It is always difficult trying to make predictions about the likely outcome for an individual patient at diagnosis. Information about a treatment is based on treating large groups of patients. Your doctors will be able to tell you how 100 similar patients responded to treatment X or what happened to 100 patients with disease Y. However, the patient wants to know what is likely to happen for them and this uncertainty can be very difficult to deal with. For most conditions there have been studies looking at various factors that can predict who is going to do well and who is going to do poorly. This is important in counselling patients appropriately but is also important in guiding treatments. These systems allow doctors to give stronger treatment to poor prognosis patients and to avoid strong treatments with potential side effects in good prognosis patients.

The newly developed prognostic system in follicular NHL is the Follicular Lymphoma International Prognostic Index [FLIPI]. This has 5 components to give each patient a score out of 5. These include:

• Age over 60
• Haemoglobin < 12g/dl
• > 4 nodal areas involved
• A blood test marker called LDH raised above the normal range
• Extent of disease spread [stage III or IV]

This system divides patients up into 3 groups based on their total: low [0,1], intermediate [2] and high [3, 4, 5]. Survival rates vary with each of these 3 groups.

Ask your doctor what your FLIPI is and what that means for you. It is important to emphasise that none of these pieces of information are absolute predictors of the future, and the information that they give must be put into context for each individual patient. Your doctor will explain what your unique risk factors are and what this may mean for you in terms of treatment and prognosis.