The Lugano classification for staging and response assessment of lymphoma: Looking towards the future

The International Conference on Malignant Lymphoma (ICML), taking place in Lugano since 1981, is the most important meeting in the field of lymphoma research. ICML is traditionally preceded by a Closed Workshop aimed at delving into controversial or critical issues in the lymphoma field. This Workshop has in the past launched important collaboration and has led to significant achievements (e.g., the REAL Classification and the so-called Lugano Classification).

The Lugano Classification found broad acceptance by physicians and investigators and provides the current criteria for initial evaluation, staging and response assessment of lymphoma. It has been routinely used worldwide in the last decade for the patients’ care and represents the formal reference for patients’ assessment in clinical trials. Indeed, its guidelines provided definitions intended to standardize the assessment of patients that were adopted by the US Food and Drug Administration and European Medicines Agency for the evaluation of new drugs in lymphoma.

Evidence-based disease classifications are fundamental for the treatment of individual patients, as well as for comparing clinical trials and investigating all aspects of disease course.

The Lugano Classification of lymphoma is the global reference for the initial evaluation, staging and response assessment of Hodgkin and non-Hodgkin lymphoma. Since its publication in 2014, this classification has indeed provided the community with standardized guidelines for the use of PET scans in the evaluation of lymphoma patients and how these can substitute older procedures (e.g., routine bone marrow biopsies).

In the last decade, we have seen significant progress in the imaging methodologies as well as in the molecular biology tools for lymphoma staging and monitoring (e.g., PET radiomics and liquid biopsy). This prompted the scientific advisory board and the organizing committee of the ICML to gather an international panel to provide updated evidence- and expert opinion–based recommendations aiming at revising and updating the Lugano Classification. To start the revision process, in the last two years, several virtual meetings of five expert subcommittees discussed open issues and questions, potential recommendations, and unresolved issues requiring more research in the fields of nodal lymphomas, extranodal lymphomas, pediatric lymphomas, lymphoma imaging, and molecular monitoring.

The next ICML Workshop will be held on Tuesday, June 13, 2023, in Lugano. It will be also supported by AACR (American Association for Cancer Research) and ESO (European School of Oncology) and will be devoted to discussing proposal for the revised classification with a joint panel of biology, hematology, oncology imaging, and pathology experts to review the available evidence and to reconciliate the work of the subcommittees for developing a wide consensus on the changes needed to update the Lugano Classification.