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Classical Hodgkin's disease. Clinical impact of the immunophenotype
R von Wasielewski1, M Mengel, R Fischer
1Pathologisches Institut, Medizinischen Hochschule Hannover, Germany.
Insights
Immunohistochemistry for CD15, CD30, and CD20 aids Hodgkin's lymphoma diagnosis. Lack of CD15 expression in classical Hodgkin's lymphoma is an independent negative prognostic factor for survival.
Area of Science:
- Oncology
- Immunohistochemistry
- Hematopathology
Background:
- Antibodies against CD15, CD30, and CD20 are crucial for diagnosing Hodgkin's Disease (HD).
- Classical HD typically expresses CD15, CD30, and lacks CD20, but CD15 positivity can be inconsistent.
- The prognostic significance of antigen expression in HD remains largely unexplored.
Purpose of the Study:
- To investigate the prognostic relevance of CD15, CD30, and CD20 expression in classical Hodgkin's Disease.
- To determine if antigen expression correlates with clinical outcome and survival.
Main Methods:
- Analysis of 1751 Hodgkin's Disease cases using immunohistochemistry with microwave epitope retrieval.
- Evaluation of CD15, CD30, and CD20 expression patterns.
- Correlation of immunophenotypes with clinical follow-up data from 1286 patients.
Main Results:
- Eighty-three percent of cases exhibited a classical immunophenotype (CD15+, CD30+, CD20-).
- Twelve percent lacked CD15 positivity (CD15-, CD30+, CD20-).
- CD15 negativity was significantly associated with poorer freedom from treatment failure (P=0.0022) and overall survival (P=0.0001).
Conclusions:
- Lack of CD15 expression in classical HD is an independent negative prognostic factor for relapses and survival.
- Immunohistochemistry can identify classical HD cases with unfavorable clinical outcomes.
- This finding aids in refining prognostic assessments and treatment strategies for Hodgkin's lymphoma.
Abstract:
Antibodies against CD15, -30, and -20 are often used to support morphological diagnosis of Hodgkin's Disease (HD). The classical HD, i.e., the non-lymphocyte-predominance types, are CD15+, CD30+, and CD20- in general. However, the results for CD15 are less clear-cut in many studies, showing up to 40% of classical HD that lack positivity for this maker. Little is currently known about the relevance of antigen expression in relation to clinical outcome in HD. Therefore, the three markers were analyzed in 1751 cases from the German Hodgkin Study Group, using micro-wave epitope retrieval to optimize staining sensitivity. Eighty-three percent of the cases showed a classical immunophenotype (CD15+, CD30+, CD20-), twelve percent lacked CD15 positivity (CD15-, CD30+, CD20-), and five percent showed other combinations. For 1286 cases, clinical follow-up was available, which revealed significant differences for freedom from treatment failure (P = 0.0022) and overall survival (P = 0.0001) between cases with classical immunophenotype and CD15 negativity (CD30+, CD20-). Multivariate Cox regression using the three markers, age, sex, histology, stage, B-symptoms (fever, sweats, weight loss > 10% of body weight), hemoglobin, and erythrocyte sedimentation rate as factors showed that lack of CD15 expression in classical HD is an independent negative prognostic factor for relapses (P = 0.022) and survival (P = 0.0035). In conclusion, immunohistochemistry is able to identify classical HD cases with unfavorable clinical outcome.