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Prepublished online as a Blood First Edition Paper on January 23, 2003; DOI 10.1182/blood-2002-05-1548.
Submitted May 28, 2002
Accepted December 30, 2002
Nodular sclerosing Hodgkin's disease: new grading predicts prognosis in intermediate and advanced stages
Sabine von Wasielewski, Jeremy Franklin, Robert Fischer, Klaus Huebner, Martin L Hansmann, Volker Diehl, Axel Georgii, and Reinhard von Wasielewski*
Institute of Pathologie, Medizinische Hochschule Hannover, Hannover, Germany
Innere Klinik I, Universitaet Koeln, Koeln, Germany
Institute of Pathologie, Universitaet Koeln, Koeln, Germany
Institute of Pathologie, Universitaet Frankfurt/Main, Frankfurt/Main, Germany
* Corresponding author; email: wasielewski.reinhard.von{at}mh-hannover.de.
The prognostic value of histological classification and single histomorphological parameters in Hodgkin's 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 under modern treatment. Grading of the largest histological category of Hodgkin's Disease, nodular sclerosis, has been controversially discussed concerning clinical relevance. 965 cases of NS were reviewed to assess nine histomorphological parameters. The histological 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 three 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 since 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 multi-modality 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 in order to reduce severe therapy related side effects such as acute toxicity and chronic sequelae like cardio pulmonary complications and secondary neoplasias.
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