T-Cell, NK-Cell Lymphoma Classification: Disease Heterogeneity a Persisting Issue

A new review article presents the current state of T-cell and natural killer (NK)-cell lymphoma clinical diagnosis and classification. It was coauthored by Laurence de Leval, MD, PhD, of Lausanne University Hospital in Switzerland; Philippe Gaulard, MD, PhD, of the Mondor Biomedical Research Institute in Créteil, France; and Ahmet Dogan, MD, PhD, of Memorial Sloan Kettering Cancer Center in New York City. The article was published in Blood.

As the authors cite the latest scientific research relevant to this clinical topic, they highlight the heterogeneity of these two malignancies as a continuing challenge in diagnosis and classification. They note how in the composition of the 2022 updates to the International Consensus Classification and World Health Organization classification systems for these diseases, it was necessary to address their wide varieties of clinical presentation, etiology, type of originating cell, and genetics.

Regarding how categories were formulated in the classification systems, the coauthors wrote that “Cell derivation from innate immune cells or specific functional subsets of CD4+ T cells such as follicular helper T cells is a major determinant delineating entities.”

The authors explain that tissue biopsy remains the center of diagnosing T-cell and NK-cell lymphomas, and that this is another area where clinicians encounter difficulties from the heterogeneity of these diseases. They can present with a variety of histological features and be hard to differentiate from benign lymphoid proliferations or B-cell lymphomas.

“Disease location, morphology, and immunophenotyping remain the main features guiding the diagnosis, often complemented by genetic analysis including clonality and high-throughput sequencing mutational studies,” the authors elaborated.

Reference

de Leval L, Gaulard P, Dogan A. A practical approach to the modern diagnosis and classification of T- and NK-cell lymphomas. Blood. 2024;144(18):1855-1872. doi:10.1182/blood.2023021786