Delayed hypersensitivity in Hodgkin's disease: A study of 103 untreated patients

Abstract

Delayed hypersensitivity in Hodgkin's disease was examined in 103 untreated patients in all stages of disease and related to prognosis. No relationship was found between skin test reactivity at the time of diagnosis and survival, frequency of relapses or duration of remission. Skin test reactivity at the onset of Hodgkin's disease is not a useful prognostic sign. Cutaneous anergy was uncommon in these patients; only 11.7 per cent had no reaction to any of the six skin tests applied. No patient with stage I disease was anergic. The incidence of anergy increased with stage but only 26.6 per cent of the patients with stage IV disease were anergic. Mumps antigen and dinitrochlorobenzene (DNCB) were the most likely skin tests to rule out anergy. Skin test reactivity correlates with the absence of systemic symptoms as well as with histologic type. In patients with nodular sclerosis and lymphocyte predominant patterns the incidence of skin test reactivity is higher than in patients with mixed cellularity and lymphocyte-depleted Hodgkin's disease. Absolute peripheral lymphocyte counts were noted to reflect staging and skin test reactivity. The mean absolute lymphocyte counts fell in more advanced stages, and skin test reactivity generally increased as the peripheral lymphocyte count increased. Peripheral lymphocytopenia at the onset of the patient's course, however, did seem to be a bad prognostic sign.