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Blood. 2016 Nov 24;128(21):2489-2496. Epub 2016 Aug 29.

Refinement of the Lugano Classification lymphoma response criteria in the era of immunomodulatory therapy.

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Division of Hematology-Oncology, Department of Medicine, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC.
Division of Hematology, Mayo Clinic, Rochester, MN.
Department of Radiology, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, NY.
Division of Hematology-Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Chicago, IL.
Department of Medicine/Oncology, Stanford University, Stanford, CA.
Department of Imaging, Dana-Farber Cancer Institute, Boston, MA.
Oncology R&D, GlaxoSmithKline, Collegeville, PA; and.
Department of Nuclear Medicine, PET Imaging Centre at St. Thomas', London, United Kingdom.


Uniformly adopted response criteria are essential for assessment of therapies incorporating conventional chemotherapy and chemoimmunotherapy regimens. Recently, immunomodulatory agents, such as immune checkpoint inhibitors, have demonstrated impressive activity in a broad range of lymphoma histologies. However, these agents may be associated with clinical and imaging findings during treatment suggestive of progressive disease (PD) despite evidence of clinical benefit (eg, tumor flare or pseudo-progression). Considering this finding as PD could lead to patients being prematurely removed from a treatment from which they actually stand to benefit. This phenomenon has been well described with checkpoint blockade therapy in solid tumors and anecdotally seen in lymphoma as well. To address this issue in the context of lymphoma immunomodulatory therapy, a workshop was convened to provide provisional recommendations to modify current response criteria in patients receiving these and future agents in clinical trials. The term "indeterminate response" was introduced to identify such lesions until confirmed as flare/pseudo-progression or true PD by either biopsy or subsequent imaging.

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