Tissue eosinophilia correlates strongly with poor prognosis in nodular sclerosing Hodgkin's disease, allowing for known prognostic factors

Abstract

Although eosinophilic granulocytes are frequently observed in lymphatic tissue of Hodgkin's patients, no substantial data reveal the prognostic role, if any, of tissue eosinophilia. Thus, eosinophilia was analyzed histologically in 1511 diagnostic biopsy specimens of patients treated under protocol therapy of the German Hodgkin's Lymphoma Study Group between 1988 and 1994. Prominent eosinophilia was seen in 38% of cases, which differed among the histologic types of Hodgkin's disease (HD): none in lymphocyte predominant, 14% in lymphocyte rich classical, 40% in nodular sclerosis grade 1 (NS-1), 55% in nodular sclerosis grade 2, 43% in mixed cellularity (MC), and 54% in lymphocyte depleted. In a multivariate analysis, tissue eosinophilia proved to be the strongest prognostic factor for freedom from treatment failure (P < .001) and overall survival (P < .001) in a stage-stratified model. Among NS-1 patients, the effect was highly significant. In MC, no significant effect of eosinophilia on survival could be demonstrated. Eosinophils secrete CD30 ligand that is capable of binding to CD30 positive HD cells. The activation of TRAF2, followed by NF-kappaB, which occurs on CD30L/CD30 binding, may explain the neoplastic proliferation and apoptosis protection of HD cells. TRAF2 is also activated by EBV-LMP expression, which is detectable in the majority of MC but not NS cases. In addition to the possibility that eosinophils are only passive indicators for other unknown prognostic determinants, it may be concluded that the positive clinical outcome of eosinophilia-negative NS cases could be due to lower NF-kappaB activity.

Primary cutaneous CD30+ anaplastic large cell lymphoma with keratoacanthoma‐like pseudocarcinomatous hyperplasia and marked eosinophilia and neutrophilia

“…1,2 Recently, tissue eosinophilia has been showed to correlate strongly with poor prognosis in nodular sclerosing Hodgkin's disease. 14 The prognostic implication of massive eosinophilic infiltration in our patient or other eosinophil-rich CD30 þ ALCL remains to be determined.…”

Clinical and histopathological features of pemphigus foliaceus with and without eosinophilic infiltrates: a retrospective evaluation of 40 dogs

“…The clinical importance of specific tissue cell populations has been investigated as a diagnostic tool, mechanism of pathogenesis and prognostic indicator in humans. [12][13][14][15][16][17][18][19][20][21][22][23][24][25] These studies demonstrate the importance of classifying and quantifying cellular tissue infiltrates. However, to the authors' knowledge, this is the first study to evaluate the cellular infiltrate at different microanatomic locations in canine PF, and to compare different cellular infiltrates with clinical features and outcomes.…”

“…[12][13][14] Eosinophil-predominant Hodgkin's lymphoma is associated with worse treatment results and a poorer prognosis. [15][16][17] The presence of eosinophils and neutrophils within the epidermis may be recognized as the first indication of immunobullous and other inflammatory dermatological disorders in people. 18,19 In addition, analyses of chemotactic cytokines in blister fluid and sera have been correlated with the character of the cellular infiltrate in people with autoimmune blistering diseases.…”

Current status of prognostication in classical Hodgkin lymphoma

“…Although grade II NS cases typically run an aggressive clinical course, there is conflicting data regarding its prognostic significance (Ferry et al, 1993;van Spronsen et al, 1997). The WHO nevertheless recommends that this designation should be noted since it may still be useful from a research perspective for future studies (Swerdlow et al, 2008) Other large-scale studies from the GHSG correlated tissue eosinophilia and atypia of HRS cells with outcome (von Wasielewski et al, 2000(von Wasielewski et al, , 2003; however, this has not gained widespread acceptance. The mixed cellularity subtype (MCCHL) occurs more frequently in resource-poor eastern populations with more frequent abdominal and splenic involvement as well as rather common Epstein-Barr virus (EBV) association (in nearly 70% of cases) in comparison with NSCHL.…”