Lymphocyte abnormalities predicting a poor prognosis in Hodgkin's disease. A long-term follow-up

Abstract

Two hundred sixty-two adult patients with Hodgkin's disease (HD) were studied. Incorporation of carbon-14-thymidine was measured in unstimulated monocyte-depleted lymphocyte cultures, and in cultures activated by concanavalin A (Con-A) before institution of therapy in all patients. Total blood lymphocytes and T-cell subsets were enumerated in the last 108 patients. Patients had significantly decreased total (CD3+, CD4+, CD8+) and relative (CD3+, CD4+) T-cell counts compared with healthy controls. Stage IV patients tended to have lower total lymphocyte and subset counts than remaining patients. However, significantly reduced total lymphocyte and CD8+ counts were only observed in comparison to patients in clinical stage II. Thirty-three percent of patients had an increased spontaneous and a decreased Con-A-induced blood lymphocyte DNA synthesis. Functional lymphocyte abnormalities were related to advanced clinical stage, high age, mixed cellularity, and lymphocyte depletion histopathology and presence of B symptoms. The 10-year survival of patients in this group was 36%, compared with 62% for the remainder. In a multivariate analysis of the whole series lymphocyte DNA synthesis was besides age the strongest predictor of prognosis. In univariate analyses of the second patient series total lymphocyte, T-cell and subset counts were related to prognosis. These relatively simple lymphocyte functional tests may help to identify young HD patients for whom intensive cytoreductive therapy with or without autologous stem cell support may be the best therapeutic option.

Patients above Sixty Years Lymphoma Treated with a New Strategy of Age with Hodgkin's

“…Opportunistic infections, however, also occurred in periods when the patients were not neutropenic. Since elderly HL patients have an even more pronounced immune de ciency (28) than young patients, they might also bene t from prophylactic antibiotics. Since virtually all patients received the highest dose level up-front, doctors treating lymphoma had either no con dence in starting with a lower dose, or they overestimated the ability of their patients to tolerate the treatment.…”

“…High levels of TNF are also seen in patients with HL (27). The immune de ciency described in HL patients (28) combined with the myelosuppression caused by TNF might be extra deleterious in elderly HL patients. None of the patients in the present study received G-CSF.…”

HIV-associated Hodgkin lymphoma during the first months on combination antiretroviral therapy

“…Changes within individuals have not been evaluated to corroborate the shift reported from a low CD4/CD8 ratio to total lymphocytopenia during the 1-2 years before HL diagnosis. 8 HL in the general population that is unrelated to HIV is associated with elevated circulating levels of immunoregulatory T cells, [24][25][26] as well as with T-cell and total lymphopenia, 27 perhaps the result of chemoattraction of T cells from the blood to tumorassociated malignant Hodgkin/Reed-Sternberg cells. [28][29][30] Chemokines CCL22 and especially CCL17 have been specifically implicated, 28,29,31 but other chemokines may also be involved.…”

Epstein–Barr virus expression in Hodgkin’s disease in relation to patient characteristics, serum factors and blood lymphocyte function

“…Peripheral blood lymphocytes (PBL) were assayed for spontaneous and concanavallin A (Con A) induced DNA synthesis as previously described (Tullgren et al, 1991). Patients with an increased spontaneous (> mean of controls + 1 s.d.)…”

“…(Table 1) Ninety-five patients, diagnosed during 1974-1991 in Stockholm as having HD, were included in the study, since they had previously EpsteinÐBarr virus expression in HodgkinÕs disease in relation to patient characteristics, serum factors and blood lymphocyte function been tested for blood lymphocyte function and various soluble serum markers (Björkholm et al, 1978;Tullgren et al, 1991;Grimfors et al, 1992;Merk et al, 1992;Axdorph et al, 1995). Three patients were discordant with regard to LMP-1 and EBER expression and were excluded from further analysis; thus 92 patients remained.…”