Delayed hypersensitivity and lymphocytic transformation in patients with Hodgkin's disease and granulomas

Noncaseating, sarcoid-like granulomas were found in the tissues of 9 out of 31 patients with Hodgkin's disease. In vivo and in vitro cell-mediated immunity was evaluated in patients with and without granulomas and compared to a group of 20 normal controls. Hodgkin's disease patients of both groups showed a significantly reduced in vivo and in vitro response when compared to the control group. However, when patients in stages IIIB and IV were eliminated and patients in stages I, II, and IIIA examined separately, a positive skin test response to one or more antigens was elicited in 85.7% of patients with granulomas, while a markedly decreased-dose dependent response was observed in patients without granulomas. In vitro lymphocyte blastic transformation by phytohemagglutinin (PHA) was severely impaired in both groups of patients as determined by dose-responses curves. These results indicate that Hodgkin's disease patients with granulomas have a significantly better skin test response than those without granulomas.