title: Refinement of the Lugano Classification lymphoma response criteria in the era of immunomodulatory therapy.
abstract: 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.
authors: Division of Hematology-Oncology, Department of Medicine, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC.
authors: Bruce D
authors: BD
authors: Cheson
authors: Division of Hematology, Mayo Clinic, Rochester, MN.
authors: Stephen
authors: S
authors: Ansell
authors: Department of Radiology, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, NY.
authors: Larry
authors: L
authors: Schwartz
authors: Division of Hematology-Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Chicago, IL.
authors: Leo I
authors: LI
authors: Gordon
authors: Department of Medicine/Oncology, Stanford University, Stanford, CA.
authors: Ranjana
authors: R
authors: Advani
authors: Department of Imaging, Dana-Farber Cancer Institute, Boston, MA.
authors: Heather A
authors: HA
authors: Jacene
authors: Oncology R&D, GlaxoSmithKline, Collegeville, PA; and.
authors: Axel
authors: A
authors: Hoos
authors: Department of Nuclear Medicine, PET Imaging Centre at St. Thomas', London, United Kingdom.
authors: Sally F
authors: SF
authors: Barrington
authors: Department of Imaging, Dana-Farber Cancer Institute, Boston, MA.
authors: Philippe
authors: P
authors: Armand
mesh_terms: D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007167:Immunotherapy / Q000379:methods*; D008223:Lymphoma / Q000145:classification* / Q000628:therapy*
chemical_list: D007155:Immunologic Factors