Mir et al reported the Follicular Lymphoma Evaluation Index (FLEX). This is a prognostic score for a patient with advanced-stage follicular lymphoma. The authors are from Royal Marsden NHS Trust, Hoffman-La Roche Ltd, Austin Hospital (Melbourne), University Hospital Munich, University of Melbourne, Genentech and University of Rochester.
Patient selection: advanced stage follicular lymphoma (Stage III, Stage IV or Stage 2 with bulky disease)
Risk factors:
(1) histologic grade 3A
(2) > 2 extranodal sites
(3) ECOG performance status >= 2
(4) hemoglobin < 12 g/dL
(5) serum beta-2 microglobulin> institutional upper limit of normal
(6) absolute natural killer cell count in the peripheral blood < 100 per microliter
(7) serum LDH > upper limit of normal
(8) male sex
(9) sum of products of lesion diameters (SPD) in highest quartile (> 9,320 square mm)
where:
• Bulky disease (any lesion > 7 cm in diameter) was substituted for SPD in development.
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 9
Number of Risk Factors
Risk Group
3-Year PFS
0 or 1
low
88%
2
intermediate
82%
>= 3
high
67%
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