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Expert Explains WHO Classification Refinements in Hematologic Malignancies

Gina Columbus @ginacolumbusonc
Published: Friday, Dec 30, 2016

Ahmet Dogan, MD, PhD

Ahmet Dogan, MD, PhD

Changes are underway in the field of hematologic malignancies, as the World Health Organization (WHO) is publishing a revised classification of tumors of hematopoietic and lymphoid tissues—slated to be released in early 2017.

Dogan, who is chief of Hematopathology Service, Departments of Pathology and Laboratory Medicine at Memorial Sloan Kettering Cancer Center, discusses the updates to the WHO classification and the impact this will have on clinical practice, specifically in the areas of mantle cell lymphoma (MCL), diffuse large B-cell lymphoma (DLBCL), and Hodgkin lymphoma.

OncLive: What did you discuss at this State of the Science Summit?

Dogan: There is a new WHO classification that will be published early in 2017. We were following the developments at the 2016 ASH Annual Meeting in the context of that new classification.

The highlights of the classification include a number of changes or refinements of existing entities. These include the definition of so-called monoclonal B-cell lymphocytosis (MBL), the definition of indolent variant of MCL, refinements to the DLBCL classification, refinements to assess more aggressive large B-cell lymphomas and Burkitt-like lymphomas, as well as refinements to biomarkers in classical Hodgkin lymphomas.

What are the details of these refinements?

In the 2008 WHO classification, we introduced a concept of MBL. This was set at 5000 neoplastic B cells in 1 microliter of blood. This is now recognized as a precursor lesion of chronic lymphocytic leukemia (CLL). But also, the number of neoplastic cells presented in the blood may determine the prognosis. It is now thought that low count—less than 500 cells—is associated with a low rate of progression and those patients may be left alone and not followed up.
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