IntroductionTumors frequently develop evasion strategies that may influence every stage of the tumor-specific immune response, from the activation of antigen-presenting cells to T-cell recruitment, activation, and effector function. [1][2][3] Hodgkin lymphoma (HL) seems to be a role model for an ineffective tumor immune response, because the minority of tumor cells, so called Reed-Sternberg (RS) cells, are surrounded mainly by a mixture of reactive cells including lymphocytes, plasma cells, eosinophils, and histiocytes. 4,5 The majority of lymphocytes in close proximity to the tumor cells are CD4 ϩ T cells with anergic phenotype, indicating poor immune surveillance of the tumor. 6 In fact, several immune evasion strategies are described in HL, including down-regulation of immunodominant Epstein-Barr Virus (EBV) antigens, and secretion of soluble factors such as transforming growth factor beta (TGF), interleukin-10 (IL10), or prostaglandin E 2 (PGE 2 ), that have been shown to inhibit the activation of specific cytotoxic T lymphocytes (CTLs) and professional antigen-presenting cells in vitro and in murine models. [7][8][9][10] Also cell-to-cell interactions via inhibitory receptors might lead to immune inhibition. For example, neoplastic CD20 ϩ B cells in nodular lymphocyte-predominant HL express PDL-1, and the respective inhibitory receptor PD-1 is expressed by T cells in close proximity to the tumor cells. 11 So far, a general limitation studying immune inhibition within the tumor microenvironment, particularly in humans, is the fact that we rely solely on indirect evidence. This is best exemplified for soluble factors such as TGF, which is found to be elevated within the tumor microenvironment of many human tumors including lymphomas. 12,13 It is also well established that T cells isolated from tumor tissue exhibit an anergic phenotype [14][15][16][17] and that such a phenotype can be induced in vitro in normal T cells exposed to inhibitory factors. 14,17,18 However, no direct evidence exists that the anergic phenotype observed in tumor infiltrating T cells is indeed due to exposure to inhibitory cytokines such as TGF, IL10, or PGE 2 . Moreover, there is not even direct evidence that these factors lead to signaling events within tumor-infiltrating T cells in vivo.HL is a very good example for the existing circumstantial evidence. Activated lymphocytes, binucleate RS cells, and mononuclear Hodgkin cells have been described to express activated TGF. 7,13 The expression of TGF as well as the functional phenotype of T cells in HL suggested that this cytokine might be involved in immunosuppression in HL, however, direct evidence is lacking. Other possible mechanisms of immune escape in HL might involve ligands for inhibitory receptors such as PDL-1 on the surface of the neoplastic cells. 11 PD-1 is a receptor of the Ig superfamily that negatively regulates T-cell antigen receptor signaling by interacting with the specific ligands (PDLs) and is suggested to play a role in the maintenance of self-tolerance. [19]...