Lymphoma Classifications

Classification of Non-Hodgkin Lymphomas is necessary to determine treatment.

Lymphoma Classification

Medically reviewed by Dr. C.H. Weaver M.D. 10/2018

Cancers that begin in cells of the lymph system are referred to as malignant lymphomas. The lymph system includes the spleen, thymus, tonsils, bone marrow, lymph nodes and circulating white blood cells called lymphocytes. Lymphocytes and the lymph system are part of the immune system that protects the body from disease and infection. Cancers of the lymph system are referred to as Hodgkin’s lymphoma or non-Hodgkin’s lymphoma.

Understanding treatment of lymphoma is fairly complicated because patients must know the correct histologic diagnosis and the stage of their lymphoma. Histologic classification of non-Hodgkin lymphomas has undergone considerable changes that can lead to confusion for patients and doctors. In order to learn about treatment options, patients need to know the answers to the following questions:

  • Is the lymphoma classified as Hodgkin or non-Hodgkin lymphoma?
  • If it is non-Hodgkin lymphoma, what kind (histologic type) of non-Hodgkin lymphoma is it?
  • What is the stage or extent of spread of the lymphoma?

The purpose of classifying Non-Hodgkin lymphomas into specific categories is to describe the individual behavior and develop appropriate precision treatment strategies for each type of lymphoma when possible. Non-Hodgkin lymphomas have been classified by several different systems over the past 40 years.

This current system is called the Revised European American Lymphoma (REAL) classification and has been recommended for use by all doctors.

In order to understand the prognosis and optimal treatment of NHL, “click” the NHL of interest below.

Revised European American Lymphoma (Real) Classification

  1. B-Cell Chronic Lymphocytic Leukemia/Small Lymphocytic Leukemia
  2. Lymphoplasmacytic Lymphoma
  3. Mantle Cell Lymphoma
  4. Follicle Center Lymphomas, Follicular
  5. Marginal Zone B-Cell Lymphoma
  6. MALToma
  7. Diffuse Large B-Cell Lymphoma
  8. Burkitt’s Lymphoma
  9. Burkitt’s Like Lymphoma
  10. Precursor B or T-Cell Lymphoblastic Lymphoma/Leukemia
  11. Sezary-Mycosis-fundoides-T cell lymphomas

International Working Formulation Classification Of Non-Hodgkin Lymphoma

The most common system used in the 1980’s-1990’s was the International Working Formulation (IWF). The IWF divided Non-Hodgkin lymphomas into 3 grades based on the lymphoma’s appearance under a microscope. Since the IWF was utilized, a great deal of additional work has been performed that further classifies Non-Hodgkin lymphomas into individual cancers, each with their own specific features and behavior.

High Grade:

  1. Large Cell Immunoblastic
  2. Lymphoblastic Lymphoma
  3. Small Noncleaved cell, Burkitt’s

Intermediate Grade:

  1. Diffuse Large Cell
  2. Follicular Large Cell
  3. Diffuse Small Cleaved Cell
  4. Diffuse Mixed Small and Large cell

Low Grade:

  1. Small Lymphocytic/Chronic Lymphocytic Leukemia
  2. Follicular Small Cleaved Cell
  3. Follicular Mixed Small and Large Cell

Understanding Classification of Non-Hodgkin Lymphomas

The purpose of further classifying non-Hodgkin lymphomas into specific categories is to describe the individual behavior and develop appropriate treatment strategies for each type of lymphoma. Non-Hodgkin lymphomas have been classified by several different systems over the past 30 years. The most common system used in the 1980?s-1990?s was the International Working Formulation (IWF). The IWF divided non-Hodgkin lymphomas into 3 grades based on the lymphoma’s appearance under a microscope. Since the IWF was utilized, a great deal of additional work has been performed that further classifies non-Hodgkin lymphomas into individual cancers, each with their own specific features and behavior. This newer system is called the Revised European American Lymphoma (REAL) classification and has been recommended for use by all doctors. Unfortunately, it will take several years for all doctors and the results of clinical trials to refer to the REAL system.

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