GELF: high tumour burden criteria
Marks the GELF high tumour burden criteria in follicular lymphoma; any one of them indicates treatment.
When to use
Newly diagnosed follicular lymphoma, to decide between observation and starting treatment.
Pearls and pitfalls
- A single criterion already defines high tumour burden: it is not a sum with a cutoff.
- Without criteria, observation is a standard option, with a median time to needing treatment of about three years.
- The 7 cm size is the GELF one, and the guideline notes that alternative cutoffs of 6 and 10 cm have been discussed.
- The fever of B symptoms has to be unexplained: fever from an established infection does not count as a criterion.
Low tumour burden criteria
Nodal mass of 7 cm or more: No
Three or more nodal sites, each 3 cm or more: No
Symptomatic splenomegaly: No
Organ compression or a painful lesion: No
Pleural effusion or ascites attributed to lymphoma: No
Haemoglobin below 10 g/dL or platelets below 100 × 10⁹/L from infiltration: No
B symptoms: unexplained fever above 38 °C, night sweats or more than 10% weight loss in 6 months: No
Rapidly progressive disease within 3 months: No
Formula
Count of the criteria present among a 7 cm mass, three 3 cm sites, symptomatic splenomegaly, compression, effusion, cytopenia, B symptoms and progression within 3 months.
Evidence
High tumour burden criteria used to indicate treatment in follicular lymphoma, as tabulated by the European Hematology Association guideline.
References
- Dreyling M, Ghielmini M, Tedeschi A, et al. Newly diagnosed and relapsed follicular lymphoma: EHA clinical practice guidelines. Hemasphere. 2026;10(2):e70507. doi:10.1002/hem3.70507
Frequently asked questions
What is GELF: high tumour burden criteria?
Marks the GELF high tumour burden criteria in follicular lymphoma; any one of them indicates treatment. Newly diagnosed follicular lymphoma, to decide between observation and starting treatment.
How is the result calculated?
Count of the criteria present among a 7 cm mass, three 3 cm sites, symptomatic splenomegaly, compression, effusion, cytopenia, B symptoms and progression within 3 months.
How should the result be interpreted?
High tumour burden criteria used to indicate treatment in follicular lymphoma, as tabulated by the European Hematology Association guideline.
What are the sources?
Dreyling M, Ghielmini M, Tedeschi A, et al. Newly diagnosed and relapsed follicular lymphoma: EHA clinical practice guidelines. Hemasphere. 2026;10(2):e70507.