Lymphoma Response to Immunomodulatory Therapy Criteria (LYRIC)

The Lymphoma Response to Immunomodulatory Therapy Criteria (LYRIC) is an extension of the Lugano classification for evaluating lymphoma after immune-based treatment.

Usage

During immunomodulatory agents (e.g., checkpoint inhibitors) therapy, imaging findings suggestive of progressive disease (PD) without clinical deterioration may represent a flare reaction or pseudoprogression. Therefore, “indeterminate response” was added to the Lugano classification to address such lesions until they were confirmed as true disease progression ^1-3. The other criteria are the same as the Lugana classification ³.

Classification

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) ^1,2.

After an IR, a biopsy or subsequent imaging within 12 weeks is recommended to confirm true progressive disease versus a flare or pseudoprogression ^1,2.