Quantity Does Not Matter: Number, Ratio, or Grouping of Hodgkin/Reed–Sternberg Cells Does Not Affect Prognosis in Patients with Classic Hodgkin Lymphoma

Background and Objectives: The prognostic effect of the number of neoplastic cells in classic Hodgkin lymphoma (CHL) regardless of the histological subgroup has not been studied to date. We aimed to evaluate the prognostic impact of the number, ratio, and/or grouping of Hodgkin/Reed–Sternberg (HRS) cells in patients with CHL. Materials and Methods: 135 consecutive adult patients with CHL were included. The number, ratio, and grouping of HRS cells were evaluated on hematoxylin–eosin (HE) and CD30-stained slides. The ratio and group formation were scored. Results: Female:male ratio was 0.82. The median age was 36 ± 15.8 (range: 18–82 years). The number of HRS cells was significantly higher in nodular sclerosis CHL than in mixed-cellularity CHL and lymphocyte-rich CHL. Also, the number of HRS cells was significantly higher in syncytial variant nodular sclerosis CHL (SV-NSCHL). HRS cell ratio was in the range of 6–25% in more than 50% of the cases on both HE- and CD30-stained slides. The number of cases with a group score of 0 (no HRS groups) was significantly higher among men compared to women. HRS cells mostly did not form groups in EBER-positive patients. Confluent/large groups were more common in SV-NSCHL. Response to first-line therapy, gender, and EBER positivity were found to be independent prognostic factors. The number, ratio, and grouping of HRS cells were not associated with OS, stage, recurrence, and/or response to first-line treatment. Conclusions: The number, ratio, and/or grouping of HRS cells do not have any significant prognostic impact on CHL patients, however future studies are required to explore their pathogenetic implications.