The clinical staging of diffuse large cell lymphoma in patients treated aggressively may be better achieved by assessing tumor burden and serum LDH levels than using the Ann Arbor staging scheme. The groups identified correlate with 10 year survival , complete remission rate and relapse rate.
Evaluation of patients
(1) extent of nodal disease
(2) extent of extranodal disease
(3) serum LDH (at or below the upper limit of normal, versus above)
|
Region |
Criteria for Extensive Nodal Disease |
|
peripheral |
mass >= 7 cm |
|
|
tight cluster of nodes >= 7 cm |
|
abdominal or pelvic |
any palpable mass |
|
|
any mass >= 7 cm (can be by imaging techniques) |
|
|
organ displacement (can be by imaging techniques) |
|
|
concomitant involvement of para-aortic and pelvic nodes (can be by imaging techniques) |
|
mediastinal |
any mass visualized on routine chest X-rays |
Criteria for extensive extranodal disease:
(1) involvement of more than 50% of solid organ (lung, liver, kidney or bone marrow)
(2) involvement of 2 or more serosal surfaces (pleura, mediastinum, pericardium, peritoneum)
(3) any involvement of the CNS except for epidural mass < 7 cm
(4) T3 or T4 extranodal involvement in the head and neck using TNM classification
Criteria for estimating total tumor burden
|
Tumor Burden |
Number of Nodal Regions with Extensive Disease |
Number of Extranodal sites with Extensive Disease |
Number of Extranodal Sites with Focal Disease |
|
low |
0 |
0 |
0, 1 or 2 |
|
intermediate |
1 |
0 |
0 or 1 |
|
|
0 |
1 |
0 or 1 |
|
high |
1 |
1 |
0 |
|
|
2 |
0 |
0 |
|
|
0 |
2 |
0 |
|
|
1 |
0 |
2 |
|
|
0 |
1 |
2 |
|
|
0 |
0 |
3 |
|
Risk Group |
Tumor Burden |
LDH |
|
A |
low |
normal |
|
B |
low |
high |
|
|
intermediate |
normal |
|
C |
intermediate |
high |
|
|
high |
normal |
|
D |
high |
high |
|
Risk Group |
10 year Survival |
|
A |
85% |
|
B |
66% |
|
C |
43% |
|
D |
0% |
Additional risk factors
|
Risk Factor |
favorable |
unfavorable |
|
age in years |
< 56 |
>= 56 |
|
constitutional symptoms |
A |
B |
|
Ann Arbor stage |
I |
II, III or IV |
where:
• 10 year survivals for Ann Arbor stage I disease was 76%, for stage II 55%, stage III 42% and stage IV 40%
Specialty: Hematology Oncology
ICD-10: ,
