Originally published as JCO Early Release 10.1200/JCO.2006.09.2403 on January 22 2007

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Revised Response Criteria for Malignant Lymphoma

Bruce D. Cheson, Beate Pfistner, Malik E. Juweid, Randy D. Gascoyne, Lena Specht, Sandra J. Horning, Bertrand Coiffier, Richard I. Fisher, Anton Hagenbeek, Emanuele Zucca, Steven T. Rosen, Sigrid Stroobants, T. Andrew Lister, Richard T. Hoppe, Martin Dreyling, Kensei Tobinai, Julie M. Vose, Joseph M. Connors, Massimo Federico, Volker Diehl

From the Division of Hematology/Oncology, Georgetown University Hospital, Washington, DC; University of Cologne, Cologne; Department of Nuclear Medicine, University of Iowa, Iowa City, IA; Department of Pathology, British Columbia Cancer Agency and the University of British Columbia, Vancouver, British Columbia, Canada; Department of Oncology and Hematology, Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Oncology and Department of Radiation Oncology, Stanford University, Stanford, CA; Department of Hematology, Hospices Civils de Lyon and Université Claude Bernard, Lyon, France; James P. Wilmot Cancer Center, University of Rochester, Rochester, NY; Academic Medical Center, Department of Hematology, Amsterdam, the Netherlands; Lymphoma Unit, Department of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Lurie Cancer Center, Northwestern University, Chicago, IL; Department of Nuclear Medicine, University Hospital Gasthuisberg, Leuven, Belgium; Cancer Research UK Medical Oncology Unit, St Bartholomew's Hospital, London, United Kingdom; Department of Medicine III, University of Munich, Hospital Grosshadern, Munich, Germany; Hematology and Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan; Section of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE; and Dipartimento di Oncologia ed Ematologia, Università di Modena e Reggio Emilia, Modena, Italy

Address reprint requests to Bruce D. Cheson, MD, Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007; e-mail: bdc4{at}georgetown.edu

Purpose: Standardized response criteria are needed to interpret and compare clinical trials and for approval of new therapeutic agents by regulatory agencies.

Methods: The International Working Group response criteria (Cheson et al, J Clin Oncol 17:1244, 1999) were widely adopted, but required reassessment because of identified limitations and the increased use of [¹⁸F]fluorodeoxyglucose-positron emission tomography (PET), immunohistochemistry (IHC), and flow cytometry. The International Harmonization Project was convened to provide updated recommendations.

Results: New guidelines are presented incorporating PET, IHC, and flow cytometry for definitions of response in non-Hodgkin's and Hodgkin's lymphoma. Standardized definitions of end points are provided.

Conclusion: We hope that these guidelines will be adopted widely by study groups, pharmaceutical and biotechnology companies, and regulatory agencies to facilitate the development of new and more effective therapies to improve the outcome of patients with lymphoma.

published online ahead of print at www.jco.org on January 22, 2007.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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