FLIPI Calculator For Follicular Lymphoma

As a tool for survival rate stratification in patients diagnosed with follicular lymphoma, the FLIPI calculator consists of 5 items that evaluate characteristics of the disease that double up as adverse outcome factors.

■ Age;

■ Number of nodal areas;

■ LDH level;

■ Hemoglobin level;

■ Stage.

The original study took place between 1985 and 1992 and involved data collected from 4,167 patients who suffered from follicular lymphoma and were treated with chemotherapy drugs.

There are three risk categories:

■ Low;

■ Intermediate;

■ High.

Each result provides the estimated survival rate over 5 and 10 years:

■ Scores of 0 and 1: Low risk with 91% estimated survival over 5 years and 71% over 10 years.

■ Scores of 2: Intermediate risk with 78% estimated survival over 5 years and 51% over 10 years.

■ Scores of 3, 4 and 5: High risk with 53% estimated survival over 5 years and 36% over 10 years.

Follicular Lymphoma International Prognostic Index items

The following table introduces the risk factors considered in the Follicular Lymphoma International Prognostic Index:

Item	Item description	Answer choices (points)
Age	FLIPI is an age adjusted model with two separate age groups.	60 or below (0) Above 60 (1)
Number of nodal areas	Enlarged limph nodes in single nodal areas such as cervical, axillary or mesenteric.	Between 0 and 3 (0) 4 or more (1)
LDH level	Elevated lactate dehydrogenase level as risk factor.	Normal (0) Elevated (1)
Hemoglobin level	Evaluates oxygen distribution to the tissues.	12.0 g/dL or above (0) Below 12.0 g/dL (1)
Stage	Based on the Ann Arbor FL staging.	Stage I/II (0) Stage III/IV (1)

FLIPI score interpretation

FLIPI is currently recommended as a way to improve treatment plans and for use in clinical trials.

The presence of either of the 5 adverse factors is awarded 1 point, therefore the total score ranges between 0 (with no adverse factors present) and 5 (all risk factors present).

The following table introduces the 5 and 10-year survival rates based on each FLIPI result.

FLIPI score	5-year survival %	10-year survival %
0, 1	91%	71%
2	78%	51%
3, 4, 5	53%	36%

About the study

The study consisted in the analysis of 4,167 patient data collected between 1985 and 1992. Subjects were diagnosed with FL and have underwent chemotherapy with drugs such as rituximab.

Each of the five adverse prognostic factors was found to be independently correlated with poor outcomes in patients with non-Hodgkin lymphomas. The resultant index, FLIPI was then tested on 919 patients.

Derivation and external validation were also performed. A subsequent study has validated the index and has proposed the inclusion of cerebrovascular disease amongst the factors considered.

Compared to the International Prognostic Index, the Follicular Lymphoma International Prognostic Index (FLIPI) is more discriminant in non-Hodgkin lymphomas.

Dr Philippe Solal-Célignym, the creator of FLIPI is a professor and principal investigator at Laboratoire Central d’Hematologie at Centre Jean Bernard in France.

Follicular lymphoma staging

FL belongs to the non-Hodgkin lymphomas NHLs and consists of 3 histologic grades:

■ Grade 1: 0 - 5 centroblasts/high-power field (HPF);

■ Grade 2: 6 - 15 centroblasts/HPF;

■ Grade 3: >15 centroblasts/HPF.

The Ann Arbor staging system, also considered in FLIPI, is based on the above grades but introduces information on bulky disease, X and regions of lymph node involvements, E:

X: Bulk larger than 10 cm;

E: Extranodal extension or single isolated site of extranodal disease;

A/B: B symptoms: weight loss > 10%, fever, drenching night sweats;

Stage I: Single lymph node group;

Stage II: Multiple lymph node groups on same side of diaphragm;

Stage III: Multiple lymph node groups on both sides of diaphragm;

Stage IV: Multiple extranodal sites or lymph nodes and extranodal disease.

Original source

Solal-Céligny P, Roy P, Colombat P, White J, Armitage JO, Arranz-Saez R, Au WY, Bellei M, Brice P, Caballero D, Coiffier B, Conde-Garcia E, Doyen C, Federico M, Fisher RI, Garcia-Conde JF, Guglielmi C, Hagenbeek A, Haïoun C, LeBlanc M, Lister AT, Lopez-Guillermo A, McLaughlin P, Milpied N, Morel P, Mounier N, Proctor SJ, Rohatiner A, Smith P, Soubeyran P, Tilly H, Vitolo U, Zinzani PL, Zucca E, Montserrat E. Follicular lymphoma international prognostic index. Blood. 2004; 104(5):1258-65.

Validation

Van de Schans SAM, Steyerberg EW, Nijziel MR et al. Validation, revision and extension of the Follicular Lymphoma International Prognostic Index (FLIPI) in a population-based setting. Ann Oncol. 2009; 20 (10): 1697-1702.

FLIPI Calculator For Follicular Lymphoma

Jump to:

Age

Number of nodal areas

LDH level

Hemoglobin level