Neue Klassifikationen maligner Lymphome – Welche Änderungen sind für die Praxis relevant?

Für die Vergleichbarkeit klinischer Studien ist eine international einheitliche Lymphom-Klassifikation von grundlegender Bedeutung. Aktuell gibt es 2 parallele Klassifikationen: die „International Consensus Classification“ und die WHO-Klassifikation. Neben vielen Gemeinsamkeiten gibt es auch einige Unterschiede, wobei die traditionelle Unterteilung in indolente und aggressive B-Zell-Lymphome, Hodgkin-Lymphome und T-Zell-Lymphome weiter besteht.

Abstract

An internationally uniform lymphoma classification is of fundamental importance for the comparability of clinical studies. There are currently 2 parallel classifications: the “International Consensus Classification” and the WHO-classification. Follicular lymphoma 3B is classified separately as follicular large cell lymphoma in WHO-HAEM5. The diagnostic criteria of lymphoplasmocytic lymphoma (LPL) have been adjusted, both classifications recommend molecular testing for MYD88 and CXCR4 mutations. There are no significant diagnostic changes in aggressive B-cell lymphomas. The ICC classify NLPBL and THRLBCL into the group of large B-cell lymphomas (LBCL). NLPHL/NLPBL-specific therapy must be considered, which differs greatly from the therapy of DLBCL, especially in the early stages. Peripheral T-cell lymphomas are a group of nodal T-cell lymphomas with a TFH phenotype and frequent mutations; peripheral T-cell lymphoma (NOS) is therefore a diagnosis of exclusion. Indolent T-cell lymphomas/lymphoproliferations of the GI tract are rare but must be differentiated from aggressive T-cell lymphomas. The WHO-HAEM5 also includes reactive/non-neoplastic lymph node lesions classified according to B or T cell predominance.

Kernaussagen

• Kürzlich sind 2 neue Klassifikationen für lymphatische Neoplasien erschienen, die überwiegend Gemeinsamkeiten, aber auch kleinere Unterschiede aufweisen.

• Es ist notwendig, beide Klassifikationen zu kennen, um eine korrekte Diagnose und eine adäquate Behandlung der Patienten zu gewährleisten.

• Unterschiede zwischen den Klassifikationen sollten als Chance für eine erneute Diskussion verstanden werden.

• Insbesondere im Hinblick auf den Einschluss und die Behandlung im Rahmen von Studien und die Entwicklung internationaler Therapiestandards ist eine zukünftige Konsensus-Klassifikation anzustreben.

• Aktuell ist es empfehlenswert, bei Differenzen beide Nomenklaturen anzuwenden.

Schlüsselwörter

Klassifikation - International Consensus Classification - WHO - B-Zell-Lymphom - Hodgkin-Lymphom - T-Zell-Lymphom

Keywords

classification - International Consensus Classification - WHO - B-cell lymphoma - Hodgkin lymphoma - T-cell lymphoma

Publication History

Article published online:
15 May 2024

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