Follicular Lymphoma International Prognostic Index (FLIPI)
Estimates overall survival based on clinical information.
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A FLIPI score of 0 to 1 is considered “low risk” with a 10 year overall survival of 70%. A score of 2 is considered “intermediate risk” with a 10 year overall survival of 50%. Finally, a score of ≥ 3 is considered “high risk” with a 10 year overall survival of 35%. Patients with an initial remission duration less than the median progression free survival for a particular treatment regimen and/or with a high FLIPI score are more likely to have a shorter remission duration.
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.
