classification of non Hodgkin's lymphoma (NHL)

Last reviewed 01/2018

classification

Several different classification systems have been brought forward over the past few years but none have gained universal acceptance. 

  • historically NHL was classified according to the International Working Formulation (IWF) as either low, intermediate or high grade based on the morphology and natural history (1).
  • currently the Revised European American Lymphoma (REAL)/WHO classification is in use

REAL/ WHO classification

B-cell neoplasms

  1. Precursor B-cell neoplasm: precursor B-acute lymphoblastic leukemia/lymphoblastic lymphoma (LBL).
  2. Peripheral B-cell neoplasms
    • B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma.
    • B-cell prolymphocytic leukemia.
    • Lymphoplasmacytic lymphoma/immunocytoma.
    • Mantle cell lymphoma.
    • Follicular lymphoma.
    • Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphatic tissue (MALT) type.
    • Nodal marginal zone B-cell lymphoma (± monocytoid B-cells).
    • Splenic marginal zone lymphoma (± villous lymphocytes).
    • Hairy cell leukemia.
    • Plasmacytoma/plasma cell myeloma.
    • Diffuse large B-cell lymphoma.
    • Burkitt lymphoma.

T-cell and putative NK-cell neoplasms

  1. Precursor T-cell neoplasm: precursor T-acute lymphoblastic leukemia/LBL.
  2. Peripheral T-cell and NK-cell neoplasms.
    • T-cell chronic lymphocytic leukemia/prolymphocytic leukemia.
    • T-cell granular lymphocytic leukemia.
    • Mycosis fungoides/Sézary syndrome.
    • Peripheral T-cell lymphoma, not otherwise characterized.
    • Hepatosplenic gamma/delta T-cell lymphoma.
    • Subcutaneous panniculitis-like T-cell lymphoma.
    • Angioimmunoblastic T-cell lymphoma.
    • Extranodal T-/NK-cell lymphoma, nasal type.
    • Enteropathy-type intestinal T-cell lymphoma.
    • Adult T-cell lymphoma/leukemia (human T-lymphotrophic virus [HTLV] 1+).
    • Anaplastic large cell lymphoma, primary systemic type.
    • Anaplastic large cell lymphoma, primary cutaneous type.
    • Aggressive NK-cell leukemia.

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