Tables
 


Ann Arbor staging classification for Hodgkin and non-Hodgkin lymphomas


Stage I

Involvement of a single lymph node region (I) or of a single extralymphatic organ or site (IE)*

Stage II

Involvement of two or more lymph node regions or lymphatic structures on the same side of the diaphragm alone (II) or with involvement of limited, contiguous extralymphatic organ or tissue (IIE)

Stage III

Involvement of lymph node regions on both sides of the diaphragm (III) which may include the spleen (IIIS) or limited, contiguous extralymphatic organ or site (IIIE) or both (IIIES)

Stage IV

Diffuse or disseminated foci of involvement of one or more extralymphatic organs or tissues, with or without associated lymphatic involvement












Eastern cooperative oncology group (ECOG, Zubrod) performance scale


    Performance status                                 Definition

    

       0            Fully active; no performance restrictions

       1            Strenuous physical activity restricted; fully ambulatory and able to carry out light work

       2            Capable of all selfcare but unable to carry out any work activities. Up about >50% of

                     waking hours

       3            Capable of only limited selfcare; confined to bed or chair >50 percent of waking hours

       4            Completely disabled; cannot carry out any selfcare; totally confined to bed or chair


       Excerpted from Oken, MM, et al. Am J Clin Oncol 1982; 5:649.





International Workshop Criteria (IWC) for assessing response to treatment in non-Hodgkin's lymphoma (NHL)


Complete remission (CR)


Complete disappearance of all detectable clinical and radiographic evidence of disease

Disappearance of all disease-related symptoms if present before therapy

Normalization of biochemical abnormalities (eg, LDH) if definitely assignable to NHL

An adequate bone marrow biopsy (ie, core size
20 mm) from the same site must be negative if positive before therapy
Previously involved nodes or nodal masses on CT >1.5 cm in greatest diameter must regress to
1.5 cm and previously involved nodes/nodal masses 1.1 to 1.5 cm must regress to
1.0 cm post-therapy

The spleen, if enlarged on CT scan prior to therapy, must have regressed in size and be non-palpable on physical examination


Complete remission unconfirmed (CRu)


Complete disappearance of all detectable clinical evidence of disease

Disappearance of all disease-related symptoms if present before therapy

Normalization of biochemical abnormalities

Residual lymph mass >1.5 cm in greatest transverse diameter that has regressed by more than 75 percent, or

Indeterminate bone marrow (increased number or size of aggregates without cytologic or architectural atypia)



Partial remission (PR)


At least 50 percent reduction in the sum of the product of the greatest diameters of the six largest dominant nodes or nodal masses (SPD)

No increase in the size of other nodes, liver, or spleen

No new sites of disease

Bone marrow biopsy results are not relevant for determination of PR in this system


Stable disease (SD)

Less than a partial remission but not progressive disease


Progressive disease (PD) [for patients with a prior PR or NR]

50% or more increase in the SPD from nadir of any previously identified abnormal node, or

Appearance of any new lesion during or at the end of therapy


Relapsed disease (RD) [for patients with a prior CR or CRu]

Appearance of any new lesion, or

Increase by
50 percent in the size of previously involved sites, or

50% or more increase in the greatest diameter of any previously identified node >1 cm in short axis or in the SPD of more than one node


Excerpted from Cheson, BD, et al. J Clin Oncol 1999; 17:1244 and Juweid, ME, et al. J Clin Oncol 2005; 23:4652.


Risk factors for neuraxis involvement by non-Hodgkin's lymphoma








 

All cases are subclassified to indicate the absence (A) or presence (B) of the systemic ("B") symptoms of significant unexplained fever, night sweats, or unexplained weight loss exceeding 10 percent of body weight during the six months prior to diagnosis.

Clinical stage refers to the extent of disease determined by diagnostic tests following a single diagnostic biopsy. If a second biopsy of any kind is obtained, even if negative, the term pathologic stage is used.

* The designation "E" generally refers to extranodal contiguous extension (ie, proximal or contiguous extranodal disease) that can be encompassed within an irradiation field appropriate for nodal disease of the same anatomic extent. A single extralymphatic site as the only site of disease should be classified as IE, rather than stage IV.

Adapted from Carbone, PP, et al, Cancer Res 1971; 31:1860 and Lister, TA, et al, J Clin Oncol 1989; 7:1630.

Stage III/IV disease*

Presence of B symptoms

Retroperitoneal lymph node involvement

Bone marrow involvement

Involvement of >1 extranodal site*

Elevated serum lactate dehydrogenase level*

Low serum albumin concentration

Age >60 years*

Aggressive or highly aggressive disease

High- or high-intermediate risk disease by the IPI#

Testicular involvement (see text for other primary sites)

IPI: International Prognostic Index.

* Components of the IPI.