Radiation Oncology/NHL/Overview/Classification

NHL Classification Schemes 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: 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: 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: 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: 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