# Radiation Oncology/NHL/Overview/Classification

* 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

* 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

* 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