Further considerations on the Revised European-American Lymphoma classification

The proposal from the International Lymphoma Study Group (ILSG) of a new classification for lymphoid neoplasm, known as the Revised European-American Lymphoma (REAL) classification, has been received by clinicians and pathologists with mixed reactions. Numerous letters, editorials, and abstracts have been published in the past year praising and criticizing this proposal. The feasibility as well as the clinical validity of the ILSG proposal has been tested in retrospective studies based on large multicenter trials, and a large multi-institutional effort to prove or disprove the validity of the REAL classification was undertaken by the International Non Hodgkin's Lymphoma Classification Project. All these studies seems to confirm the usefulness of the REAL classification. Besides the overall evaluation of the ILSG proposal, the clinical validity of the newly defined entities (eg, mantle cell lymphoma, marginal zone cell lymphoma) has been shown by these and other retrospective studies. However, the main objection of clinicians remains the lack of grouping of lymphoma entities according to their clinical behavior, which we as pathologists believe to be the clinician's task.