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

Bruce D. Cheson, Stephen Ansell, Larry Schwartz, Leo I. Gordon, Ranjana Advani, Heather A. Jacene, Axel Hoos, Sally F. Barrington and Philippe Armand

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  • RE: Is our future our past?
    • Reyad Dada, Associate Professor and Senior Consultant Medical Oncology King Faisal Specialist Hospital and Research Center, Jeddah, College of Medicine, Al-Faisal University, Saudia Arabia

    Pseudo-progression has become major challenge in new era of immunooncology. Recent published results of workshop of Lymphoma Research Foundation and others on refinement of Lugano criteria was eagerly awaited1. The new so-called lymphoma response to immunomodulatory therapy criteria (LYRIC) are taking in consideration those patients with pseudo-progression. Therefore, authors have created new response category of indeterminate response “IR”.
    According to this interesting publication patients would be in IR if increase of overall tumor burden (IOTB) is ≥50% without clinical deterioration. However, one might ask is this step forward or backward to prior images era without understating relevance of clinical judgment. Is our future our past?
    We know that some patients can have real IOTB by ≥100% without being symptomatic. On other hand, responding lymphomas with significant lesion size nearby critical structures can become clinical symptomatic due to pseudo-progression. These dilemmas are difficult to be immediately captured with LYRIC. Additionally, the new criteria are complicated with many numbers/percentages that have to be followed which is not practical in a busy daily practice. Furthermore, authors call, in case of IR1 and IR2 in first 12 weeks, for early biopsy of concerning lesions. Such approach might be helpful in fast responding lymphomas such as Hodgkin disease and to limited extent DLBCL. However, despite sensitivity to treatment many low grade lympho...

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    Conflict of Interest:
    None declared.