Radiation Oncology/NHL/Overview/Classification

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Front Page: Radiation Oncology | RTOG Trials | Randomized Trials

Non-Hodgkin lymphoma: Main Page | Randomized
Overview: Overview | Follicular | Diffuse large B-cell | MALT | Nodal marginal zone | Mantle cell | CLL/SLL | Lymphoblastic | Burkitt | NK/T cell | Anaplastic large cell | Primary CNS Lymphoma
Treatment: Aggressive | Specific sites | Radioimmunotherapy

NHL Classification Schemes[edit]

  • Rappaport classification (1966) — oldest
    • Developed by the AFIP (Armed Forces Institute of Pathology)
    • Was before lymphomas were divided into B and T cells
    • types:
      • NODULAR: nodular histiocytic, nodular mixed histiocytic-lymphocytic, nodular lymphocytic poorly differentiated, nodular lymphocytic well differentiated
      • DIFFUSE: diffuse histiocytic, diffuse mixed histiocytic-lymphocytic, diffuse lymphocytic poorly differentiated, diffuse lymphocytic well differentiated, diffuse undifferentiated
    • ref: PMID 4574662
  • Kiel classification (1974)
    • Used in Europe
    • Low grade and high grade, T cell and B cell
    • Low grade B cell: Lymphocytic (chronic lymphocytic and prolymphocytic leukemia, hairy-cell leukemia), Lymphoplasmacytic/cytoid, Plasmacytic, Centroblastic/centrocytic (follicular or diffuse), Centrocytic
    • High grade B cell: Centroblastic, Immunoblastic, Large cell anaplastic, Burkitt's lymphoma, Lymphoblastic
  • Lukes and Collins (1974)
    • Separates B and T cells using immunologic typing. Was used in the United States.
  • Working Formulation (1982)
    • Devised to translate among the many different classification systems
    • Was based only on morphology. Based on low-power architectural arrangement (i.e. diffuse vs follicular proliferation) and high-power cytologic characteristics (nuclear outline: cleaved vs non-cleaved; cell size: small, large, or mixed). Does not consider B or T cell lineage.
    • low, intermediate, high grades. Special studies not used. Only 10 categories. Used letters A-J and grouped according to prognosis.
    • Low grade (groups A-C): small lymphocytic, follicular small-cleaved cell, follicular mixed small-cleaved and large cell.
    • Intermediate grade (D-G): follicular large cell, diffuse small cleaved cell (Mantle cell), diffuse mixed small and large cell, diffuse large cell
    • High grade (H-J): Large cell immunoblastic, lymphoblastic, small non-cleaved cell (Burkitt and non-Burkitt)
    • Reference: PMID 6896167 - "National Cancer Institute sponsored study of classifications of non-Hodgkin's lymphomas: summary and description of a working formulation for clinical usage. The Non-Hodgkin's Lymphoma Pathologic Classification Project." Cancer. 1982 May 15;49(10):2112-35.
  • WHO/REAL (1994) (Revised European-American Classification of Lymphoid Neoplasms)
    • Introduced by the International Lymphoma Study Group (ILSG) in 1994
    • Reference: PMID 8068936 (1994) -- "A revised European-American classification of lymphoid neoplasms: a proposal from the International Lymphoma Study Group." (Harris NL, Blood. 1994 Sep 1;84(5):1361-92.)
    • Incorporates morphology, immunophenotype, genetic features, clinical features
    • Is not based on prognosis (unlike Working Formulation); treats each lymphoma as a separate disease process with a spectrum of aggressiveness (such as breast cancers).
    • About 25 categories (includes all lymphoid neoplams: Hodgkins lymphoma, non-Hodgkins, leukemias, plasma cell neoplasms, etc.). Also has myeloid, mast cell, and Langerhans cell diseases.
    • WHO (World Health Organization) adopted the REAL classification
    • Reference: PMID 10577857 (1999) -- "World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee meeting-Airlie House, Virginia, November 1997." (Harris NL, J Clin Oncol. 1999 Dec;17(12):3835-49.)
  • Others: Dorfman, British lymphoma system

WHO classification[edit]