Originally published as JCO Early Release 10.1200/JCO.2006.09.6396 on March 12 2007

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Reclassification of 300 Primary Cutaneous B-Cell Lymphomas According to the New WHO–EORTC Classification for Cutaneous Lymphomas: Comparison With Previous Classifications and Identification of Prognostic Markers

Nancy J. Senff, Juliette J. Hoefnagel, Patty M. Jansen, Maarten H. Vermeer, Joop van Baarlen, Willeke A. Blokx, Marijke R. Canninga-van Dijk, Marie-Louise Geerts, Konnie M. Hebeda, Philip M. Kluin, King H. Lam, Chris J.L.M. Meijer, Rein Willemze

From the Departments of Dermatology and Pathology, Leiden University Medical Center, Leiden; Department of Pathology, Medisch Spectrum Twente, Enschede; Department of Pathology, University Medical Center Nijmegen, Nijmegen; Department of Pathology, University Medical Center Utrecht, Utrecht; Department of Pathology, University Medical Center Groningen, Groningen; Department of Pathology, Erasmus Medical Center, Rotterdam; Department of Pathology, Vrije Universiteit Medical Center, Amsterdam, the Netherlands; and the Department of Dermatology, University Hospital Gent, Gent, Belgium

Address reprint requests to Nancy Senff, MD, Department of Dermatology, B1-Q, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands; e-mail: N.J.Senff{at}LUMC.nl

Purpose: In the new WHO–European Organisation for Research and Treatment of Cancer (WHO-EORTC) classification for cutaneous lymphomas three major groups of primary cutaneous B-cell lymphoma (CBCL) are distinguished: primary cutaneous marginal zone B-cell lymphoma (PCMZL) and primary cutaneous follicle center lymphoma (PCFCL) with a good prognosis, and primary cutaneous large B-cell lymphoma, leg type (PCLBCL-LT), with an intermediate-level prognosis. This study aimed to assess the clinical significance of the new classification compared with previous classification schemes (EORTC 1997; WHO 2001) and to define prognostic factors within the newly defined categories.

Patients and Methods: In the present study clinical data and histologic sections of 300 patients with CBCL, formerly classified according to the EORTC classification, were reviewed and reclassified according to the WHO and the new WHO-EORTC classification schemes.

Results: After reclassification, the study comprised 71 patients with PCMZL, 171 patients with PCFCL, and 58 patients with PCLBCL-LT, showing 5-year disease-specific survivals of 98%, 95%, and 50%, respectively. When compared with the EORTC and WHO schemes, 5.3% and 36.3% of patients with CBCL were reclassified into another prognostic category. Multivariate analysis of PCFCL revealed localization on the leg and expression of FOXP1 as independent parameters associated with a poor prognosis. Expression of Bcl-2 or MUM-1 had no significant effect on survival in this group. In PCLBCL-LT, no independent prognostic parameters were found.

Conclusion: These results emphasize the clinical significance of the WHO-EORTC classification, but suggest that within the group of PCFCL, distinction should be made between lymphomas presenting on the legs and lymphomas presenting at other sites.

published online ahead of print at www.jco.org on March 12, 2007.

Supported by Grant No. UL 2006-3705 from the Dutch Cancer Society (N.J.S., M.H.V.).

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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