One article to master the evaluation of the efficacy of lymphoma.

This article is authorized by the author and released by yimaitong. Please do not reprint without authorization.lymphoma has become one of the top ten malignant tumors threatening human health. In daily clinical work, we pay more attention to the diagnosis and treatment of lymphoma. In fact, we should pay more attention to the evaluation of the curative effect of the same important lymphoma.accurate judgment of the mid-term or end-stage efficacy of lymphoma patients can make our treatment more accurate and maximize the benefits of patients.in this paper, we will sort out the key points that need to be paid attention to in the evaluation of the curative effect of lymphoma, so as to learn together with everyone and evaluate the curative effect of patients more accurately in daily work.complete and comprehensive baseline examination 1 imaging examination for most lymphoma, especially for Hodgkin's lymphoma (HL) and invasive non Hodgkin's lymphoma (NHL), whole body PET-CT examination is recommended at present. This molecular imaging method combining functional imaging (PET) and anatomical imaging (CT) with 18F-FDG as tracer can accurately judge the involvement The specific anatomic location, size and activity of the lesion have high sensitivity and specificity. It is a very significant examination method for the staging, prognosis and follow-up accurate judgment of curative effect of lymphoma.for some inert NHL, general CT examination should be performed, which usually includes (neck + chest + upper abdomen + pelvis) plain scan and enhanced CT baseline examination. In addition, comprehensive CT baseline examination should also be performed for patients who are unable to perform PET-CT baseline examination due to economic conditions or other reasons.it should be noted that ultrasound can not be used as a routine baseline examination for comparison of follow-up efficacy evaluation of lymphoma.2 at present, it is generally accepted that PET-CT examination can replace bone marrow biopsy and biopsy in patients with HL; for patients with diffuse large B-cell lymphoma (DLBCL), if PET-CT indicates positive bone marrow, bone marrow puncture and biopsy are not required; if PET-CT indicates bone marrow negative, further bone marrow puncture and biopsy are required; in addition, other pathological types of lymphoma Bone marrow biopsy and biopsy were recommended at baseline, and bone marrow involvement was confirmed by morphological, flow cytometry and immunohistochemistry.At present, for patients with primary central nervous system lymphoma or lymphoma with central nervous system involvement, it is recommended that baseline plain scan and enhanced cranial MRI should be performed at the baseline, and the morphology and flow cytometry of cerebrospinal fluid (CSF) should be performed by lumbar puncture without contraindication, while patients suspected of ocular and accessory organ involvement should be performed Comprehensive ophthalmic examination, including slit lamp and fundus examination.4 special extranodal involvement site related examination. For lymphoma with special extranodal involvement indicated by PET-CT, pathological biopsy should be carried out if necessary to further confirm whether there is real involvement, such as digestive system, skin and other parts.the accurate judgment of the baseline lesions is very important for the follow-up intermediate / end-stage efficacy evaluation of lymphoma patients. Similarly, the accurate judgment of the positive involved lesions at the baseline is also important for the evaluation of the intermediate / terminal efficacy of lymphoma. The specific judgment criteria are shown in the table below.the time for judging the intermediate / final efficacy of lymphoma is generally accepted after 2-4 cycles of treatment, and the time of final efficacy judgment is the complete completion of the whole treatment and before the regular follow-up.PET-CT examination in the middle stage (during chemotherapy) is generally recommended in the first three days of the next cycle of chemotherapy; the final stage (after the end of the last treatment) PET-CT examination is generally recommended to be 6-8 weeks after chemotherapy and 8-12 weeks after radiotherapy. In addition, if the initial PET-CT results cannot determine the efficacy of the final efficacy evaluation, it is recommended to review PET-CT again after 2 months of follow-up.the Deauville 5-point method is recommended for the evaluation of the curative effect of lymphoma with PET-CT. The specific criteria are shown in the table below.in 2014, Lugano meeting revised the criteria for evaluating the efficacy of lymphoma. The independent evaluation criteria for lymphoma were first proposed by Professor cheson in 1999. With the wide application of PET-CT in lymphoma, Professor cheson proposed an improved chenson efficacy evaluation standard in 2007; in 2014, the 11th International Conference on lymphoma confirmed Lugano revision The revised version of lymphoma efficacy evaluation criteria is currently internationally recognized for lymphoma efficacy evaluation criteria. See the table below for details.note: as for the choice of superior lesions that can be measured in the evaluation of curative effect with CT, the maximum diameter of 6 lymph nodes or extranodal lesions can be selected, and the longest transverse diameter (LDI) and the shortest diameter perpendicular to LDI (SDI) of each lesion can be clearly measured; lymph nodes should preferably come from different regions of the body, and include mediastinum and retroperitoneal areas when applicable, extranodal diseases Lesions include solid organs (such as liver, spleen, kidney, lung), gastrointestinal tract involvement, skin lesions or palpable lesions.follow up after the treatment of lymphoma, there is still a risk of relapse after the treatment of lymphoma, so regular follow-up should be carried out after the treatment, and the state of the disease should be closely monitored. generally speaking, PET-CT is not recommended as a follow-up examination for lymphoma patients, because it has a certain false positive and does not conform to the economic effect. plain scan and enhanced CT are currently recommended routine follow-up examinations for patients with lymphoma. For HL and aggressive NHL, it is recommended to check every 3 months in the first two years and every 6 months in the third to fifth year, while in inert lymphoma, it is recommended to check once every 3-6 months; for patients with suspected recurrence by CT, PET-CT should be performed again. References: [1]. Cheson BD, et al. Report of an international workshop to standardize response criteria for non Hodgkin's lymphamas. NCI sponsored international working group. 1999 Apr; 17 (4): 1244. [2]. Malik EJ, Et al.Use of Positron Emission Tomography for Response Assessment of Lymphoma: Consensus of the Imaging Subcommittee of International Harmonization Project in Lymphoma. J Clin Oncol. 2007 Feb 10;25(5):571-8.[3]. Cheson BD, et al. Recommendations for Initial Evaluation, Staging, The Lugano classification. J Clin Oncol. 2014 Sep 20; 32 (27): 3059-68. [4]. NCCN guidelines version 1.2020. B-cell lymphamas. [5]. NCCN guidelines version 1.2020. T-cell lymphamas. [6]. NCCN guidelines version 1.2020. Hodgkin lymphama. [7]. topic circle updated! Since the establishment of the medical pulse blood group, thousands of doctors have been exchanging and discussing clinical problems in the group. The little assistant will collect valuable content regularly and share it in the medical knowledge source topic circle. In this issue, we will share with you "rash caused by oral gefitinib (grade 2-3). What are the" tips "of teachers in the group If you want to join the group communication, please long press add small assistant QR code, according to the prompt to enter the group Oh ~ stamp "read the original", we progress together