Adverse prognostic significance of CD20 positive Reed–Sternberg cells in classical Hodgkin's disease*

Abstract

Summary The prognostic significance of CD20 positive classical Hodgkin's disease (cHD) is uncertain. All cHD cases referred to the Memorial Sloan–Kettering Cancer Center (MSKCC) were retrospectively identified (5/92–11/00); the samples were immunostained, and clinical data ascertained. Cases were re‐reviewed without knowledge of clinical outcome. Univariate and multivariate analyses were performed 248 patients had cHD: 28 CD20+ (11%); 220 CD20−. All clinical characteristics were comparable except haemoglobin level at presentation. With a median follow‐up of 29·2 months, significant prognostic factors in multivariate analysis were: CD20 positivity, elevated white blood cell count (WBC) and low absolute lymphocyte count for time‐to treatment failure (TTF); and for overall survival (OS), CD20 positivity, elevated WBC count, bone marrow involvement and age ≥45 years. TTF was significantly poorer for ABVD‐treated patients with CD20+ cHD as compared with CD20− cHD. Among 167 patients treated at MSKCC, both TTF (P < 0·0001) and OS (P = 0·017) were significantly decreased in CD20+ patients as compared with CD20− cHD. CD20+ cHD is a poor prognostic factor for TTF and OS. All cHD cases should be immunophenotyped for CD20. A large prospective trial is needed to confirm these findings.

Phase 2 study of rituximab plus ABVD in patients with newly diagnosed classical Hodgkin lymphoma

“…11,12 In Hodgkin lymphoma, the malignant cells express CD20 of the lymphocyte-predominant subtype, but only in 20%-30% of the cHL subtype. [13][14][15][16] In those cases, rituximab also demonstrated single-agent activity. 17 Emerging data have suggested that rituximab may also have therapeutic value in patients with cHL whose tumors do not express CD20 by either depleting reactive B lymphocytes from the microenvironment, which may enhance antitumor immunity, 18 or by killing the putative CD20-expressing HL stem cells.…”

Mediastinal gray zone lymphoma

“…Although the prognostic importance of CD20 expression in CHL is still controversial, two independent studies have shown that patients with CD20 + CHL do poorly in clinical trials compared to cases with the classical phenotype (CD20 -CD30 + CD15 + ). 18,19 It should also be noted that, in the light of current knowledge, some of these patients would very probably now be given different diagnoses, including MGZL. The results cannot, therefore, be extrapolated to those obtained with modern standards and used to draw conclusions about the poor prognosis or optimal treatment for MGZL.…”

Aberrant T-cell antigen expression in classical Hodgkin lymphoma is associated with decreased event-free survival and overall survival

“…Despite the incorporation of several such parameters in a prognostic model, a sizeable fraction of high-risk patients still could not be identified in one study, 1 underscoring the need for better biomarkers. In this quest, several recent studies have focused on evaluating tissue-specific predictive biomarkers related either to the microenvironment of cHL [2][3][4][5][6][7] or to antigens expressed on the Hodgkin/Reed-Sternberg (HRS) cells [8][9][10] with variable success in identifying patients with poor outcomes, although they warrant validation in larger independent cohorts.…”