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Prepublished online as a Blood First Edition Paper on January 23, 2003; DOI 10.1182/blood-2002-05-1548.
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Blood, 15 May 2003, Vol. 101, No. 10, pp. 4063-4069
NEOPLASIA
Nodular sclerosing Hodgkin disease: new grading predicts
prognosis in intermediate and advanced stages
Sabine von Wasielewski,
Jeremy Franklin,
Robert Fischer,
Klaus Hübner,
Martin L. Hansmann,
Volker Diehl,
Axel Georgii, and
Reinhard von Wasielewski
From the Institute of Pathology, Medizinische
Hochschule Hannover, Germany; Innere Klinik I,
Universität Köln, Germany; Institute of
Pathology, Universität Köln, Germany; and
Institute of Pathology, Universität Frankfurt/Main,
Germany.
The prognostic value of histologic classification and single
histomorphologic parameters in Hodgkin disease has been widely debated
in the literature. Whereas several former studies identified single
parameters to be of clinical relevance, some recent reports have
doubted the prognostic value of histology using modern treatment. Grading of the largest histologic category of Hodgkin disease, nodular
sclerosis (NS), has been controversially discussed concerning clinical
relevance. In this study, 965 cases of NS were reviewed to assess 9 histomorphologic parameters. The histologic results were correlated
with laboratory and clinical findings and with overall survival and
disease-free survival. Based on these results, a new grading of the NS
category was established. The new grading, based on the 3 criteria
eosinophilia, lymphocyte depletion, and atypia of the
Hodgkin/Reed-Sternberg cells, was a significant indicator of prognosis
in intermediate and advanced stages. Patients investigated in this
study represent an outstanding collection because all of them were
enrolled in the prospective multicenter clinical trial of the German
Hodgkin Lymphoma Study Group. All of them had been staged uniformly
according to the Ann Arbor system and had received stage-adapted modern
treatment according to multimodality protocols. A subtle analysis of
histology could represent a possible way to identify patients with a
significantly better or worse prognosis. This new grading should help
to avoid overtreatment to reduce severe therapy-related side effects
such as acute toxicity and chronic sequelae such as cardiopulmonary
complications and secondary neoplasias.
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