{"entity":{"id":"flipi","kind":"term","name":"FLIPI, FLIPI2 and POD24 (follicular lymphoma risk)","aka":["FLIPI","FLIPI2","FLIPI-2","m7-FLIPI","Follicular Lymphoma International Prognostic Index","POD24","progression of disease within 24 months","early progression follicular lymphoma","GELF criteria","high tumour burden follicular lymphoma"],"tldr":"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.","summary":"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.","asOf":"2026-09-17","wikipedia":"https://en.wikipedia.org/wiki/Follicular_Lymphoma_International_Prognostic_Index","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Follicular_Lymphoma_International_Prognostic_Index"},{"label":"Morin et al., Nat Genet 2010: somatic EZH2 Tyr641 mutations in follicular and germinal-centre diffuse large B-cell lymphoma","url":"https://doi.org/10.1038/ng.518"},{"label":"Pasqualucci et al., Nature 2011: inactivating mutations of the acetyltransferase genes CREBBP and EP300 in B-cell lymphoma","url":"https://doi.org/10.1038/nature09730"},{"label":"Morin et al., Nature 2011: frequent mutation of histone-modifying genes in non-Hodgkin lymphoma","url":"https://doi.org/10.1038/nature10351"}],"tags":[],"related":["ipi-score","lugano-classification","deauville","tumour-markers","rituximab","obinutuzumab","lenalidomide","tazemetostat","ezh2"],"cancers":["follicular-lymphoma"],"sections":[],"technologies":[],"targets":["ezh2","crebbp","ep300"],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["lymphoma-bio-germinal-centre"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":["The molecular layer under the score. The seven genes in m7-FLIPI are not an arbitrary panel: EZH2, CREBBP and EP300 are the chromatin machinery of the germinal centre reaction, and their mutations are the reason a follicular lymphoma cannot complete it. EZH2 Tyr641 substitutions occur in 7.2% of follicular lymphomas and are gain-of-function rather than loss, which is what makes tazemetostat work (Morin 2010); CREBBP or EP300 inactivation is present in about 41% (Pasqualucci 2011); KMT2D is mutated in 89% of cases in the discovery series (Morin 2011). An EZH2 mutation in m7-FLIPI counts towards a lower-risk score and, separately, opens a treatment at relapse, which is a confusing pair of facts worth separating for a patient."],"category":"Biomarkers"},"route":"/terms/flipi/","neighbours":{"term":[{"id":"deauville","kind":"term","name":"Deauville score and PET-adapted therapy","route":"/terms/deauville/"},{"id":"ipi-score","kind":"term","name":"International Prognostic Index (IPI)","route":"/terms/ipi-score/"},{"id":"lymphoma-living-indolent-lymphoma","kind":"term","name":"Living with an indolent lymphoma rather than being cured of one","route":"/terms/lymphoma-living-indolent-lymphoma/"},{"id":"lugano-classification","kind":"term","name":"Lugano classification / Ann Arbor staging","route":"/terms/lugano-classification/"},{"id":"lymphoma-tx-pod24","kind":"term","name":"POD24: progression of follicular lymphoma within two years, and why it changes the plan","route":"/terms/lymphoma-tx-pod24/"},{"id":"lymphoma-pit-score","kind":"term","name":"Prognostic Index for T-cell lymphoma (PIT)","route":"/terms/lymphoma-pit-score/"},{"id":"lymphoma-bio-germinal-centre","kind":"term","name":"The germinal centre: why lymphoma starts where antibodies are made","route":"/terms/lymphoma-bio-germinal-centre/"},{"id":"lymphoma-bio-transformation","kind":"term","name":"Transformation: when a slow lymphoma turns into a fast one","route":"/terms/lymphoma-bio-transformation/"},{"id":"tumour-markers","kind":"term","name":"Tumour markers (CEA, LDH, chromogranin, thyroglobulin)","route":"/terms/tumour-markers/"},{"id":"lymphoma-decision-watch-and-wait","kind":"term","name":"Watch and wait in follicular lymphoma: being told you have cancer and that nobody will treat it","route":"/terms/lymphoma-decision-watch-and-wait/"},{"id":"lymphoma-tx-watch-and-wait","kind":"term","name":"Watch and wait in lymphoma: when the right treatment is none yet","route":"/terms/lymphoma-tx-watch-and-wait/"}],"drug":[{"id":"lenalidomide","kind":"drug","name":"Lenalidomide","route":"/drugs/lenalidomide/"},{"id":"obinutuzumab","kind":"drug","name":"Obinutuzumab","route":"/drugs/obinutuzumab/"},{"id":"rituximab","kind":"drug","name":"Rituximab","route":"/drugs/rituximab/"},{"id":"tazemetostat","kind":"drug","name":"Tazemetostat","route":"/drugs/tazemetostat/"}],"target":[{"id":"crebbp","kind":"target","name":"CREBBP","route":"/targets/crebbp/"},{"id":"ep300","kind":"target","name":"EP300","route":"/targets/ep300/"},{"id":"ezh2","kind":"target","name":"EZH2","route":"/targets/ezh2/"}],"cancer":[{"id":"follicular-lymphoma","kind":"cancer","name":"Follicular lymphoma","route":"/cancers/follicular-lymphoma/"},{"id":"non-hodgkin-lymphoma","kind":"cancer","name":"Non-Hodgkin lymphoma (all types)","route":"/cancers/non-hodgkin-lymphoma/"}],"biomarker":[{"id":"ezh2-y646-mutation","kind":"biomarker","name":"EZH2 gain-of-function mutation (Tyr646, originally Tyr641)","route":"/biomarkers/ezh2-y646-mutation/"}],"trial":[{"id":"mosun-lbt-fl","kind":"trial","name":"Mosunetuzumab against rituximab in low tumour burden follicular lymphoma","route":"/trials/mosun-lbt-fl/"},{"id":"prima-follicular","kind":"trial","name":"PRIMA","route":"/trials/prima-follicular/"}],"paper":[{"id":"paper-casulo-pod24-follicular-lymphoma-jco-2015","kind":"paper","name":"Early relapse of follicular lymphoma after R-CHOP defines patients at high risk for death: an analysis from the National LymphoCare Study","route":"/key-papers/paper-casulo-pod24-follicular-lymphoma-jco-2015/"},{"id":"paper-prima-rituximab-maintenance-follicular-lancet-2011","kind":"paper","name":"Rituximab maintenance for 2 years in patients with high tumour burden follicular lymphoma responding to rituximab plus chemotherapy (PRIMA): a phase 3, randomised controlled trial","route":"/key-papers/paper-prima-rituximab-maintenance-follicular-lancet-2011/"}],"roadmap":[{"id":"lymphoma-roadmap","kind":"roadmap","name":"Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting","route":"/roadmaps/lymphoma-roadmap/"}]}}