Groupe d'Etude des Lymphomes Folliculaires (GELF) Criteria

GELF Criteria Calculator

Any Nodal or Extranodal Mass ≥7 cm

≥3 Nodal Sites Each ≥3 cm

B Symptoms Present

Splenomegaly

Pleural Effusion or Ascites

Cytopenias (WBC <1,000 or Platelets <100,000)

Leukemic Phase (>5,000/µL Circulating Tumor Cells)

Criteria Met: –

Awaiting input

Select all criteria to compute the score.

Determines if immediate therapy for follicular lymphoma is required.

Why Use

The GELF criteria is easy to use with information most providers will already have available. Clinical evaluation, laboratory testing, and imaging are all that is needed to determine who has a high tumor burden based on the GELF criteria.

When to Use

The criteria can help identify those patients with follicular lymphoma at higher risk for rapid disease progression and in whom immediate therapy may be needed.

Formula

Patients must meet ≥1 criteria to be considered “high” tumor burden; criteria below: Any nodal or extranodal tumor mass >7 cm diameter Involvement of at least 3 nodal sites, each with diameter >3 cm Presence of any systemic or B symptoms Splenic enlargement with inferior margin below the umbilical line Compression syndrome (ureteral, orbital, gastrointestinal) Pleural or peritoneal serous effusion (irrespective of cell content) Leukemic phase (>5.0 x10 9 /L circulating malignant cells) Cytopenia (granulocyte count <1.0 x10 9 /L and/or platelets <100x10 9 /L)

Pearls / Pitfalls

This tool is best used as an instantaneous assessment of a patient’s disease burden. Ultimately, clinical judgement and comprehensive review of the patient’s previous workup are critical to make this assessment. For overall prognosis, the FLIPI can risk stratify further than the GELF criteria.

Management

Treatment is varied depending on the stage and tumor burden. Stages I-II Treatment options include: Involved field radiotherapy (IFRT) Clinical trials Active surveillance Stages III-IV or Bulky Stage II – asymptomatic Treatment options include: Clinical trials Active surveillance Stages III-IV or Bulky Stage II – with GELF/BNLI risk factors or high-risk FLIPI score Treatment options include: RiTUXimab + cyclophosphamide, vinCRIStine, DOXOrubicin, predniSONE RiTUXimab alone Bendamustine + riTUXimab RiTUXimab + cyclophosphamide, vinCRIStine, predniSONE Clinical trials

Critical Actions

There is continued controversy around when and how to treat follicular lymphoma, including in patients with relapsed/refractory disease. Questions to consider when making treatment decisions: When to initiate therapy versus active surveillance Deciding amongst various treatment options Balancing efficacy and toxicities of treatment options Determining what constitutes a complete response/endpoint of treatment Finally, with follicular lymphoma, a provider should be aware of transformation to diffuse large B-cell lymphoma, which is a more aggressive disease and would require prompt treatment.

Advice

Refer to the staging systems FLIPI and Lugano classification to assist with risk stratifying patients. The GELF criteria is a quick test to determine which patients should be monitored versus treated now.

More Information

Nodal Sites