Cheson et al proposed standardized criteria for response to therapy in patients with non-Hodgkin's lymphoma. These are helpful in clinical trials and comparing different therapeutic interventions. The authors are from the National Cancer Institute (NCI) and multiple cancer centers in North America and Europe.
Response categories:
(1) complete response (CR)
(2) unconfirmed complete response (CRu)
(3) partial response (PR)
(4) relapse or disease progression
(5) stable disease
Measures for determining response:
(1) physical examination, including hepatosplenomegaly
(2) lymphadenopathy
(3) lymph node masses
(4) bone marrow involvement (based on a core biopsy >= 20 mm)
|
Physical Exam |
Lymph Node |
Lymph Node Masses |
Bone Marrow |
Response |
|
normal |
normal |
normal |
normal |
complete response |
|
normal |
normal |
normal |
indeterminate |
complete response unconfirmed |
|
normal |
normal |
> 75% decrease |
normal or indeterminate |
complete response unconfirmed |
|
normal |
normal |
normal |
positive |
partial response |
|
normal |
>= 50% decrease |
>= 50% decrease |
NA |
partial response |
|
decrease in liver and spleen |
>= 50% decrease |
>= 50% decrease |
NA |
partial response |
|
no change or decrease |
< 50% decrease |
< 50% decrease |
NA |
stable disease |
|
enlarging liver and/or spleen; new sites |
increased or new |
increased or new |
reappearance |
relapse or progression |
where:
• The bone marrow for relapse or progression is limited to reappearance, which may be too restrictive.
• Complete response is complete disappearance of all detectable evidence of disease including disease-related symptoms and normalization of biochemical changes.
• Lymph node size is expressed in the sum of the products of the greatest diameters (SPD), which gives a cuboidal volume where than spherical.
• A normal lymph node is one that is either (a) <= 1.5 cm in maximum diameter if > 1.5 cm before therapy or (b) <= 1.0 cm in maximum diameter if 1.1 - 1.5 cm before therapy.
• Regression in splenic size involves (a) decrease in size on CT scan and (b) no longer palpable on physical examination.
• Further definitions of findings are listed on pages 1249-1250.
Purpose: To evaluate the therapeutic response of a patient with non-Hodgkin's lymphoma using the standardized criteria of Cheson et al.
Specialty: Hematology Oncology
Objective: response to therapy
ICD-10: C82, C83, C84, C85,
