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Blood, Vol. 95 No. 4 (February 15), 2000:
pp. 1207-1213
Tissue eosinophilia correlates strongly with poor prognosis in
nodular sclerosing Hodgkin's disease, allowing for known prognostic
factors
R. von Wasielewski,
S. Seth,
J. Franklin,
R. Fischer,
K. Hübner,
M. L. Hansmann,
V. Diehl, and
A. Georgii
From the Institut für Pathologie: Medizinischen Hochschule
Hannover, Universität Köln, Universität Frankfurt;
and Innere Klinik I Universität Köln, Germany
Although eosinophilic granulocytes are frequently observed in
lymphatic tissue of Hodgkin's patients, no substantial data reveal the
prognostic role, if any, of tissue eosinophilia. Thus, eosinophilia was
analyzed histologically in 1511 diagnostic biopsy specimens of patients
treated under protocol therapy of the German Hodgkin's Lymphoma Study
Group between 1988 and 1994. Prominent eosinophilia was seen in
38% of cases, which differed among the histologic types of Hodgkin's
disease (HD): none in lymphocyte predominant, 14% in lymphocyte rich
classical, 40% in nodular sclerosis grade 1 (NS-1), 55% in nodular
sclerosis grade 2, 43% in mixed cellularity (MC), and 54% in
lymphocyte depleted. In a multivariate analysis, tissue eosinophilia
proved to be the strongest prognostic factor for freedom from treatment
failure (P < .001) and overall survival
(P < .001) in a stage-stratified model. Among NS-1
patients, the effect was highly significant. In MC, no significant
effect of eosinophilia on survival could be demonstrated. Eosinophils
secrete CD30 ligand that is capable of binding to CD30 positive HD
cells. The activation of TRAF2, followed by NF-kappaB, which occurs on
CD30L/CD30 binding, may explain the neoplastic proliferation and
apoptosis protection of HD cells. TRAF2 is also activated by EBV-LMP
expression, which is detectable in the majority of MC but not NS cases.
In addition to the possibility that eosinophils are only passive
indicators for other unknown prognostic determinants, it may be
concluded that the positive clinical outcome of eosinophilia-negative
NS cases could be due to lower NF-kappaB activity.
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