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• W2610546974 abstract "TotheEditor:WereadwithinterestthearticleofDinandetal.[1]about the prognostic impact of a high proliferative index (PI) andCD15negativityinpediatricHodgkinlymphoma(HL).Theauthorsshowed that 9.9% of their cases were CD15 negative, associatedwith low OS, high stages (III/IV) and lack of p53 expression,concluding that CD15 negativity in Hodgkin and Reed-Sternbergcells (H-RS) and a PI 74%, are independent unfavorable prog-nostic factors for overall survival (OS) and failure-free survival(FFS), respectively [1]. In adult HL, CD15 prognostic value iscontroversial [2–8]: Only two studies showed clinical impact [2,6],whileseveralothersdidnotshoweffectofCD15ondiseaseoutcome(Table I). We studied 65 children (single center) with classical HL,treated with anthracyclin-based protocols. CD15 negativity wasobserved in 33.8% of the cases and no association with clinicalpresentation or survival (OS, 95% CD15þ and CD15 ; FFS, 82%CD15þ vs. 80% CD15 ) was found. Dinand et al. [1] also foundthat CD15 negativity was associated with p53 negativity(P¼0.009), leading them to suggest that CD15 expression wouldrelatetoH-RScellsurvivalandthat‘‘p53deregulationmighthavearole in the loss of CD15 antigen expression.’’ This statement isdifficult to interpret, since it is accepted that detection, and notabsence of p53 immunoexpression, indicates p53 deregulation [9].Moreover, no information on the percentage of tumor cells ex-pressingp53usedtodefinepositiveandnegativecases(cut-off),wasprovided;theuseofdifferentcut-offcriteriaisarecognizedcauseofthe controversy about the prognostic value of p53 expression indifferent HL studies [10]. Therefore, although statistically con-sistent, the results of Dinand et al. lack a biological modelsupportingtheclinicalobservations.CD15is agroupoffucosylatedmolecules that may function in cell adhesion and regulation ofsignaling cascades, pointing to an activation rather than a survivalrole in H-RS cells [11]. CD15 expression is variable in the differentseries, which may be due either to biological heterogeneity ortechnical issues. Thecontrasting results regardingCD15 prognosticvaluemightrelatetothecharacteristics ofparticularstudies(patientnumber,selectionbias,retrospectivevs.prospective,etc).However,at present, it is not possible to rule out the presence of a diseasepattern characterized by a small number of CD15 negative casesassociatedwithhighclinicalstagesandpoorprognosis,asdescribedbyDinandetal.[1]inchildhoodandbyvonWasielewskietal.[6]inadult HL.The prognostic value of PI is undetermined because of differ-ences in Ki-67 cut-off used in the different studies [3,8,12]. Dinandetal.showedgoodFFSinchildrenwithhighPI[1].Accordingly,wefound a high FFS in children belonging to the unfavorable groups(IIB, IIB, and IV), when Ki-67 was expressed in 51% H-RScells (P¼0.05). HL with high PI may represent a disease moreresponsivetochemotherapy,sincedrugsensitivityisproportionaltothe proliferating cell fraction.The identification of prognostic factors in pediatric HL isrelevant to tailor therapies for the 20–30% of patients who willrelapse. We believe that further research on the prognostic role ofCD15 in pediatric HL is warranted.Ma´rio Henrique M. Barros," @default.
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• W2610546974 date "2008-01-01" @default.
• W2610546974 modified "2023-09-26" @default.
• W2610546974 title "LETTER TO THE EDITOR Prognostic Impact of CD15 Expression and Proliferative Index in the Outcome of Children With Classical Hodgkin Lymphoma" @default.
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