Criteria

Modified Ann Arbor staging system for NHL[80]

Stage I: Single lymph node group

Stage II: Multiple lymph node groups on same side of diaphragm

Stage III: Multiple lymph node groups on both sides of diaphragm

Stage IV: Multiple extranodal sites or lymph nodes and extranodal disease (an X denotes extranodal disease bulk >10 cm)

The following are added to the stage where relevant:

  • E: extranodal extension or single isolated site of extranodal disease

  • A: absence of symptoms

  • B: presence of B symptoms (weight loss >10% of body weight within 6 months of diagnosis; fever; and drenching night sweats)

Lugano modification of Ann Arbor staging system (for primary nodal lymphomas)[81]

  • Stage I: One node or group of adjacent nodes

  • Stage IE: Single extranodal lesions without nodal involvement

  • Stage II: Two or more nodal groups on the same side of the diaphragm

  • Stage IIE: Stage I or II by nodal extent with limited contiguous extranodal involvement

  • Stage II bulky: Two or more nodal groups on the same side of the diaphragm (i.e., stage II) with 'bulky' disease

  • Stage III: Nodes on both sides of the diaphragm; nodes above the diaphragm with spleen involvement

  • Stage IV: Additional noncontiguous extralymphatic involvement

International Prognostic Index (IPI)[82]

A prognostic scoring system for patients with aggressive NHL (e.g., diffuse large B-cell lymphoma [DLBCL]) based on the following risk factors:

  • Age >60 years

  • Serum lactate dehydrogenase (LDH) level >1 times normal

  • Performance status 2-4

  • Stage III-IV disease

  • Extranodal involvement >1 site

Patients are risk-stratified based on the number of risk factors present:

  • Low risk: 0 or 1

  • Low-intermediate risk: 2

  • High-intermediate risk: 3

  • High risk: 4 or 5

Age-adjusted International Prognostic Index (IPI)[82]​ 

An age-adjusted version of the IPI prognostic scoring system for patients aged ≤60 years based on the following risk factors:

  • Stage III-IV disease

  • Serum LDH level >1 times normal

  • Performance status 2-4

Patients are risk-stratified based on the number of risk factors present:

  • ​Low risk: 0

  • Low-intermediate risk: 1

  • High-intermediate risk: 2

  • High risk: 3

Stage-modified International Prognostic Index (smIPI)[83]

A stage-modified version of the IPI prognostic scoring system for patients with localised (stage I or II) disease, based on the following risk factors:

  • Age >60 years

  • Stage II disease

  • Serum LDH level >1 times normal

  • Performance status 2-4

Patients are risk-stratified based on the number of risk factors present:

  • Low risk: 0 or 1

  • High risk: 2-4

NCCN International Prognostic Index (IPI)[84]

A modified version of the IPI prognostic scoring system (using data from the NCCN NHL database in the rituximab era) based on the following risk factors (with assigned scores):

  • Age >40 to ≤60 years (score: 1)

  • Age >60 to ≤75 years (score: 2)

  • Age >75 years (score: 3)

  • LDH ratio* >1 to ≤3 (score: 1)

  • LDH ratio* >4 (score: 2)

  • Ann Arbor stage III-IV (score: 1)

  • Extranodal disease (in bone marrow, central nervous system, liver/gastrointestinal tract, or lung) (score: 1)

  • Eastern Cooperative Oncology Group (ECOG) performance status ≥2 (score: 1)

*Normalised LDH (ratio ≤1) used as a reference.

Patients are risk-stratified based on total score:

  • Low risk: 0 or 1

  • Low-intermediate risk: 2 or 3

  • High-intermediate risk: 4 or 5

  • High risk: ≥6

Groupe d'Etude des Lymphomes Folliculaires (GELF) criteria[85]

Criteria used to assess tumour burden in patients with follicular lymphoma. Patients with any of the following are classified as having a high tumour burden:

  • Involvement of ≥3 nodal sites, each with a diameter of ≥3 cm

  • Any nodal or extranodal tumour mass with a diameter of ≥7 cm

  • B symptoms

  • Splenomegaly

  • Pleural effusions or peritoneal ascites

  • Cytopenias (leukocytes <1.0 × 10⁹/L and/or platelets <100 × 10⁹/L)

  • Leukaemia (>5.0 × 10⁹/L malignant cells)

Follicular lymphoma International Prognostic Index 1 (FLIPI-1)[86]

A prognostic scoring system for patients with follicular lymphoma (developed before the availability of rituximab) based on the following risk factors:

  • Age >60 years

  • Stage III-IV disease

  • Haemoglobin level <12 g/dL

  • Serum LDH > upper limit of normal (>ULN)

  • Number of nodal sites >4

Patients are risk-stratified based on the number of risk factors present:

  • Low risk: 0 or 1

  • Intermediate risk: 2

  • High risk: 3-5

Follicular lymphoma International Prognostic Index 2 (FLIPI-2)[64]

An updated version of the FLIPI-1 prognostic scoring system for patients with follicular lymphoma (developed after the availability of rituximab) based on the following risk factors:

  • Age >60 years

  • Haemoglobin level <12 g/dL

  • Longest diameter of largest involved lymph node >6 cm

  • Beta-2 microglobulin level >ULN

  • Bone marrow involvement present

Patients are risk-stratified based on the number of risk factors present:

  • Low risk: 0 or 1

  • Intermediate risk: 2

  • High risk: 3-5

Central nervous system (CNS) International Prognostic Index (CNS-IPI)[87]

A prognostic tool used to estimate the risk of CNS relapse/progression in patients with DLBCL based on the following risk factors:

  • Kidney and/or adrenal glands involved

  • Age >60 years

  • Elevated LDH

  • ECOG performance status >1

  • Stage III-IV disease

  • >1 extranodal site

Patients are risk-stratified based on the number of risk factors present:

  • Low risk: 0 or 1

  • Intermediate risk: 2 or 3

  • High risk: 4-6

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