Radiation Oncology/NHL/Overview/Classification

NHL Classification Schemes

 * Rappaport classification (1966) &mdash; 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

 * B-cell neoplasms
 * Precursor B-cell neoplasms
 * Precursor B-lymphoblastic leukemia/lymphoma (precursor B-cell acute lymphoblastic leukemia)
 * Mature (peripheral) B-cell neoplasms
 * B-cell chronic lymphocytic leukemia / small lymphocytic lymphoma
 * B-cell prolymphocytic leukemia
 * Lymphoplasmacytic lymphoma
 * Splenic marginal zone B-cell lymphoma
 * Hairy cell leukemia
 * Plasma cell myeloma/plasmacytoma
 * Extranodal marginal zone B-cell lymphoma of MALT type
 * Nodal marginal zone B-cell lymphoma
 * Follicular lymphoma
 * Mantle cell lymphoma
 * Diffuse large B-cell lymphoma
 * Burkitt lymphoma / Burkitt cell leukemia
 * T-cell and NK-cell neoplasms
 * Precursor T-cell neoplasm
 * Precursor T-lymphoblastic lymphoma/leukemia (precursor T-cell acute lymphoblastic leukemia)
 * Mature (peripheral) T/NK-cell neoplasms
 * T-cell prolymphocytic leukemia
 * T-cell granular lymphocytic leukemia
 * Aggressive NK-cell leukemia
 * Adult T-cell lymphoma/leukemia (HTLV1+)
 * Extranodal NK/T-cell lymphoma, nasal type
 * Enteropathy-type T-cell lymphoma
 * Hepatosplenic gamma-delta T-cell lymphoma
 * Subcutaneous panniculitis-like T-cell lymphoma
 * Mycosis fungoides / Sezary syndrome
 * Anaplastic large cell lymphoma, T/null cell, primary cutaneous type
 * Anaplastic large cell lymphoma, T/null cell, primary systemic type
 * Peripheral T-cell lymphoma, not otherwise characterized
 * Angioimmunoblastic T-cell lymphoma