Proposed Modification of the “Real Working” Classification of Lymphoid Neoplasms

Extract

The classification of malignant lymphomas has been a matter of debate for three decades. The Working Formulation, which offers an association between histopathologic entities and clinical categories, was appreciated, accepted, and broadly applied by clinicians ( 1 ). However, the basic flaw in the Working Formulation is that it was based on treatment outcome, not on the recognition of individual disease entities or on cell of origin for a malignant neoplasm ( 2 ). The Revised European-American Classification of Lymphoid Neoplasms (REAL) ( 3 ) provided a comprehensive list of pathologic entities as well as translations of new terms into the older nomenclatures of previous classifications. Nevertheless, some clinicians showed serious resistance to the REAL listing because of the exclusion of grading that usually reflects the clinical outcome of the lymphoid neoplastic disease ( 4 , 5 ).

Hence, Hiddemann et al. ( 5 ), after the Sixth Lugano Conference, designated a new schema to facilitate the translation of the REAL classification into a clinically useful grouping and to reach a broad international consensus.