BACKGROUND: Despite advances in treatments for Hodgkin's lymphoma, about 20% of patients still die from progressive disease. Current prognostic models predict the outcome of treatment with imperfect accuracy, and clinically relevant biomarkers have not been established to improve on the International Prognostic Score. METHODS: Using gene-expression profiling, we analyzed 130 frozen samples obtained from patients with classic Hodgkin's lymphoma during diagnostic lymph-node biopsy to determine which cellular signatures were correlated with treatment outcome. We confirmed our findings in an independent cohort of 166 patients, using immunohistochemical analysis. RESULTS: Gene-expression profiling identified a gene signature of tumor-associated macrophages that was significantly associated with primary treatment failure (P=0.02). In an independent cohort of patients, we found that an increased number of CD68+ macrophages was correlated with a shortened progression-free survival (P=0.03) and with an increased likelihood of relapse after autologous hematopoietic stem-cell transplantation (P=0.008), resulting in shortened disease-specific survival (P=0.003). In multivariate analysis, this adverse prognostic factor outperformed the International Prognostic Score for disease-specific survival (P=0.003 vs. P=0.03). The absence of an elevated number of CD68+ cells in patients with limited-stage disease defined a subgroup of patients with a long-term disease-specific survival of 100% with the use of current treatment strategies. CONCLUSIONS: An increased number of tumor-associated macrophages was strongly associated with shortened survival in patients with classic Hodgkin's lymphoma and provides a new biomarker for risk stratification. 2010 Massachusetts Medical Society

 

                                                           

 

in questo articolo uscito sul New England Journal of Medicine  di marzo 2010 si dimostra come  nei pazienti in cui il tessuto tumorale contiene una  alta percentuale di macrofagi ( le  cellule  che digeriscono i detriti cellulari)  CD68+ hanno una maggior probabilita' di recidiva e la tendenza ad una sopravvivenza minore

per questi pazienti  occorre percio'  una terapia  piu' personalizzata , per garantire loro le stesse chances degli altri  pazienti

 

Certo che se ne ha fatta di strada da quando  Thomas Hodgkin descrisse la malattia nel 1832 !