FLIPI (Follicular Lymphoma International Prognostic Index)
Risk group at diagnosis of follicular lymphoma
- Onkopedia FL (DGHO)
Sources last checked: 2026-10-13
FLIPI (Follicular Lymphoma International Prognostic Index)
Risk group at diagnosis of follicular lymphoma
36 % of the derivation cohort; reference group.
Derived in patients diagnosed 1985–1992, before rituximab. Onkopedia uses it for risk estimation, not on its own to decide whether or how to treat.
Interpretation
| 0–1 — low risk | 36 % of the derivation cohort; reference group. |
|---|---|
| 2 — intermediate risk | 37 % of patients; hazard ratio for death 2.3 vs low risk. |
| 3–5 — high risk | 27 % of patients; hazard ratio for death 4.3 vs low risk. |
What is the FLIPI (Follicular Lymphoma International Prognostic Index)?
The Follicular Lymphoma International Prognostic Index (FLIPI) sorts patients with newly diagnosed follicular lymphoma into low, intermediate and high risk from five factors: age > 60, stage III/IV, haemoglobin < 120 g/L, more than four nodal areas and raised LDH. It was derived by Solal-Céligny and colleagues in 2004 from 4,167 patients diagnosed in 1985–1992 and confirmed in an independent group of 919.
When to use it
- At diagnosis of follicular lymphoma, for prognosis and documentation
- For trial stratification and comparing cohorts
- When a regimen choice is discussed in FLIPI-defined subgroups (e.g. FLIPI 2–5 in the GALLIUM subgroup analysis cited by Onkopedia)
When not to use it
- On its own to decide whether to start treatment — that depends on symptoms and tumour burden
- In aggressive lymphomas (use IPI/R-IPI) or transformed disease
How it is calculated
| Criterion | Points |
|---|---|
| Age > 60 years | +1 |
| Ann Arbor stage III or IV | +1 |
| Haemoglobin < 120 g/L | +1 |
| More than 4 nodal areas involved | +1 |
| Serum LDH above the upper limit of normal | +1 |
Clinical pearls and limitations
- Derived in patients diagnosed 1985–1992, before rituximab. Onkopedia uses it for risk estimation, not on its own to decide whether or how to treat.
- Mnemonic NoLASH: Nodal areas > 4, LDH raised, Age > 60, Stage III/IV, Haemoglobin < 120 g/L.
- Nodal areas are not the same as Ann Arbor regions; FLIPI uses its own map of nodal areas.
- Early relapse within 24 months of first treatment (POD24) predicts outcome more strongly than FLIPI.
- FLIPI-2 and PRIMA-PI are alternatives that use β2-microglobulin.
Frequently asked questions
What is a high-risk FLIPI?
Three or more of the five factors. In the derivation cohort this group carried a hazard ratio for death of 4.3 versus low risk.
Does FLIPI decide treatment in follicular lymphoma?
Not by itself. Onkopedia recommends using it for risk estimation, while the indication to treat depends on symptoms and tumour burden.
Is the haemoglobin cut-off 12 g/dL?
Yes — 120 g/L, which is 12 g/dL.
Evidence and guidelines
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