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Despite its well known histological and clinical features, Hodgkin's lymphoma (HL) has recently been the object of intense research activity, leading to a better understanding of its phenotype, molecular characteristics, histogenesis, and possible mechanisms of lymphomagenesis. There is complete consensus on the B cell derivation of the tumour in most cases, and on the relevance of Epstein-Barr virus infection and defective cytokinesis in at least a proportion of patients. The REAL/WHO classification recognises a basic distinction between lymphocyte predominance HL (LP-HL) and classic HL (CHL), reflecting the differences in clinical presentation and behaviour, morphology, phenotype, and molecular features. CHL has been classified into four subtypes: lymphocyte rich, nodular sclerosing, with mixed cellularity, and lymphocyte depleted. The borders between CHL and anaplastic large cell lymphoma have become sharper, whereas those between LP-HL and T cell rich B cell lymphoma remain ill defined. Treatments adjusted to the pathobiological characteristics of the tumour in at risk patients have been proposed and are on the way to being applied.

AimTo assess a newly developed immunohistochemical detection system, the EnVision^TM+.MethodsA large series of differently processed normal and pathological samples and 53 relevant monoclonal antibodies were chosen. A chessboard titration assay was used to compare the results provided by the EnVision^TM+ system with those of the APAAP, CSA, LSAB, SABC, and ChemMate^TM methods, when applied either manually or in a TechMate 500 immunostainer.ResultsWith the vast majority of the antibodies, EnVision^TM+ allowed two- to fivefold higher dilutions than the APAAP, LSAB, SABC, and ChemMateTM techniques, the staining intensity and percentage of expected positive cells being the same. With some critical antibodies (such as the anti-CD5), it turned out to be superior in that it achieved consistently reproducible results with differently fixed or overfixed samples. Only the CSA method, which includes tyramide based enhancement, allowed the same dilutions as the EnVision^TM+ system, and in one instance (with the anti-cyclin D1 antibody) represented the gold standard.ConclusionsThe EnVision^TM+ is an easy to use system, which avoids the possibility of disturbing endogenous biotin and lowers the cost per test by increasing the dilutions of the primary antibodies. Being a two step procedure, it reduces both the assay time and the workload.

Prognosis for PTCL patients is poor; the 5-year overall survival rate ranges from 25 to 40%. Despite variable CD52 expression in T-cell malignancies, promising results have been demonstrated with alemtuzumab (Campath ®). We report preliminary results of standard CHOP therapy plus alemtuzumab (CHOP-C) in a cohort of untreated PTCL patients (pts). Beginning Jan 03, 25 consecutive PTCL pts were treated with 8 courses of CHOP. In the first cohort, 4 pts received alemtuzumab 30 mg. sc 1 day prior to the first 4 courses of CHOP, whereas in cohort 2 (N=21) alemtuzumab 30 mg was given one day prior to all 8 CHOP courses administered. The histopathology was centrally reviewed and included 16 patients with PTCL-U, 6 patients with AILD-T, and 3 patients with ALCL Alk. CD52 expression was checked by immunohistochemisty on paraffin-embedded material. Median age of patients was 51.2 years (range: 28–69), 22 (88%) were stage III–IV, 3 (12%) had bulky disease, 11 (44%) had bone marrow involvement, and 13 (52%) had high LDH values. The age-adjusted IPI values were 0 in 5 pts, 1 in 8 pts, 2 in 9 pts, and 3 in 3 pts. All 25 pts completed therapy. Results: at a mean follow-up of 436 days (range:105–1124) 14/25 pts. are still alive and 11/25 have died, mostly of progressive disease (10/11). 17/25 pts achieved CR, 1 PR and 1 minimal response (MR); 6 pts. progressed. Of these 6 pts, 1 pt achieved a PR, and 1 pt in MR and 2 pts in CR died despite salvage treatment; one patient died +198 d. in CR due to pneumonia. Three pts relapsed +62, +119 and +145 days after achieving a CR. The mean duration of response was 273 days. The 2-year OS and FFS (Failure Free Survival) were 45% and 50% days, respectively (Figure). CD52 expression was available for 16 of 25 pts. Of 11 pts who progressed on, or relapsed after therapy, CD52 was positive in 5, negative in 2 and not available for 4 pts. Among the 14 responding pts, 7 were positive, 2 negative, and not available in 5. Conclusions: CHOP-C seems to be a feasible chemoimmunotherapy regimen: the efficacy of this therapy seems fairly good with a CR rate of 68%; however 6/25 pts showed disease progression during therapy, most frequently after the third C-CHOP course. Although most pts were positive for CD52 expression (12/16), no relationship between CD52 expression and treatment outcome was identified. Failure free survival (25 pts.) Failure free survival (25 pts.)

Prognosis for PTCL patients is poor; the 5-year overall survival rate ranges from 25 to 40%. Despite variable CD52 expression in T-cell malignancies, promising results have been demonstrated with alemtuzumab (Campath ®). We report preliminary results of standard CHOP therapy plus alemtuzumab (CHOP-C) in a cohort of untreated PTCL patients (pts). Beginning Jan 03, 25 consecutive PTCL pts were treated with 8 courses of CHOP. In the first cohort, 4 pts received alemtuzumab 30 mg. sc 1 day prior to the first 4 courses of CHOP, whereas in cohort 2 (N=21) alemtuzumab 30 mg was given one day prior to all 8 CHOP courses administered. The histopathology was centrally reviewed and included 16 patients with PTCL-U, 6 patients with AILD-T, and 3 patients with ALCL Alk. CD52 expression was checked by immunohistochemisty on paraffin-embedded material. Median age of patients was 51.2 years (range: 28–69), 22 (88%) were stage III–IV, 3 (12%) had bulky disease, 11 (44%) had bone marrow involvement, and 13 (52%) had high LDH values. The age-adjusted IPI values were 0 in 5 pts, 1 in 8 pts, 2 in 9 pts, and 3 in 3 pts. All 25 pts completed therapy.