Apoptotic index as a prognostic factor in Hodgkin's disease

Hodgkin's disease (HD) is an unusual malignant neoplasm, mainly because of the rarity of tumor cells in the diseased tissues, but also due to a relati vely favorable response to treatment. In a previous study, we have shown a variable degree of apoptosis in lymph nodes from HD patients. We now looked for clinicopathological correlations of apoptosis with special emphasis on the prognosis in this disease. A retrospective study of 92 patients was ca rried out, using in situ end labelling of DNA fragments and an apoptosis de fection kit. An apoptotic index (Al) was calculated in each case, as the pe rcentage of apoptotic Hodgkin-Reed-Sternberg cells out of the total number of tumor cells in 10 selected high power fields. An association between a h igh Al and advanced stages was noted. A Kaplan-Meier analysis showed a nega tive correlation between Al and survival (p=0.05). In a multivariable analy sis adjusting for Ann Arbor stage, a high Al carried a 3.27 fold risk of dy ing of HD (OR=3.27; Cl=0.89-11.94). However, in our limited cohort of HD pa tients, Al was not an independent prognostic factor. The results of this st udy confirm the important role played by apoptosis in Hb and suggest that t he apoptotic index is probably a negative prognostic marker in this disease . Its assessment in patients with HD may provide a new, important clinical tool.