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Inclusion criteria were 1) children up to the age of 18 years, 2) proven diagnosis of primary cHL. We collected 73 samples of children diagnosed with classical Hodgkin lymphoma (cHL) between 20. We performed this retrospective, explorative study at the Erasmus Medical Center-Sophia Children’s Hospital (Erasmus MC-Sophia) in Rotterdam, the Netherlands. CD15, CD30 and PAX5 were chosen to confirm diagnosis of cHL, and the level of expression of these markers was analyzed as prognostic marker since there are some studies which found an association of this expression with survival ( 6, 9, 10). TARC was chosen based on the prognostic impact in blood samples in both adult and pediatric studies ( 11, 18, 19). PD-1, PD-L1, CD68 and CD163 have previously been analyzed in pediatric studies and show conflicting outcomes ( 8– 10, 12).
Therefore, we investigated the prognostic value of eight different immunohistochemical markers in pediatric cHL. So, it is uncertain whether outcomes of studies in adults with cHL are applicable to children with cHL. Previous studies have shown differences in TME composition, PD-L1 expression, and the role of Epstein Barr Virus (EBV) between pediatric and adult cHL patients ( 12, 14– 17).
However, most studies have been performed in adult patients, and studies based on pediatric populations are scarce and inconsistent ( 8– 10, 12). Multiple studies have demonstrated that the presence of certain immune cell types and immunohistochemical markers in the TME and on HRS cells is associated with treatment outcome ( 4– 13). Furthermore, these markers could be new treatment targets. These variations may be used to identify prognostic markers in pediatric patients to develop risk-adapted treatment strategies, leading to better outcome and less treatment-related toxicities ( 1, 2). There is a strong variation among individual patients in the frequency and distribution of HRS cells and the cells of the TME ( 3). These cells produce different cytokines and chemokines, maintaining a specific tumor microenvironment (TME) in which the HRS cells can thrive ( 1, 2).
This underlines the importance of future research into specific prognostic factors in pediatric cHL, indispensable for improvement of treatment in this population.Ĭlassical Hodgkin lymphoma (cHL) contains a notably small amount of 0.1%–10% malignant Hodgkin and Reed-Sternberg (HRS) cells, surrounded by benign inflammatory cells. Our data suggest a difference between pediatric and adult cHL. Low expression of PD-L1 was associated with complete remission at interim PET-scan. Low CD15 and low TARC expression were associated with relapsed disease.
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We investigated in 67 children with cHL, whether the expression of CD15, CD30, PAX5, PD-1, PD-L1, CD68, CD163 and TARC at diagnosis is associated with disease free survival (DFS) and with interim remission status. Studies in children are scarce and inconsistent. Immunohistochemical markers are associated with treatment outcome in adults with classical Hodgkin Lymphoma (cHL). 3Department of Pathology, Erasmus Medical Center, Rotterdam, Netherlands.2Department of Pediatric Hematology and Oncology, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands.1Department of Hemato-Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.Zijtregtop 1,2 †, Ilse Tromp 2 †, Rana Dandis 1, Christian M.