Follicular lymphoma meeting GELF criteria for high tumor burden — any of: nodal mass ≥7 c...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-FL-HIGH-TUMOR-BURDEN-GELF`
Type	Red flag
Status	reviewed 2026-04-25 \| pending_clinical_signoff
Diseases	`DIS-FL`
Sources	`SRC-ESMO-FL-2024` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	Follicular lymphoma meeting GELF criteria for high tumor burden — any of: nodal mass ≥7 cm; ≥3 nodal sites each ≥3 cm; B-symptoms; splenomegaly below umbilicus; pleural/peritoneal effusion; cytopenia (Hb <10, plt <100K, ANC <1.5K) attributable to lymphoma; LDH >ULN; β2M elevated; rapidly progressive disease
Clinical direction	intensify
Category	risk-score
Shifts algorithm	ALGO-FL-1L

Trigger Logic

{
  "any_of": [
    {
      "finding": "fl_gelf_high_burden",
      "value": true
    },
    {
      "comparator": ">=",
      "finding": "dominant_nodal_mass_cm",
      "threshold": 7.0
    },
    {
      "finding": "b_symptoms_present",
      "value": true
    },
    {
      "finding": "ldh_above_uln",
      "value": true
    },
    {
      "finding": "rapid_progression",
      "value": true
    }
  ],
  "type": "composite_clinical"
}

Notes

GELF (Groupe d'Étude des Lymphomes Folliculaires) criteria are the long-standing trigger for active treatment vs watch-and-wait. Without GELF criteria, observation is preferred — patients in this group have median time-to-progression of multiple years and identical OS to early-treatment cohorts (multiple RCTs).

Used By

Algorithms

ALGO-FL-1L - ALGO-FL-1L
ALGO-NMZL-1L - ALGO-NMZL-1L

Indications

IND-FL-1L-WATCH - IND-FL-1L-WATCH
IND-NMZL-1L-HCV-POSITIVE - IND-NMZL-1L-HCV-POSITIVE
IND-NMZL-1L-WATCH - IND-NMZL-1L-WATCH

Red flag

RF-GELF-CRITERIA-MET - Follicular lymphoma meeting any GELF criterion — high tumor burden warranting systemic th...