Statistical & Clinical Analysis
FLIPI Score Formula: Follicular Lymphoma International Prognostic Index (0 to 5)
Stratify newly diagnosed follicular lymphoma survival across Low (0–1), Intermediate (2), and High Risk (3–5) using Philippe Solal-Céligny’s 5-factor FLIPI score (NoLASH: Nodal areas > 4, LDH > ULN, Age >= 60, Stage III–IV, Hemoglobin < 12 g/dL).
Why indolent Follicular Lymphoma needed its own 5-factor NoLASH index distinct from aggressive DLBCL IPI!
When the standard aggressive-lymphoma IPI was applied to indolent follicular lymphoma, too few patients had ECOG >= 2 or > 1 extranodal site, crowding most cases into low-risk tiers! Philippe Solal-Céligny et al. (2004, Blood — international collaborative cohort of 4,167 patients) derived the 5-factor Follicular Lymphoma International Prognostic Index (FLIPI, mnemonic NoLASH, 1 point each -> 0–5): Nodal sites > 4 involved lymph-node areas (+1), Serum LDH > upper limit of normal (+1), Age >= 60 years (+1), Ann Arbor Stage III or IV (+1), and Hemoglobin < 12.0 g/dL (+1)!
FLIPI cleanly partitions patients into roughly balanced Risk Groups: Low Risk (0–1 factors), Intermediate Risk (2 factors), and High Risk (3–5 factors, associated with higher POD24 early progression risk and shortened overall survival)!
| FLIPI Total Factors (0–5) | FLIPI Risk Group | 10-Year OS Benchmark (Rituximab Era ~Higher) |
|---|---|---|
| FLIPI 0–1 Factors | Low Risk | Favorable Indolent Course (~71% pre-R / >85% R-era) |
| FLIPI 2 Factors | Intermediate Risk | Moderate Progression Hazard |
| FLIPI 3–5 Factors (e.g., 4) | High Risk | Elevated POD24 / Shorter Remission Duration |
Total Solal-Céligny FLIPI Score (0 to 5 NoLASH Factors)
Sums the 5 binary FLIPI adverse factors across B2:B6.
=IF(OR(MIN(B2:B6) < 0, MAX(B2:B6) > 1), "Each FLIPI Factor Must Be 0 or 1", SUM(B2:B6))FLIPI Three-Group Follicular Lymphoma Risk Stratification
Classifies FLIPI into Low Risk (0–1), Intermediate Risk (2), or High Risk (3–5).
=IF(OR(MIN(B2:B6) < 0, MAX(B2:B6) > 1), "Each FLIPI Factor Must Be 0 or 1", IF(SUM(B2:B6) >= 3, "High Risk (FLIPI 3–5 Factors)", IF(SUM(B2:B6) = 2, "Intermediate Risk (FLIPI 2 Factors)", "Low Risk (FLIPI 0–1 Factors)")))Try the example
Use the original values or change them to test your understanding.