Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification
- Study type
- Clinical guideline
- Study name
- Lugano 2014
- Design
- International consensus guideline (workshops of the 11th and 12th International Conference on Malignant Lymphoma, Lugano, with participation of the major lymphoma trial groups)
- Source
- J Clin Oncol · 2014
In plain words
The Lugano classification is the common language that doctors around the world use to describe the stage of lymphoma and to measure how well treatment is working. Under it, a PET-CT scan (which shows how active the cancer cells are) is the main way to stage most lymphomas and to check the response to treatment, and many patients no longer need a painful bone marrow biopsy. After treatment has ended successfully, repeated routine scans are not recommended unless there is a new symptom or finding.
Key guideline recommendations
- International consensus (ungraded)
FDG PET-CT is formally incorporated into standard staging of FDG-avid lymphomas.
- International consensus (ungraded)
A modified Ann Arbor classification should be used to describe disease extent; the A and B suffixes (symptoms) apply only to Hodgkin lymphoma. In practice, treatment is chosen on the basis of limited (non-bulky stages I and II) or advanced (stages III and IV) disease, and bulky stage II is considered limited or advanced depending on histology and prognostic factors.
- International consensus (ungraded)
Bone marrow biopsy is no longer needed for routine staging of Hodgkin lymphoma and most diffuse large B-cell lymphomas.
- International consensus (ungraded)
Response to treatment in FDG-avid lymphomas should be assessed with PET-CT using the 5-point scale (Deauville).
- International consensus (ungraded)
The product of the perpendicular diameters of a single node can be used to identify progressive disease.
- International consensus (ungraded)
Routine surveillance scans (without symptoms) after treatment are not recommended.
Study population
Patients with Hodgkin and non-Hodgkin lymphoma; initial evaluation, staging and assessment of response to treatment.
Clinical significance and place in guidelines
The Lugano classification remains the worldwide standard for staging and response assessment of lymphoma in clinical practice and trials, and the ESMO and NCCN guidelines rely on it. Response assessment in key trials such as TRANSFORM, POLARIX and HD21 was based on these criteria.
Limitations
This guideline addresses staging and response assessment and makes no treatment recommendations. Response criteria for immune-based therapies (such as immunotherapy and cellular therapies, which may cause "pseudoprogression") were later added in the LYRIC criteria. A comprehensive ESMO clinical guideline for lymphomas (Annals of Oncology, 2025; doi:10.1016/j.annonc.2025.07.014) has been published, but its full text was not available for preparing this card.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.