The Revised European-American Classification of Lymphoid Neoplasms: One Clinician's Comments.

Abstract

Characteristics, merits and some problems of the clinical relevance of the Revised European-American Lymphoma (REAL) classification are described, and the present status of research regarding is discussed. Several retrospective studies including pathologic reviews using the REAL system demonstrated that accurate diagnosis of newly incorporated categories such as mantle cell lymphoma and mucosaassociated lymphoid tissue (MALT)-lymphoma. was clinically significant, and that T-cell phenotype was an unfavorably prognostic factor on multivariate analysis. Although a considerable number of criticisms have been raised against the “REAL classification” such as the paucity of reproducibility studies, too many categories, lack of prognostic groupings, uncertain practicability in the patients whose immunophenotypic or molecular genetic data are not available, and questionable consensus among major hematopathologists, the REAL classification is still an attractive and probably useful classification, because each category is defined according to the presumed cell of origin, and the newly-incorporated categories are well described, using a combination of updated morphologic, immunologic, and genetic information. To evaluate the clinical implications of the REAL classification properly and establish useful clinical groupings, further clinicopathologic studies are needed.