# FLIPI24 follicular lymphoma EFS24

FLIPI24

Status: LIVE
Price: $0.005 USDC
`GET /api/calc/flipi24`
HTML: https://magentlab.com/docs/flipi24
Markdown: https://magentlab.com/docs/flipi24.md

Not a medical device. Not a diagnosis, dose, or listing recommendation.

## What it computes

Compute the Maurer 2025 Table S5 probability of an event within 24 months (progression, transformation, second-line treatment, or death) in newly diagnosed follicular lymphoma from age, hemoglobin, WBC, LDH/ULN, and beta-2 microglobulin, assuming R-CHOP or B-R-like immunochemotherapy and a 50% likelihood of anti-CD20 maintenance.

## When to use

When an agent already has those five caller-assigned values and needs the locked FLIPI24 EFS24 probability and Table S5 low/intermediate/high groups. Not Solal-Céligny FLIPI 2004. magent does not assay labs or order immunochemotherapy.

## When not to use

- Not a medical device and not a diagnosis. Not a treatment order, trial-eligibility order, or immunochemotherapy prescription.
- Table S5 assumes first-line R-CHOP or B-R-like immunochemotherapy and a 50% likelihood of anti-CD20 maintenance. That maintenance term is already in the 0.7115 centering; magent does not take a maintenance flag.
- This is Maurer 2025 FLIPI24 only. It is not original FLIPI (Solal-Céligny 2004).
- Hemoglobin, WBC, LDH/ULN, and beta-2 microglobulin are caller-assigned. magent does not assay those labs or set the LDH upper limit of normal.
- Continuous inputs are clamped to Table S5 linear ranges (age 60-90 with extra years after 75 capped at 15; hemoglobin 8-17 g/dL; WBC 4-11 10^9/L; LDH/ULN 0.5-5; B2M 1-10 mg/L). Discrete groups are Table S5 low (<=0.10), intermediate (0.10-0.15], and high (>0.15).

## Formula

```
efs24_event_probability = 1 - 0.89^exp(lp); lp = 0.01*age60 + 0.038*age_over_75 + 0.364*ldh_uln + 0.159*b2m_mg_l - 0.081*hemoglobin_g_dl + 0.075*wbc_10e9_l - 0.7115; age60 = clamp(age, 60, 90); age_over_75 = min(15, max(0, clamp(age, 0, 90)-75)); ldh_uln clamp 0.5-5; b2m clamp 1-10 mg/L; hemoglobin clamp 8-17 g/dL; wbc clamp 4-11 10^9/L; Maurer 2025 Table S5; S0(24)=0.89; 50% anti-CD20 maintenance is in the 0.7115 centering; risk low if p<=0.10, intermediate if p<=0.15, else high; assumes R-CHOP or B-R-like immunochemotherapy
```

## Citation

[FLIPI24: A Modern Prognostic Model and Clinical Trial Enrichment Tool for Newly Diagnosed Follicular Lymphoma](https://doi.org/10.1200/jco-25-00892)
Maurer MJ, et al.
J Clin Oncol. 2026;44(2):117-128
DOI: [10.1200/jco-25-00892](https://doi.org/10.1200/jco-25-00892)

## Worked example

### Age 61, hemoglobin 13.0 g/dL, WBC 7.0, LDH/ULN 1.0, B2M 2.0 mg/L

Given: `age=61, b2m_mg_l=2.0, hemoglobin_g_dl=13.0, ldh_uln_ratio=1.0, wbc_10e9_l=7.0`

1. Table S5 clamps: age 61 stays 61 (between 60 and 75, so age_over_75 = 0); hemoglobin 13.0, WBC 7.0, LDH/ULN 1.0, and B2M 2.0 are inside the linear ranges
2. cov_lp = 0.01*61 + 0.038*0 + 0.364*1.0 + 0.159*2.0 - 0.081*13.0 + 0.075*7.0 = 0.61 + 0 + 0.364 + 0.318 - 1.053 + 0.525 = 0.764
3. lp = 0.764 - 0.7115 = 0.0525; efs24_event_probability = 1 - 0.89^exp(0.0525), 4 decimals; Table S5 risk_group intermediate (0.10 < p ≤ 0.15)


### Age 80 with otherwise the age-61 example labs

Given: `age=80, b2m_mg_l=2.0, hemoglobin_g_dl=13.0, ldh_uln_ratio=1.0, wbc_10e9_l=7.0`

1. Same labs as the age-61 example; age 80 → age60 = 80; age_over_75 = min(15, max(0, 80-75)) = 5
2. cov_lp = 0.01*80 + 0.038*5 + 0.364*1.0 + 0.159*2.0 - 0.081*13.0 + 0.075*7.0 = 1.144; lp = 1.144 - 0.7115 = 0.4325
3. efs24_event_probability = 1 - 0.89^exp(0.4325), 4 decimals; Table S5 risk_group high (p > 0.15)


