Pathologic and clinical features of 77 Hodgkin's lymphoma patients treatedin a lymphoma protocol (LNH87) - A GELA study

Between 1987 and 1993, 77 of 2855 lymphomas included in the LNH87 protocol of the GELA as non-Hodgkin lymphoma (NHL) and reviewed by a panel of pathol ogists had a diagnosis changed to Hodgkin lymphoma (HL). Some of these lymp homas had been initially interpreted as anaplastic large-cell lymphoma Hodg kin-like (ALCL-HL subtype). The purpose of this study was to analyze the hi stologic pitfalls initially encountered, to define more clearly the diagnos tic criteria of lymphomas placed in the gray zone around HL, and to follow the survival of these 77 patients affected with HL and initially treated wi th NHL regimens. The 77 cases of HL were reviewed by three hematopathologis ts and immunostained with a large panel of antibodies, including CD30, CD15 , CD3, CD20, CD45, CD43, LMP-1, EMA, BNH-9, TiA1, and ALK1. Each case was c lassified according to the Lukes-Rye system and the British National Lympho ma Investigation (BNLI) grading. The initial clinical presentation of patie nts was analyzed, and the overall and event-free survival rates of the 77 p atients were estimated. Among the 77 HLs, 46 were misinterpreted as NHL by primary individual pathologists (12 as ALCL, 8 as ALC-LHL, 12 as peripheral T-cell lymphoma (PTCL), 6 as B-cell lymphoma, and 8 as unclassifiable NHL) . The other 31 cases had been first considered by the panel as consistent w ith ALCL-HL (n = 18) or with PTCL(n = 13) and were changed later in view of an immunophenotype concordant with HL. Fifty-five percent of the patients completed the full NHL treatment. The 5-year event-free and overall surviva l rates were 54% and 77%, respectively. The current results indicate that l ymphomas initially called ALCL-HL should not be regarded as a variant of AL CL, but as HL. The clinical consequences of misdiagnoses seem to be a lower event-free survival rate compared with that of classical HL, probably beca use of more relapses of initially inappropriately treated HL.