Lymphoma response to immunomodulatory therapy criteria (LYRIC)
During immunomodulatory agents (e.g. checkpoint inhibitors) therapy, imaging findings suggestive of progressive disease (PD) without clinical deterioration may instead represent flare or pseudo-progression, therefore the term “indeterminate response” was added to Lugano classification to address such lesions until confirmed as being true disease progression or not.
Indeterminate response (IR)
- IR(1): ≥ 50% increase in overall tumor burden (sum of the product of the perpendicular diameters (SPD) of up to six target measurable nodes and extranodal sites) occurred in the first 12 weeks of therapy and without clinical deterioration
- IR(2): new lesions or ≥ 50% increase of existing lesion(s) without a ≥ 50% increase of overall tumor burden at any time during treatment.
- IR(3): increased FDG uptake of one or more lesions without any increase in size or number of those lesions.
If two patterns of IR are present at the same time, priority should be given to IR(1) or (2) over IR(3).
After an IR, a biopsy or subsequent imaging within 12 weeks is recommended to confirm true progressive disease versus a flare or pseudoprogression.
- 1. Cheson BD, Ansell S, Schwartz L, Gordon LI, Advani R, Jacene HA, Hoos A, Barrington SF, Armand P. Refinement of the Lugano Classification lymphoma response criteria in the era of immunomodulatory therapy. (2016) Blood. 128 (21): 2489-2496. doi:10.1182/blood-2016-05-718528 - Pubmed
- 2. Cheson BD, Fisher RI, Barrington SF, Cavalli F, Schwartz LH, Zucca E, Lister TA. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. (2014) Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 32 (27): 3059-68. doi:10.1200/JCO.2013.54.8800 - Pubmed
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