Lymphoma Classification

 Many classification systems have been used over the years. Presented here is only the current 2008 WHO classification system. Developed in 2008 by the WHO, and adopted by most haematologists/oncologists in 2009 it represents the latest update. There is a link at the bottom of this page to older systems.

Click here to read an article about the classification and staging of NHL over the years.

2008 WHO classification.

Mature B-cell neoplasms

• Chronic lymphocytic leukemia/small lymphocytic lymphoma
• B-cell prolymphocytic leukemia
• Splenic marginal zone lymphoma
• Hairy cell leukemia
  • Splenic lymphoma/leukemia, unclassifiable     
  • Splenic diffuse red pulp small B-cell lymphoma*   
  • Hairy cell leukemia-variant*
• Lymphoplasmacytic lymphoma     
  • Waldenström macroglobulinemia
• Heavy chain diseases     
  • Alpha heavy chain disease     
  • Gamma heavy chain disease     
  • Mu heavy chain disease Plasma cell myeloma
• Solitary plasmacytoma of bone
• Extraosseous plasmacytoma
• Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma)
• Nodal marginal zone B-cell lymphoma (MZL)     
  • Pediatric type nodal MZL
• Follicular lymphoma     
  • Pediatric type follicular lymphoma
• Primary cutaneous follicle center lymphoma
• Mantle cell lymphoma
• Diffuse large B-cell lymphoma (DLBCL), not otherwise specified     
  • T cell/histiocyte rich large B-cell lymphoma     
  • DLBCL associated with chronic inflammation     
  • Epstein-Barr virus (EBV)+ DLBCL of the elderly
• Lymphomatoid granulomatosis
• Primary mediastinal (thymic) large B-cell lymphoma
• Intravascular large B-cell lymphoma
• Primary cutaneous DLBCL, leg type
• ALK+ large B-cell lymphoma
• Plasmablastic lymphoma
• Primary effusion lymphoma
• Large B-cell lymphoma arising in HHV8-associated multicentric Castleman disease
• Burkitt lymphoma
• B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma
• B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma
• Hodgkin Lymphoma
• Nodular lymphocyte-predominant Hodgkin lymphoma
• Classical Hodgkin lymphoma     
  • Nodular sclerosis classical Hodgkin lymphoma
  • Lymphocyte-rich classical Hodgkin lymphoma
  • Mixed cellularity classical Hodgkin lymphoma
  • Lymphocyte-depleted classical Hodgkin lymphoma

Mature T-cell neoplasms

• T-cell prolymphocytic leukemia
• T-cell large granular lymphocytic leukemia
• Chronic lymphoproliferative disorder of NK-cells*
• Aggressive NK cell leukemia Systemic EBV+ T-cell lymphoproliferative disease of childhood (associated with chronic active EBV infection)
• Hydroa vacciniforme-like lymphoma
• Adult T-cell leukemia/lymphoma
• Extranodal NK/T cell lymphoma, nasal type
• Enteropathy-associated T-cell lymphoma
• Hepatosplenic T-cell lymphoma
• Subcutaneous panniculitis-like T-cell lymphoma
• Mycosis fungoides Sézary syndrome
• Primary cutaneous CD30+ T-cell lymphoproliferative disorder
  • Lymphomatoid papulosis     
  • Primary cutaneous anaplastic large-cell lymphoma
• Primary cutaneous aggressive epidermotropic CD8+ cytotoxic T-cell lymphoma*
• Primary cutaneous gamma-delta T-cell lymphoma
• Primary cutaneous small/medium CD4+ T-cell lymphoma*
• Peripheral T-cell lymphoma, not otherwise specified
• Angioimmunoblastic T-cell lymphoma
• Anaplastic large cell lymphoma (ALCL),
• ALK+ Anaplastic large cell lymphoma (ALCL), ALK–*

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

Source information from Blood Journal and the 2009 ASH education series

The chart below outlines what types of lymphoma correspond with what stage of B-cell development.  

Indolent / Aggressive classification

The following table classifies the lymphoproliferative disorders according to whether they belong to the indolent (slow growing) or aggressive subtype. This includes lymphomas, leukaemias, and myelomas.  This is based on the previous REAL/WHO classification system not the current 2008 WHO system.

Indolent lymphoma/leukemia

• A. Follicular lymphoma (follicular small cleaved cell [grade 1], follicular mixed small cleaved and large cell [grade 2], diffuse small cleaved cell)
• B. Chronic lymphocytic leukemia/small lymphocytic lymphoma
• C. Lymphoplasmacytic lymphoma (Waldenstrom's macroglobulinemia)
• D. Extranodal marginal zone B-cell lymphoma (MALT lymphoma
• E. Nodal marginal zone B-cell lymphoma (monocytoid B-cell lymphoma)
• F. Splenic marginal zone lymphoma (splenic lymphoma with villous lymphocytes)
• G. Hairy cell leukemia
• H. Mycosis fungoides/Sezary syndrome
• I. T-cell granular lymphocytic leukemia
• J. Primary cutaneous anaplastic large cell lymphoma/lymphomatoid papulosis (CD30+)
• K. Nodular lymphocyte predominant Hodgkin's lymphoma  

Aggressive lymphoma/leukemia

• A. Diffuse large cell lymphoma (includes diffuse mixed cell, diffuse large cell, immunoblastic, T-cell rich large B-cell lymphoma) Distinguish:
  • 1. Mediastinal large B-cell lymphoma
  • 2. Follicular large cell lymphoma (grade 3)
  • 3. Anaplastic large cell lymphoma (CD30+)
  • 4. Extranodal NK/T-cell lymphoma, nasal type
  • 5. Lymphomatoid granulomatosis (angiocentric pulmonary B-cell lymphoma)
  • 6. Angioimmunoblastic T-cell lymphoma
  • 7. Peripheral T-cell lymphoma, unspecified
  • 8. Subcutaneous panniculitis-like T-cell lymphoma
  • 9. Hepatosplenic T-cell lymphoma
  • 10. Enteropathy-type T-cell lymphoma
  • 11. Intravascular large B-cell lymphoma
• B. Burkitt lymphoma/Burkitt cell leukaemia/Burkitt-like lymphoma
• C. Precursor B- or T-cell lymphoblastic lymphoma/leukaemia
• D. Primary CNS lymphoma
• E. Adult T-cell leukaemia/lymphoma (HTLV 1+)
• F. Mantle cell lymphoma
• G. Polymorphic post-transplantation lymphoproliferative disorder (PTLD)
• H. AIDS-related lymphoma
• I. True histiocytic lymphoma
• J. Primary effusion lymphoma
• K. Aggressive NK-cell leukemia/blastic NK-cell lymphoma
• L. B- or T-cell prolymphocytic leukemia  

Click here to view older classification systems