Metabolic Criteria

Complete Remission (CR)

Complete metabolic remission requires all of the following:

  • A score of 1, 2, or 3 with or without a residual mass on a PET 5 point scale; and
  • Disappearance of any previously non-measured lesions; and
  • No new lesions; and
  • No evidence of FDG-avid disease in the marrow.

Partial Remission

Partial metabolic remission requires all of the following:

  • Score 4 or 5 on a PET 5 point scale with reduced uptake compared with baseline; and
  • No new lesions.

Stable Disease

Does not meet metabolic criteria for complete remission, partial remission, or progressive disease.

Progressive Disease (after Partial Remission, Stable Disease), Relapsed Disease (after Complete Remission)

Metabolic progression or relapse requires at least one of the following:

  • Score 4 or 5 on a PET 5 point scale with increased uptake compared with baseline; or
  • Any new FDG-avid foci consistent with lymphoma; or
  • New or recurrent FDG avid foci in the bone marrow.

Radiographic Response Criteria

The following acronyms are used in the radiographic response criteria provided below:

LDi: longest transverse diameter of a lesion
SDi: shortest axis perpendicular to the LDi
SPD: sum of the product of the perpendicular diameters for multiple lesions
PPD: cross product of the LDi and perpendicular diameter

Complete Remission (CR)

Complete radiographic remission requires all of the following:

  • All target nodes / nodal masses must have regressed as measured by CT to ≤ 1.5 cm in longest diameter; and
  • Disappearance of any previously non-measured lesions; and
  • No extralymphatic sites of disease; and
  • No organomegally.

Normal morphology of bone marrow is also required for a complete radiological remission if the marrow was an involved site. Immunohistochemical stains must be negative if morphology is indeterminate.

Partial Remission

Partial radiographic remission requires all of the following:

  • ≥ 50% decrease in the SPD of up to 6 target measurable nodes and extranodal sites1; and
  • No increase in the size of previously non-measurable lesions; and
  • No new lesions.

If splenomegaly is present, a > 50% decrease in spleen length is also required to report a partial radiological remission

Stable Disease

Does not meet radiographic criteria for complete remission, partial remission, or progressive disease.

Progressive Disease (after Partial Remission, Stable Disease), Relapsed Disease (after Complete Remission)

Radiographic progression or relapse requires at least one of the following:

  • An individual node must be abnormal with:
    • LDi >1.5 cm; and
    • ≥ 50% increase from nadir in the PPD; or
  • An increase in LDi or SDi from nadir
    • ≥ 0.5 cm increase in LDi or SDi from nadir for any lesion ≤ 2cm; or
    • ≥ 1.0 cm increase in LDi or SDi from nadir for any lesion > 2 cm; or
  • A 50% increase in spleen length compared to its prior increase beyond baseline; or
  • New or recurrent splenomegally; or
  • Clear progression of pre-existing non-measured lesions; or
  • Regrowth of any previously resolved lesions; or
  • A new node > 1.5 cm in any axis; or
  • A new extranodal site > 1.0 cm in any axis or if < 1.0 cm in any axis, its presence must be unequivocally attributable to lymphoma; or
  • Assessable disease of any size unequivocally attributable to lymphoma; or
  • New or recurrent involvement of the bone marrow.

1 For lesions too small to measure on CT, assign 5mm x 5mm as the default value and then 0 mm x 0 mm when the lesion is no longer visible. For a node >5 mm x 5 mm, but smaller than normal, use the actual measurement of the node for calculations.

Adapted from: Cheson, B. D., Fisher, R. I., Barrington, S. F., Cavalli, F., Schwartz, L. H., Zucca, E., & Lister, T. A. (2014). Recommendations for Initial Evaluation, Staging, and Response Assessment of Hodgkin and Non-Hodgkin Lymphoma: The Lugano Classification. Journal of Clinical Oncology, 32(27), 3059-3067. doi:10.1200/jco.2013.54.8800

Manual Updates:
Sections of the Forms Instruction Manual are frequently updated. The most recent updates to the manual can be found below. For additional information, select the manual section and review the updated text.

If you need to reference the historical Manual Change History for this form, please click here or reference the retired manual section on the Retired Forms Manuals webpage.

Date Manual Section Add/Remove/Modify Description
11/20/2018 LYM Response Criteria Modify Modified the response criteria to show the metabolic response criteria first and then the radiographic response criteria for ease of use.
05/10/2018 LYM Response Criteria Add Added “Relapsed Disease” to “Progressive Disease” criteria and included clarification on when to report these disease status.
1/30/18 LYM Response Criteria Add Version 2 of the Lymphoma Response Criteria section of the Forms Instructions Manual released. Version 2 corresponds to revision 4 of the LYM Pre- and Post-Infusion Forms (Forms 2018 / 2118).
Last modified: Nov 20, 2018

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