Comparison of RECIST, irRC, and Lugano Classification criteria
| Criteria . | CR . | PR . | PD . |
|---|---|---|---|
| RECIST 1.1 | Disappearance of all target lesions. Any pathological lymph nodes (whether target or nontarget) must have reduction in short axis to <10 mm | At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters | At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm |
| Note: the appearance of one or more new lesions is also considered progression. | |||
| irRC | Disappearance of all lesions in two consecutive observations not less than 4 weeks apart | ≥50% decrease in tumor burden compared with baseline in 2 observations at least 4 weeks apart (as measured bidimensionally) | ≥25% increase in tumor burden compared with nadir (at any single time point) in 2 consecutive observations at least 4 weeks apart, where Tumor Burden = SPD index lesions + SPD new, measurable lesions |
| Lugano | PET-CT, score 1, 2, or 3* with or without a residual mass on 5PS† OR on CT, target nodes/nodal masses must regress to ≤1.5 cm in LDi | PET-CT score 4 or 5 with reduced uptake compared with baseline and residual mass(es) of any size. OR On CT ≥50% decrease in SPD of up to 6 target measurable nodes and extranodal sites | PET-CT score 4 or 5 with an increase in intensity of uptake from baseline and/or new FDG-avid foci consistent with lymphoma at interim or end-of-treatment assessment. OR On CT, an individual node/lesion must be abnormal with: LDi >1.5 cm and increase by ≥50% from PPD nadir and an increase in LDi or SDi from nadir 0.5 cm for lesions ≤2 cm 1.0 cm for lesions >2 cm |
| In the setting of splenomegaly, the splenic length must increase by >50% of the extent of its prior increase beyond baseline (eg, a 15-cm spleen must increase to >16 cm). If no prior splenomegaly, must increase by ≥2 cm from baseline. New or recurrent splenomegaly | |||
| New or clear progression of preexisiting nonmeasured lesions | |||
| Regrowth of previously resolved lesions | |||
| A new node >1.5 cm in any axis or a new extranodal site >1.0 cm in any axis; if <1.0 cm in any axis, its presence must be unequivocal and must be attributable to lymphoma | |||
| Assessable disease of any size unequivocally attributable to lymphoma | |||
| AND/OR new or recurrent involvement of the bone marrow | |||
| LYRIC | Same as Lugano | Same as Lugano | As with Lugano with the following exceptions: |
| IR | |||
| IR(1): ≥50% increase in SPD in first 12 weeks | |||
| IR(2): <50% increase in SPD with | |||
| a. New lesion(s), or | |||
| b. ≥50% increase in PPD of a lesion or set of lesions at any time during treatment | |||
| IR(3): Increase in FDG uptake without a concomitant increase in lesion size meeting criteria for PD |
| Criteria . | CR . | PR . | PD . |
|---|---|---|---|
| RECIST 1.1 | Disappearance of all target lesions. Any pathological lymph nodes (whether target or nontarget) must have reduction in short axis to <10 mm | At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters | At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm |
| Note: the appearance of one or more new lesions is also considered progression. | |||
| irRC | Disappearance of all lesions in two consecutive observations not less than 4 weeks apart | ≥50% decrease in tumor burden compared with baseline in 2 observations at least 4 weeks apart (as measured bidimensionally) | ≥25% increase in tumor burden compared with nadir (at any single time point) in 2 consecutive observations at least 4 weeks apart, where Tumor Burden = SPD index lesions + SPD new, measurable lesions |
| Lugano | PET-CT, score 1, 2, or 3* with or without a residual mass on 5PS† OR on CT, target nodes/nodal masses must regress to ≤1.5 cm in LDi | PET-CT score 4 or 5 with reduced uptake compared with baseline and residual mass(es) of any size. OR On CT ≥50% decrease in SPD of up to 6 target measurable nodes and extranodal sites | PET-CT score 4 or 5 with an increase in intensity of uptake from baseline and/or new FDG-avid foci consistent with lymphoma at interim or end-of-treatment assessment. OR On CT, an individual node/lesion must be abnormal with: LDi >1.5 cm and increase by ≥50% from PPD nadir and an increase in LDi or SDi from nadir 0.5 cm for lesions ≤2 cm 1.0 cm for lesions >2 cm |
| In the setting of splenomegaly, the splenic length must increase by >50% of the extent of its prior increase beyond baseline (eg, a 15-cm spleen must increase to >16 cm). If no prior splenomegaly, must increase by ≥2 cm from baseline. New or recurrent splenomegaly | |||
| New or clear progression of preexisiting nonmeasured lesions | |||
| Regrowth of previously resolved lesions | |||
| A new node >1.5 cm in any axis or a new extranodal site >1.0 cm in any axis; if <1.0 cm in any axis, its presence must be unequivocal and must be attributable to lymphoma | |||
| Assessable disease of any size unequivocally attributable to lymphoma | |||
| AND/OR new or recurrent involvement of the bone marrow | |||
| LYRIC | Same as Lugano | Same as Lugano | As with Lugano with the following exceptions: |
| IR | |||
| IR(1): ≥50% increase in SPD in first 12 weeks | |||
| IR(2): <50% increase in SPD with | |||
| a. New lesion(s), or | |||
| b. ≥50% increase in PPD of a lesion or set of lesions at any time during treatment | |||
| IR(3): Increase in FDG uptake without a concomitant increase in lesion size meeting criteria for PD |
IR, immune response; LDi, longest diameter; PPD, product of the perpendicular diameters; SDi, short diameter; 5PS, 5-point scale.
A score of 3 in many patients indicates a good prognosis with standard treatment, especially if at the time of an interim scan. However, in trials involving PET where de-escalation is investigated, it may be preferable to consider a score of 3 as inadequate response (to avoid undertreatment).
PET 5PS: 1, no uptake above background; 2, uptake ≤ mediastinum; 3, uptake > mediastinum but ≤ liver; 4, uptake greater than liver; 5, uptake markedly higher than liver (2-3 times SUVmax in normal liver) and/or new lesions; X, new areas of uptake unlikely to be related to lymphoma.