## Also searched as

- FLIPI24
- FLIPI-24
- Maurer FLIPI24
- follicular lymphoma EFS24
- follicular lymphoma 24-month event
- modern follicular lymphoma index
- FLIPI 24 month

## Parameters

- `age` (integer, required): Age in years (integer 18-120). Maurer 2025 Table S5: no additional age effect 18-60; HR 1.01 per year 60-75 (beta 0.01); HR 1.05 per year 75-90 (extra beta 0.038). Age is clamped to 90 for the linear predictor. magent does not assign age.
- `hemoglobin_g_dl` (number, required): Hemoglobin in g/dL (1-25). Table S5 linear 8-17 g/dL, HR 0.92 per unit (beta -0.081); values outside 8-17 are clamped. magent does not assay hemoglobin.
- `wbc_10e9_l` (number, required): White blood cell count in 10^9/L (0.1-80), equal to k/µL. Table S5 linear 4-11, HR 1.08 per unit (beta 0.075); values outside 4-11 are clamped. magent does not assay WBC.
- `ldh_uln_ratio` (number, required): Caller-assigned serum LDH divided by the local upper limit of normal (0.1-20). Table S5 linear 0.5-5, HR 1.44 per unit (beta 0.364); values outside 0.5-5 are clamped. magent does not measure LDH or set the ULN.
- `b2m_mg_l` (number, required): Beta-2 microglobulin in mg/L (0.1-40). Table S5 linear 1-10 mg/L, HR 1.17 per unit (beta 0.159); values outside 1-10 are clamped. magent does not assay B2M.

## Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

Method: `POST /api/calc/flipi24`
Max items: 25
Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic)
Status: PREVIEW

- 1 to 25 items. Each item uses the same keys as the GET query parameters.
- POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
- The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
- HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
- Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
- x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request:

```json
{
  "items": [
    {
      "age": "61",
      "b2m_mg_l": "2.0",
      "hemoglobin_g_dl": "13.0",
      "ldh_uln_ratio": "1.0",
      "wbc_10e9_l": "7.0"
    },
    {
      "age": "61",
      "b2m_mg_l": "2.0",
      "hemoglobin_g_dl": "13.0",
      "ldh_uln_ratio": "1.0",
      "wbc_10e9_l": "7.0"
    }
  ]
}
```

Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/flipi24

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/flipi24",
  "items": [
    {
      "age": 61,
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Maurer MJ, et al.",
        "doi": "10.1200/jco-25-00892",
        "id": "maurer-2025-flipi24",
        "pmid": "41329901",
        "source": "J Clin Oncol. 2026;44(2):117-128",
        "title": "FLIPI24: A Modern Prognostic Model and Clinical Trial Enrichment Tool for Newly Diagnosed Follicular Lymphoma"
      },
      "formula": "flipi24",
      "formula_expression": "efs24_event_probability = 1 - 0.89^exp(lp); lp = 0.01*age60 + 0.038*age_over_75 + 0.364*ldh_uln + 0.159*b2m_mg_l - 0.081*hemoglobin_g_dl + 0.075*wbc_10e9_l - 0.7115; age60 = clamp(age, 60, 90); age_over_75 = min(15, max(0, clamp(age, 0, 90)-75)); ldh_uln clamp 0.5-5; b2m clamp 1-10 mg/L; hemoglobin clamp 8-17 g/dL; wbc clamp 4-11 10^9/L; Maurer 2025 Table S5; S0(24)=0.89; 50% anti-CD20 maintenance is in the 0.7115 centering; risk low if p<=0.10, intermediate if p<=0.15, else high; assumes R-CHOP or B-R-like immunochemotherapy",
      "wbc_10e9_l": 7.0,
      "hemoglobin_g_dl": 13.0,
      "risk_group": "intermediate",
      "linear_predictor": 0.0525,
      "b2m_mg_l": 2.0,
      "efs24_event_probability": 0.1156,
      "ldh_uln_ratio": 1.0
    },
    {
      "age": 61,
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Maurer MJ, et al.",
        "doi": "10.1200/jco-25-00892",
        "id": "maurer-2025-flipi24",
        "pmid": "41329901",
        "source": "J Clin Oncol. 2026;44(2):117-128",
        "title": "FLIPI24: A Modern Prognostic Model and Clinical Trial Enrichment Tool for Newly Diagnosed Follicular Lymphoma"
      },
      "formula": "flipi24",
      "formula_expression": "efs24_event_probability = 1 - 0.89^exp(lp); lp = 0.01*age60 + 0.038*age_over_75 + 0.364*ldh_uln + 0.159*b2m_mg_l - 0.081*hemoglobin_g_dl + 0.075*wbc_10e9_l - 0.7115; age60 = clamp(age, 60, 90); age_over_75 = min(15, max(0, clamp(age, 0, 90)-75)); ldh_uln clamp 0.5-5; b2m clamp 1-10 mg/L; hemoglobin clamp 8-17 g/dL; wbc clamp 4-11 10^9/L; Maurer 2025 Table S5; S0(24)=0.89; 50% anti-CD20 maintenance is in the 0.7115 centering; risk low if p<=0.10, intermediate if p<=0.15, else high; assumes R-CHOP or B-R-like immunochemotherapy",
      "wbc_10e9_l": 7.0,
      "hemoglobin_g_dl": 13.0,
      "risk_group": "intermediate",
      "linear_predictor": 0.0525,
      "b2m_mg_l": 2.0,
      "efs24_event_probability": 0.1156,
      "ldh_uln_ratio": 1.0
    }
  ]
}
```

## Response fields

- `formula` (string): flipi24
- `formula_expression` (string): Maurer 2025 Table S5 EFS24 probability algorithm
- `age` (integer): Input age in years
- `hemoglobin_g_dl` (number): Input hemoglobin g/dL
- `wbc_10e9_l` (number): Input WBC 10^9/L
- `ldh_uln_ratio` (number): Input caller-assigned LDH / ULN ratio
- `b2m_mg_l` (number): Input beta-2 microglobulin mg/L
- `linear_predictor` (number): Table S5 centered linear predictor (cov_lp - 0.7115), 4 decimals
- `efs24_event_probability` (number): Probability of an event within 24 months (0-1), 4 decimals. A probability, not a treatment order.
- `risk_group` (string): Table S5 groups: low if probability ≤0.10, intermediate if ≤0.15, high otherwise
- `citation` (object): Maurer 2025 FLIPI24 citation
- `disclaimer` (string): Not-a-device notice

## Example JSON

Frozen fixture. Not a live lookup.

