Abstract
One hundred and twenty seven consecutive and previously untreated patients with Hodgkin's disease (HD) (mean age 47 years) from the Stockholm area admitted to Radiumhemmet, Karolinska Hospital, were studied. The age-matched control group consisted of 167 healthy adults. Incorporation of [14C]-dT was measured on Day 1 in unstimulated monocyte-depleted lymphocyte cultures, and on Day 3 in cultures activated by PWM, ConA and PPD, T and B cells were enumerated by surface markers. The patients had significantly decreased relative and total T-cell counts, and the lymphocyte DNA synthesis induced by mitogens and PPD was severely impaired, whilst the spontaneous DNA synthesis was significantly greater than in controls. At follow-up (mean 4 years) 40 patients have died. Deceased patients showed greater spontaneous lymphocyte activation and less response to mitogen and antigen stimulation than the survivors. The 5-year survival of patients with severe lymphocyte impairment was 20%, compared to 80% for the remainder. The lymphocyte tests added prognostic information to that from clinical staging. Disregarding the lack of knowledge of the mechanisms underlying the lymphocyte impairment, we suggest that these relatively simple immunological tests should be included in the clinical evaluation of HD patients and would guide the choice of therapy.
Highlights
In this study of 127 patients we report a close association between the pretreatment spontaneous and mitogen-induced DNA synthesis and prognosis, whilst other immunological variables gave no prognostic information
In order to pool the results an index (I) was established. For this purpose DNA synthesis of blood lymphocytes was determined by the various methods in 30 healthy 20-35 year old donors (Bjorkholm et al, 1981)
The lymphocyte response to pokeweed mitogen (PWM), concanavalin A (ConA) and purified protein derivative (PPD) was markedly decreased and the spontaneous DNA synthesis was significantly increased in the patient group (Table II)
Summary
All patients except a few over 80 years of age underwent lowerextremity lymphangiography. Fourteen patients with right-sided nodular sclerosis or lymphocyte-predominance HD stages I-II A received irradiation according to the mantle or inverted Y-field techniques. The remaining patients were treated with total nodal irradiation excluding the hepatic and splenic areas. Patients in this treatment group without clinical evidence of splenic involvement were included in a randomized study to evaluate the therapeutic effect of exploratory laparotomy with splenectomy (Askergren et at., 1980). TABLE I.-Distribution of patients according to clinical stage, histopathology and symptoms
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
