The new World Health Organization classification of lymphomas: the past, the present and the future

The REAL Classification of lymphomas, proposed in 1994, represents a new paradigm in lymphoma classification, consisting of a list of biologic entities defined by clinicopathologic and immunogenetic features. The non-Hodgkin's lymphomas comprise precursor lymphoblastic and mature cell neoplasms of B, T or putative natural killer cell lineage. An individual entity can exhibit a range of morphologic appearances and a range of clinical behavior. The categories in Hodgkin's lymphomas are identical to the widely used Rye classification except for the additional of a new category termed 'lymphocyte-rich classical Hodgkin's lymphoma'. The REAL classification has been validated by a major multi-institutional study involving 1378 cases (The Non-Hodgkin's Lymphoma Classification Project), showing that it is both reproducible and clinically relevant. The new World Health Organization classification of hematopoietic and lymphoid tumors, to be published in 2001, is a joint project of the Society for Hematopathology and European Association of Hematopathologists, under the auspices of the World Health Organization. This classification includes not only lymphoid neoplasms, but also myeloid, histiocytic and mast cell neoplasms. The lymphoma component of the classification is merely an update of the REAL classification, with minor changes necessitated by new information that has become available since its proposal. A conceptual grouping of the non-Hodgkin's lymphomas into four categories (indolent, aggressive, highly aggressive, and localized indolent) is also presented in this review. The next major impetus influencing the approach to lymphoma classification will no doubt be molecular genetics, in particular DNA microarrays, which will yield an enormous amount of new data that will aid in the understanding of lymphomas.