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National Cancer Institute Retrospective Study of the Non-Hodgkin's Lymphomas: abstract (Report No 7)* KRISTIN HENRY

A retrospective study of the non-Hodgkin's lymphomas has been set up in order to assess and compare the five new classifications with that of Rappaport and to relate them to clinical data in terms of prognosis. Following analyses of the computer data, agreement has been achieved on an acceptable 'formulation' for use in clinical trials for classification of the non-Hodgkin's lymphomas which should prove valuable in allowing cross reference between different centres.

In 1976 the National Cancer Institute (NCI), Bethesda, set up a retrospective study of the non-Hodgkin's lymphomas in order to assess and compare the five new classifications with that of Rappaport; and to relate them to clinical data in terms of prognosis. To this end six pathologists, Dorfman, Henry, Lennert, Lukes, O'Connor and Rappaport, each applying their own classification, examined histopathological mater- ial from 1175 patients at four different centres. The centres involved were Stanford University, Tufts

*The work described in this paper was carried out by collaborators in the British National Lymphoma Investigation, referred to in detail on page 482 of this journal. Reprint requests should be sent to: Dr Gillian Vaughan Hudson, British National Lymphoma Investigation, Department of Oncology, The Middlesex Hospital, London, W1.

University, the University of Minnesota and the Tumour Institute at Milan, and the material provided consisted of nodal and extranodal tissues including gastrointestinal tract. A second panel of six inter- national pathologists (Berard, Hartsock, Kruger, Namba, Robb-Smith and Sachs) also examined the same material but were required to apply all six classifications. In addition, 20% of the material was viewed a second time by all pathologists to test reproducibility. Clinicians from the participating centres provided the clinical data and the computer facilities of Stanford University were utilised.

Following analyses of the computer data at a meeting in Stanford in January 1980, agreement was achieved between the participating pathologists and clinicians on an acceptable 'formulation' for use in

Table 1 - A working formulat ion o f non-Hodgkin's l y m p h o m a

Recommendations elan expert BNLI equivalents international panel

LOW GRADE

A. Malignant lymphoma Small lymphocytic

Consistent with CLL Hasmacytoid

B. Malignant lymphoma, follicular Predominantly small cleaved cell

Diffuse areas Sclerosis

C. Malignant lymphoma, follicular Mixed, small cleaved and large cell

Diffuse areas Sclerosis

INTERMEDIATE GRADE

D. Malignant lymphoma, follicular Predominantly large cell

Diffuse areas Sclerosis

Diffuse lymphoma Lymphocytic, well differentiated (small round lymphocyte)

Plasmacytoid differentiation

Follicular lymphoma Follicle cells predominantly small

Banded or fine sclerosis

Follicular lymphoma Follicle cells mixed small and large

Banded or fine sclerosis

Follicular lymphoma Follicle cells predominantly large

Banded or fine sclerosis

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Table 1 - continued

CLINICAL RADIOLOGY

E. Malignant lymphoma, diffuse Small cleaved cell

Sclerosis

F. Malignant lymphoma, diffuse Mixed, small and large cell

Sclerosis Epithelioid cell component*

G. Malignant lymphoma, diffuse Large cell

Cleaved cell Non-cleaved cell Sclerosis

HIGH GRADE

H. Malignant lymphoma Large cell, immunoblastic

Plasmacytoid Clear cell Polymorphous Epithelioid cell component

I. Malignant lymphoma L ymphoblastic

Convoluted cell Non-convoluted cell

J. Malignant lymphoma Small non-cleaved cell

Burkitt's Follicular areas

Miscellaneous Composite Mycosis fungoides Histiocytic ExtrameduUary plasmacytoma Unclassifiable Other

Diffuse lymphoma Lymphocytic, intermediate differentiation (small follicle lymphocyte)

Banded or fine sclerosis

Diffuse lymphoma Lymphocytic, mixed small and large cell (mixed follicle cells)

Banded or fine sclerosis

Diffuse lymphoma 'Undifferentiated' large cell (large lymphoid cell)

Large irregularly nucleated follicle cells Large and small regularly nucleated follicle ceils Banded or fine sclerosis

Diffuse lymphoma 'Undifferentiated' large cell (large lymphoid cell)

Plasma cell differentiation and some examples of plasma cell lymphorna

Diffuse lymphoma Lymphocytic, poorly differentiated (lymphoblast)

Convoluted mediastinal lymphoma Non-Burkitt's lymphoma

Diffuse lymphoma Lymphocytic, poorly differentiated (lymphoblast)

Burkitt's lymphoma

No equivalent Cutaneous T-ceU lymphoma (not included in BNLI classification) Histiocytic cell (mononuclear phagocytic ceils) Plasma cell (extramedullary plasma cells) Unclassified Other

*Reactive elements are not accepted as criteria for mixed lymphomas in BNLI classification.

clinical trials in the classification of the non-Hodgkin's lymphomas (see Table 1). It can be seen that the Stanford formulation is very similar to the BNLI classification, and, even if not universally adopted, should prove valuable in allowing cross reference between centres engaged in clinical trials.

This communication analyses the new Stanford formulation in relation to other classifications, and presents the results of the NC! retrospective study applying the British National Lymphoma Investigation (BNLI) classification. The application of the BNLI

classification to the retrospective NCI study resulted in excellent reproducibility. Also the actuarial survival curves very closely matched those of similar categories in the current BNLI prospective study.

REFERENCE

National Cancer Institute Sponsored Study of Classification of Non-Hodgkin's Lymphomas: suminary and description of a working formulation for clinical usage. New England Journal o f Medicine (in press).