Tumor cells with tumorigenic potential might be limited to a small population of cells, called cancer-initiating cells (CICs). CICs efficiently form colonies in vitro, yield both CIC and non-CIC populations, maintain reactive oxygen species (ROS) at low levels, show high aldehyde dehydrogenase (ALDH) activity, and are mostly in a quiescent state of the cell cycle. CICs of Hodgkin lymphoma (HL) are small in size, with low levels of ROS. The relationship between ROS level and ALDH activity in CICs was examined in HL cell lines. ROS-low and ALDH-high populations formed colonies in semi-solid cultures more efficiently than ROS-high and ALDH-low populations. ALDH-high populations yielded both ALDH-low and -high populations, whereas ALDH-low populations rarely yielded an ALDH-high population. The number of cells in a quiescent state was significantly greater in ROS-low than in ROS-high cells, whereas that of ALDH-high and ALDH-low cells was comparable to each other. These findings show that ALDH-high and ROS-low cells share CIC-like potential, but they differ in their cell cycle status, suggesting that CICs are comprised of cells with heterogeneous characteristics. . CICs are present in several tumors, such as leukemia, breast, brain, and colon cancers. 1-8 CICs yield both CICs and non-CICs, whereas non-CICs rarely yield CICs. 1,5 CICs efficiently efflux anti-tumor chemicals, form colonies in semi-solid culture, and degrade reactive oxygen species (ROS) that are generated upon radiation-induced apoptosis. [1][2][3][4][5][6][7][8][9] Recent studies have pointed to high aldehyde dehydrogenase (ALDH) activity as a candidate CIC characteristic. [10][11][12][13][14][15][16][17][18][19][20] ALDH oxidizes retinol to retinoic acid in the early stages of stem cell differentiation. 11 High ALDH activity is detected in both physiological stem cells, such as hematopoietic and neural stem cells, 21,22 and CICs of human multiple myeloma, acute myeloid leukemia, and cancers of the lung and breast, 10,[12][13][14][15][16][17] indicating that ALDH activity may be a common marker for both normal and malignant stem cell populations. To date, information on ALDH activity in CICs of malignant lymphomas is extremely limited.The cellular origin of Hodgkin lymphoma (HL) had been controversial; however, recent molecular biology studies have revealed that HL is mostly a neoplasia of B lymphocytes. 23,24 HL can be diagnosed by the presence of multinucleated ReedSternberg (RS) cells and mononuclear Hodgkin cells intermingled with small lymphocytes and various inflammatory cells. They are regarded as pathognomonic for HL and share the expression of some cell markers with Hodgkin cells, such as CD15 and CD30, although the proliferative potential of RS cells was reported to be lower than that of Hodgkin cells. 25 To date, markers that can differentiate Hodgkin cells from RS cells have not been established.We recently reported that HL cell lines, L1236 and L428, were composed of two types of cells: cells with a single nucleus (S) that resemble Hodgk...