines if immediate therapy for follicular lymphoma is required.
Advice
Refer to the staging systems FLIPI and Lugano classification to assist with risk stratifying patients. The GELF criteria is a quick test to determine which patients should be monitored versus treated now.
Management
Treatment is varied depending on the stage and tumor burden.
Stages I-II
- Treatment options include:
- Involved field radiotherapy (IFRT)
- Clinical trials
- Active surveillance
Stages III-IV or Bulky Stage II – asymptomatic
- Treatment options include:
- Clinical trials
- Active surveillance
Stages III-IV or Bulky Stage II – with GELF/BNLI risk factors or high-risk FLIPI score
- Treatment options include:
- RiTUXimab + cyclophosphamide, vinCRIStine, DOXOrubicin, predniSONE
- RiTUXimab alone
- Bendamustine + riTUXimab
- RiTUXimab + cyclophosphamide, vinCRIStine, predniSONE
- Clinical trials
Critical Actions
- There is continued controversy around when and how to treat follicular lymphoma, including in patients with relapsed/refractory disease. Questions to consider when making treatment decisions:
- When to initiate therapy versus active surveillance
- Deciding amongst various treatment options
- Balancing efficacy and toxicities of treatment options
- Determining what constitutes a complete response/endpoint of treatment
- Finally, with follicular lymphoma, a provider should be aware of transformation to diffuse large B-cell lymphoma, which is a more aggressive disease and would require prompt treatment.