The importance of having a large lymph node mass in non-Hodgkin's lymphoma (NHL) has been known for a long time. The larger the largest node mass, the worse the outcomes after treatment. But what is the best cutoff for terming a node mass as 'bulky'? There are a few different definitions of 'bulky' disease - 10 cm and 5 cm are the most commonly used. The best is a matter of debate.
Researchers from Switzerland went through a large database of young patients with diffuse large B-cell non-Hodgkin's lymphoma (DLBCL). They found that any size cutoff between 5 cm and 10 cm makes a significant difference in how fast a patient relapses, and how long he lives. The addition of rituximab to CHOP chemotherapy reduces the impact of large masses, but still those who had masses more than 10 cm did worse in every aspect, including the survival after treatment.
In the current era of treatment with rituximab, it seems that 10 cm is the best cutoff value for differentiating paients with 'bulky' and 'nonbulky' disease.