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. (Blood. 2000;95:1207-1213)