关于FL治疗指征？

进展期FL治疗指征通常参考标准：GELF或BNLI 标准，具体如下：

• BNLI标准来源：Lancet.2003 Aug 16;362(9383):516-22

Clinically non-aggressive disease was defined as the absence of all of:

(1) pruritus or B symptoms;

(2) rapid generalised disease progression in the preceding 3 months;

(3) life-endangering organ involvement;

(4) significant bone marrow infiltration resulting in bone marrow depression that warranted immediate chemotherapy (defined as haemoglobin <100 g/L, white cell count <3·0109/L, or platelet count <100109/L, having excluded other causes of such cytopenias);

(5) localised bone lesions detected on radiography or isotope scan (because of concern over the development of pathological fractures);

(6) renal infiltration (even if renal function was well preserved);

(7) macroscopic as opposed to microscopic liver involvement.

Macroscopic disease refers to disease visible on scans. Bulk disease alone was not an exclusion criterion. 

• GELF标准来源：J Clin Oncol.1997 Mar;15(3):1110-7

Patients were considered to have a low tumor burden with the following parameters:

1. nodal or extranodal tumor mass with a diameter less than 7 cm;
2. involvement of fewer than three nodal sites with a diameter greater than 3 cm;
3. absence of systemic symptoms; no substantial splenic enlargement;
4. no serous effusion;
5. absence of local risk of compression (epidural, ureteral, etc);
6. no leukemia or blood cytopenia.

进展期FL治疗是以症状驱动的，起初的标准也是如此；不知道何时多了两个生化指标：LDH和微球蛋白；

比如RELEVANCE 研究的标准就是：

Patients were required to be in need of treatment according to Groupe d'Etude des Lymphomes Folliculaires (GELF) criteria as evidenced by at least one of the following: bulky disease defined as:

1. a nodal or extranodal (except spleen) mass > 7 cm in its greater diameter
2. involvement of at least 3 nodal or extranodal sites (each with a diameter greater than > 3 cm);
3. presence of at least one of the following B symptoms: fever (> 38 degrees Celsius) of unclear etiology, night sweats, weight loss greater than 10% within the prior 6 months;
4. symptomatic splenomegaly;
5. compression syndrome (ureteral, orbital, gastrointestinal); any one of the following cytopenias due to lymphoma: hemoglobin < 10 g/dL (6.25 mmol/L), platelets < 100 x 109/L , or absolute neutrophil count < 1.5 x 109/L;
6. pleural or peritoneal serous effusion(irrespective of cell content);
7. and/or lactate dehydrogenase or β2 microglobulin greater than the upper limit or normal.

对此，有点困惑；不知大家怎么看