Stor tumorbyrde (> 7 cm), involvering af mindst tre nodale områder (hver > 3 cm), systemiske symptomer (vægttab > 10%, feber > 38C i mere end 8 dage, eller natlige svedeture), splenomegali til under navlen, obstruktion af større organ eller kompressionssyndrom, orbital eller epidural involvering, serøs ekssudation eller leukæmi.
High tumour burden is defined as having at least one of the following: bulky tumour mass (> 7 cm), involvement of three or more nodal sites (each > 3 cm), systemic symptoms (weight loss > 10%, fever > 38°C for more than 8 days, or nocturnal sweats), splenomegaly beyond the umbilicus, major organ obstruction or compression syndrome, orbital or epidural involvement, serous effusion, or leukaemia.