FLIPI, FLIPI2 and POD24 (follicular lymphoma risk)
FLIPI counts five simple things (age over 60, stage III or IV, more than four node areas, raised LDH, low haemoglobin) to predict how a follicular lymphoma will behave; POD24, relapse within two years of starting chemo-immunotherapy, is the single strongest sign of a dangerous one.
Overview
What is measured: prognosis in follicular lymphoma. How: FLIPI (2004) gives a point each for age over 60, Ann Arbor stage III or IV, more than four nodal areas, LDH above normal and haemoglobin under 120 g/L, with 0 to 1 low, 2 intermediate and 3 or more high risk (ten-year survival of about 70, 50 and 35 percent in the pre-rituximab series). FLIPI2 (2009) uses beta-2 microglobulin, a node over 6 cm, marrow involvement, haemoglobin and age. m7-FLIPI adds the mutation status of seven genes (EZH2, ARID1A, MEF2B, EP300, FOXO1, CREBBP, CARD11) from a targeted panel. POD24 is not a score but an event: progression within 24 months of first-line chemo-immunotherapy, seen in about a fifth of patients, whose five-year survival falls to about 50 percent against 90 percent for the rest. Inputs come from examination, PET-CT staged by Lugano, blood tests and marrow. What a result changes: FLIPI does not itself trigger treatment (the GELF criteria for tumour burden do) but stratifies trials; POD24 identifies patients for bispecific antibodies (mosunetuzumab, epcoritamab), CAR-T, lenalidomide with rituximab, tazemetostat in EZH2-mutant disease, and a biopsy to exclude transformation. Where it matters: follicular lymphoma.
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