What are the most commonly used classification schemas for follicular lymphoma?

Updated: Mar 03, 2020
  • Author: Lauren C Pinter-Brown, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Guidelines contributors: Priyank P Patel, MD , Hematology/Oncology Fellow, Roswell Park Cancer Institute, University at Buffalo, Francisco J Hernandez-Ilizaliturri, MD, Chief, Lymphoma and Myeloma Section; Professor of Medicine, Department of Medical Oncology; Director of The Lymphoma Translational Research Program; Associate Professor of Immunology, Roswell Park Cancer Institute

The three most commonly used classification schemas for non-Hodgkin lymphoma (NHL) are as follows:

  • National Cancer Institute’s Working Formulation (IWF) [66]  
  • Revised European-American Classification of Lymphoid Neoplasms (REAL) [21]
  • World Health Organization (WHO) classification [67]

The Working Formulation, originally proposed in 1982, classified and grouped lymphomas by morphology and clinical behavior (ie, low, intermediate, or high grade) with 10 subgroups labeled A to J. [66]  In 1994, the REAL classification attempted to apply immunophenotypic and genetic features in identifying distinct clinicopathologic NHL entities. [21]

The WHO classification, first introduced in 2001 and updated in 2008 and 2016, further elaborates upon the REAL approach. This classification divides NHL into two groups: those of B-cell origin and those of T-cell/natural killer (NK)–cell origin. [67, 28]

Although considered obsolete, the IWF classification is still used mainly for historical data comparisons. [66]


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