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Clinical analysis of 670 cases in two trials of the European Organization
for the Research and Treatment of Cancer Lymphoma Cooperative Group
subtyped according to the Revised European-American Classification of
Lymphoid Neoplasms: a comparison with the Working Formulation
S Pittaluga, L Bijnens, I Teodorovic, A Hagenbeek, JH Meerwaldt, R Somers, J Thomas, EM Noordijk and C De Wolf-Peeters
Universitaire Ziekenhuizen, Leuven, Belgium.
In the Working Formulation (WF), non-Hodgkin's lymphomas (NHL) are grouped
according to their clinical behavior. These disorders are listed as
entities defined by morphology, phenotype, and cytogenetics in the proposed
Revised European-American Classification of Lymphoid Neoplasms (REAL), the
clinical relevance of which is still debated. We analyzed 670 NHL cases
included in two randomized clinical trials (EORTC 20855
WF-intermediate/high-grade and 20856 WF-low-grade malignancy) with
histologic material available for review. Based on
hematoxylin-eosin-stained sections, 77% of cases could be subtyped.
Immunophenotyping was considered to be mandatory only in diagnosing T- cell
lymphoma and anaplastic large-cell lymphoma. Of 522 cases subtyped, 11%
were mantle cell lymphoma (MCL), 5% were marginal zone B- cell lymphoma
(MZBCL), 46% were follicle center lymphoma, and 32% were diffuse large
B-cell lymphoma. Statistical analysis and comparisons between
classifications were made only within each trial and treatment group. MCL
and MZBCL were characterized by a shorter median survival (3.4 and 4.1
years, respectively) in comparison with low- and intermediate-grade WF
groups (> 9.3 and 5.8 years, respectively). In terms of progression-free
survival, MCL showed a behavior similar to the low-grade group, with
frequent relapses. Follicle center cell lymphomas behaved as low-grade
lymphomas as defined by the WF and diffuse large B-cell lymphomas as the
WF-intermediate grade group. Because several NHL entities have a clinical
behavior of their own, their recognition by the REAL classification offers
clinicians additional information that is not obtained when the WF is used.
Volume 87,
Issue 10,
pp. 4358-4367,
05/15/1996
Copyright © 1996 by The American Society of Hematology
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