```json
{
  "age": 61,
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Maurer MJ, et al.",
    "doi": "10.1200/jco-25-00892",
    "id": "maurer-2025-flipi24",
    "pmid": "41329901",
    "source": "J Clin Oncol. 2026;44(2):117-128",
    "title": "FLIPI24: A Modern Prognostic Model and Clinical Trial Enrichment Tool for Newly Diagnosed Follicular Lymphoma"
  },
  "formula": "flipi24",
  "formula_expression": "efs24_event_probability = 1 - 0.89^exp(lp); lp = 0.01*age60 + 0.038*age_over_75 + 0.364*ldh_uln + 0.159*b2m_mg_l - 0.081*hemoglobin_g_dl + 0.075*wbc_10e9_l - 0.7115; age60 = clamp(age, 60, 90); age_over_75 = min(15, max(0, clamp(age, 0, 90)-75)); ldh_uln clamp 0.5-5; b2m clamp 1-10 mg/L; hemoglobin clamp 8-17 g/dL; wbc clamp 4-11 10^9/L; Maurer 2025 Table S5; S0(24)=0.89; 50% anti-CD20 maintenance is in the 0.7115 centering; risk low if p<=0.10, intermediate if p<=0.15, else high; assumes R-CHOP or B-R-like immunochemotherapy",
  "wbc_10e9_l": 7.0,
  "hemoglobin_g_dl": 13.0,
  "risk_group": "intermediate",
  "linear_predictor": 0.0525,
  "b2m_mg_l": 2.0,
  "efs24_event_probability": 0.1156,
  "ldh_uln_ratio": 1.0
}
```

## Errors

- HTTP 400 `invalid_flipi24`: FLIPI24 inputs must match Maurer 2025 age, hemoglobin, WBC, LDH over ULN, and beta-2 microglobulin. Returned before settlement; you are not charged.
- HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
- HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
- HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged.

Shared HTTP 402 and 503: https://magentlab.com/docs/payments

## Related tools

- [FLIPI](https://magentlab.com/docs/flipi) — Sum the Solal-Céligny 2004 FLIPI adverse factors for follicular lymphoma and return low (0–1), intermediate (2), or high (≥3).
- [GELF criteria](https://magentlab.com/docs/gelf) — Apply the Brice 1997 GELF high-tumor-burden checklist and return low_burden or high_burden from eight caller-assigned items.

## Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s.

- GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall).
- HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote.
- Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering.
- Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional.
- Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402.

- offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront.
- offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization.

- not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search.

Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers).

Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments

Stdio MCP (one process per host): https://magentlab.com/docs/mcp

## Guarantees

- HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON.
- exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
- HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
- Execution is timeout-bounded and concurrency-capped.
- Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.