Cyclooxygenase 2 (COX-2) is an inflammatory enzyme involved in the pathogenesis and prognosis of several malignancies. In the present study, we investigated the prognostic value of COX-2 expression in a large (N ‫؍‬ 242), uniformly treated Hodgkin lymphoma (HL) population from the Spanish Network of HL using tissue microarrays. Univariate and multivariate analysis was done, including comparing the most recognized clinical variables: the early-and advanced-stage subgroups.COX-2 was expressed on Reed-Sternberg cells in 37% of patients. There were no differences in the distribution of clinical variables according to COX-2 expression. With a median follow-up time of 58 months, PFS at 5 years was 60% and 79% for COX-2 ؉ and COX-2 ؊ patients, respectively (P ‫؍‬ .003). The overall survival was 73% and 91%, respectively (P < .001). The major impact on prognosis was observed in the early AA stage (I-II) group. In fact, in these low-risk groups the expression of COX-2 defined a group with significantly worse progression-free and overall survival. In conclusion, COX-2 was expressed on Reed-Sternberg cells in one-third of HL patients and was a major independent, unfavorable prognostic factor in early-stage HL. We conclude that COX-2 may be a major prognostic variable in HL and a potential therapeutic target. (Blood. 2012;119(25):6072-6079) IntroductionHodgkin lymphoma (HL) represents 10%-15% of lymphoma cases. 1 At present, approximately 80%-90% of patients in the early and limited stages can be cured. 2 In fact, the behavior of the disease is determined by intrinsic features of tumor cells, Reed-Sternberg (RS) cells, and the characteristics of the tumor microenvironment. This microenvironment is basically composed of several other cell populations associated with their respective extracellular matrix compartment, which includes a deregulated cytokine network with secretion of inflammatory cytokines. 3,4 Recently, an increased number of tumor-associated macrophages have been related to short survival, representing a new biomarker for risk prediction. 5 Cycloxygenase-2 (COX-2) is an inflammation-associated enzyme involved in the pathogenesis and prognosis of several solid malignancies (eg, colorectal, breast, ovarian, and lung). 6,7 Its role in hematologic malignancies has been recently recognized. 8,9 It has also been reported that COX-2 constitutes an independent prognostic variable in multiple myeloma 10 and also that a significant proportion of HL patients express COX-2, because this expression is associated with proliferation and angiogenesis. 8 Furthermore, it is claimed that COX-2 upregulates several key survival and proangiogenic factors that contribute to tumor growth and survival. 11 Aside from its prognostic value in multiple myeloma, the prognostic value of COX-2 has not been studied in any other hematologic malignancy. Current prognostic indexes in this disease are based on clinical variables 12 ; however, it could be interesting to evaluate biologic markers for both the RS malignant cell and the inflammatory m...

The red blood cell distribution width (RDW) is a parameter available from an automated blood count, which measures the degree of heterogeneity of erythrocyte volume and increases in inflammatory conditions. The prognostic role of RDW has been described in different types of cancers. Hodgkin lymphoma (HL) is a hematological malignancy, known to have a proinflammatory background. We aim to study the prognostic role of RDW in HL. We retrospectively analyzed 264 patients with HL from two hospitals in the Balearic Islands between 1990 and 2018. Higher levels of RDW were independently related to anemia, B-symptoms, and low albumin. In age ≥45 years, the presence of lymphopenia and higher RDW were independently associated with worse event-free survival (EFS) and overall survival (OS). Long-term incidence of secondary malignancies was significantly higher in patients with higher RDW, particularly lung cancer. In conclusion, we report for the first time that RDW is a simple, cheap, and easily available prognostic factor in HL that identifies a group with worse EFS, OS, and a higher potential incidence of secondary malignancies. RDW seems to be related to most adverse prognostic factors in HL, making RDW an excellent candidate to be included in prognostic scores for HL.

In an outbreak situation, phage typing was found to be very useful, although it seems less suitable for long-term surveillance purposes.