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New REAL clinical entities

R I Fisher1, T P Miller, T M Grogan

  • 1Cardinal Bemardin Cancer Center, Loyola University Medical Center, Maywood, Illinois, USA.

The Cancer Journal From Scientific American
|July 22, 1998
PubMed
Summary
This summary is machine-generated.

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The Revised European-American Lymphoma (REAL) classification effectively identifies distinct lymphoma subtypes. This validation supports its use for better patient prognostication and improved therapeutic strategies in clinical practice.

Area of Science:

  • Hematology
  • Oncology
  • Pathology

Background:

  • The Revised European-American Lymphoma (REAL) classification was proposed in 1994 to address limitations in the National Cancer Institute Working Formulation.
  • It aimed to incorporate newly recognized lymphoid neoplasms and establish an international standard for lymphoma classification.

Purpose of the Study:

  • To validate the reproducibility and distinctness of clinicopathologic entities defined by the REAL classification.
  • To assess the clinical utility of the REAL classification in diagnosing lymphoid neoplasms.

Main Methods:

  • The South-west Oncology Group (SWOG) Lymphoma Committee analyzed 376 patients with stage III/IV disease treated with CHOP chemotherapy.
  • The Non-Hodgkin's Lymphoma (NHL) Classification Project retrospectively studied 1,403 untreated NHL patients from nine international sites.

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  • Consensus diagnoses were established by five expert hematopathologists using histologic, clinical, and immunophenotypic data.

    • Main Results:

    • Diffuse large B-cell lymphoma was the most frequent diagnosis (31%), encompassing WF G/H categories.
    • Follicular lymphoma was the second most common (22%), corresponding to WF B, C, and D.
    • Marginal zone B-cell, peripheral T-cell, small B-lymphocytic, and mantle cell lymphomas each represented 5-10% of cases.

    Conclusions:

    • The REAL classification defines distinct clinical entities reliably diagnosed by expert hematopathologists.
    • This validation supports the REAL classification for improved prediction of patient clinical course.
    • The findings facilitate the development of more effective therapeutic strategies for lymphoma patients.