NHL Cyberfamily

Non-Hodgkin's lymphoma support


Older lymphoma classification systems

A history of lymphoma classification


Older classification systems for lymphoma

Many classification systems have come and gone over the years. Here is a brief history of them.

  1. Rappaport and Lukes Collins
  2. Kiel Classification
  3. Working formulation
  4. REAL/WHO classification
  5. 2008 WHO classification

Rappaport and Lukes Collins

This classification was developed before lymphoid cells were divided into B-cells and T-cells. It was developed in 1966 with the Lukes Collins modifications in 1974

Well-differentiated lymphocytic lymphoma small lymphocytic lymphoma
Poorly differentiated lymphocytic lymphoma 6633 (NOS), 96643 (cellular phase) also:
96653 (HD NS, lymphocyte predominance)
96663 (HD NS mixed cellularity),
96673 (HD NS, lymphocytic depletion)
follicular center cell lymphoma with a large component of small-cleaved cells. Histiocytic lymphoma large cell lymphoma

Kiel Classification

This was developed in 1974, the first to recognize B and T cell subtypes.

Low grade
Low grade
*Lymphocytic -chronic lymphocytic and prolymphocytic leukemia -hairy-cell leukemia Lymphocytic -chronic lymphocytic and prolymphocytic leukemia
  - Small, cerebriform cell -mycosis fungoides, Sézary's syndrome
Lymphoplasmacytic/cytoid (LP immunocytoma) Lymphoepithelioid (Lennert's lymphoma)
Plasmacytic Angioimmunoblastic (AILD, LgX)
*Centroblastic/centrocytic - follicular ± diffuse - diffuse T-zone
* Centrocytic Pleomorphicm, small cell (HTLV-1
High Grade
Centroblastic Pleomorphic, medium and large cell (HTLV-1 ±)
*Immunoblastic Immunoblastic (HTLV-1 ±)
Large cell anaplastic (Ki-1+) *Large cell anaplastic (Ki-1+)
Burkitt's lymphoma  
Lymphoblastic Lymphoblastic
Rare types Rare types

Working Formulation

This was developed by the National Cancer Institute in 1982 as a method of translating among the recognized classification systems for non-Hodgkin lymphoma (Rappaport, Dorfman, Lukes and Collins, Kiel, and the British Lymphoma system). The major groups are identified by letters, A - J, and grouped according to prognosis:

Most favourable Low grade A, B, C
  Intermediate grade D, E, F, G
Least favourable High grade H, I, J

Low grade
Intermediate grade
High grade
Small lymphocytic Follicular large cell Large cell immunoblastic
Follicular small-cleaved cell Diffuse small cleaved cell Lymphoblastic
Follicular mixed small cleaved and large cell Diffuse mixed small and large cell Small non-cleaved cell (Burkitt and non-Burkitt types)
  Diffuse large cell  


Cell types categorized as unclassified by the Working Formulation include the non-specific terms malignant lymphoma, non-Hodgkin lymphoma, diffuse malignant lymphoma, nodular or follicular malignant lymphoma, and cutaneous lymphoma.
Differences in histology refer to differences in the first 3 digits of the ICD-O morphology code.
A simultaneous diagnosis of malignant lymphocytic lymphoma (small cell type) and chronic lymphocytic leukemia (CLL) is coded to CLL 

- Updated REAL/WHO Classification --

This system was used from 2001-2009 but replaced with the current 2008 WHO classification system.
NOTE: The WHO  adopted a new classification system for cutaneous lymphomas. The classification system below is still the current one used, but it will eventually be integrated with these new changes to the cutaneous lymphomas.
Click here to read about the new cutaneous classification.

B-cell neoplasms

  • I. Precursor B-cell neoplasm: precursor B-acute lymphoblastic leukemia/lymphoblastic lymphoma (B-ALL, LBL)    
  • II. Peripheral B-cell neoplasms        
    • A. B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma        
    • B. B-cell prolymphocytic leukemia        
    • C. Lymphoplasmacytic lymphoma/immunocytoma        
    • D. Mantle cell lymphoma        
    • E. Follicular lymphoma        
    • F. Extranodal marginal zone B-cell lymphoma of MALT type        
    • G. Nodal marginal zone B-cell lymphoma (+/- monocytoid B-cells)
    • H. Splenic marginal zone lymphoma (+/- villous lymphocytes)    
    • I. Hairy cell leukemia        
    • J. Plasmacytoma/plasma cell myeloma        
    • K. Diffuse large B-cell lymphoma
    • Primary mediastinal B-cell lymphoma             
    • Primary effusion lymphoma        
    • L. Burkitt's lymphoma

T-cell and putative NK-cell neoplasms    

  • I. Precursor T-cell neoplasm: precursor T-acute lymphoblastic leukemia/lymphoblastic lymphoma (T-ALL, LBL)     
  • II. Peripheral T-cell and NK-cell neoplasms         
    • A. T-cell chronic lymphocytic leukemia/prolymphocytic leukemia 
    • B. T-cell granular lymphocytic leukemia         
    • C. Mycosis fungoides/Sezary's syndrome         
    • D. Peripheral T-cell lymphoma, not otherwise characterized 
    • E. Hepatosplenic gamma/delta T-cell lymphoma         
    • F. Subcutaneous panniculitis-like T-cell lymphoma         
    • G. Angioimmunoblastic T-cell lymphoma         
    • H. Extranodal T-/NK-cell lymphoma, nasal type         
    • I. Enteropathy-type intestinal T-cell lymphoma         
    • J. Adult T-cell lymphoma/leukemia (HTLV 1+)         
    • K. Anaplastic large cell lymphoma, primary systemic type
    • L. Anaplastic large cell lymphoma, primary cutaneous type
    • M. Aggressive NK-cell leukemia Hodgkin's lymphoma

(Hodgkin's disease)     

  • I. Nodular lymphocyte-predominant Hodgkin's lymphoma
  • II. Classical Hodgkin's lymphoma
  • A. Nodular sclerosis Hodgkin's lymphoma
  • B. Lymphocyte-rich classical Hodgkin's lymphoma
  • C. Mixed cellularity Hodgkin's lymphoma.
  • D. Lymphocyte depletion Hodgkin's lymphoma

2008 WHO classification.

Mature B-cell neoplasms

Mature T-cell neoplasms

*These represent provisional entities or provisional subtypes of other neoplasms.

Source information from Blood Journal and the 2009 ASH education series

Additional information about the 2008 WHO classification.

The 2008 WHO classification of lymphoid neoplasms and beyond: evolving concepts and practical applications


Back to the current WHO classification system

Classification systems source information