The clinical utility of the Revised European-American Lymphoma (REAL) Classification: Preliminary results of a prospective study in patients with non-Hodgkin's lymphoma from a single centre

Background: The clinical applicability of the Revised European-American Lym phoma (R.E.A.L.) Classification has been demonstrated in several retrospect ive studies. The present, on-going study was initiated to evaluate the clin ical and pathological utility of the R.E.A.L. Classification compared with the Working Formulation (WF) in a prospective fashion, in an unselected pat ient population treated at a single institution. Patients and methods: Prospective data were collected on 596 biopsies from 557 patients referred with an initial diagnosis of lymphoma. After initial histologic review, 465 biopsies from 441 patients were confirmed as non-Hod gkin's lyphoma (NHL), 412 of which could be classified in R.E.A.L. and WF. Results: According to WF criteria, 25% were low grade, 58% intermediate gra de and 2% high grade. 14% could not be allocated to a WF subtype. According to R.E.A.L., 46% were diffuse large B cell, 19% follicle centre lymphoma, 6% marginal zone, 6% small lymphocytic, 4% mantle cell, and 3% T-cell anapl astic large cell. For those with B-cell NHL, 7% were unclassifiable in WF c ompared with 1% in R.E.A.L. Corresponding figures for T-cell NHL were 68% a nd 3%, respectively. Conclusions: Preliminary results confirm the clinical utility of the R.E.A. L. Classification in a single institution setting, demonstrating that cases were more readily sub-typed in R.E.A.L. compared with WF. Frequencies are comparable with I.L.S.G. data. Further follow up with large patient numbers is on-going to analyse survival data with reference to clinical prognostic factors.