Prognostic significance of T-cell or cytotoxic molecules phenotype in classical Hodgkin's lymphoma: A clinicopathologic study

Purpose: Classical Hodgkin's lymphoma (CHL) is characterized by Hodgkin's and Reed-Stemberg (H-RS) cells, most of which are derived from germinal-center B cells. Nevertheless, one or more markers for T cells and follicular dendritic cells (FDC) may be expressed in a minority of H-RS cells in some CHL patients, although the clinical significance of this remains controversial. The aim of this study was to clarify the association between phenotypic expression and clinical outcome in CHL. Patients and Methods: Participants were 324 consecutive CHL patients, comprising 132 patients with nodular sclerosis (NS), 35 patients with NS grade 2 (NS2), and 157 patients with mixed cellularity (MC). We evaluated the presenting features and prognosis of patients on categorization into four phenotypically defined groups: B-cell (CD20⁺ and/or CD79a⁺; n = 63), T-cell and/or cytotoxic molecules (CD3⁺, CD4⁺, CD8⁺, CD45RO⁺, TIA-1⁺, and/or granzyme B⁺; n = 27), FDC (CD21⁺ without B-cell marker; n = 22), and null-cell types (n = 212). Other potential prognostic factors were examined. Results: The T-cell and/or cytotoxic molecules group showed a significantly poorer prognosis than the other three groups (P < .0001). This finding was seen consistently in multivariate analyses. Morphologic subtyping (NS/NS2/MC) and Epstein-Barr virus positivity were not identified as independent prognostic factors. Conclusion: The presence of T-cell and/or cytotoxic antigens in H-RS cells may represent a poor prognostic factor in CHL, even if their expression is not regarded as lineage specific. Examination of T-cell and/or cytotoxic molecules phenotype in CHL patients is recommended as a routine pathologic practice.