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Background   CD68 + tumor-associated macrophages (TAM) play an important role in the progression of classical Hodgkin lymphoma (cHL). We assessed the role of  CD20  and  CD68  + TAM in a cohort of cHL patients from Egypt and correlated the number of  CD68  + cells with patients’ characteristics, response to treatment, overall and progression free survival rates (OS & PFS).    Methods   CD20  expression and  CD68  + TAM numbers were assessed in representative tumor tissues obtained from 81 cHL patients using flowcytometry (FCM), immunohistochemistry (IHC), and Rt-PCR techniques.    Results  The expression levels of CD68 protein by IHC was high in 27 (33.3%), moderate in 15 (18.5%), low in 15 (18.5%), and negative in 24 (29.6%) patients ( p  = 0.13). CD68-mRNA expression was high in 43/81(53.1%), and low in 38(46.9%) patients ( p  = 0.6). The number of  CD68  + TAM (by FCM) was low (< 20 cells) in 42/81 (51.9%), and high (≥20 cells) in 39/81 (48.1%) patients ( p  = 0.74).  CD68  expression (by FCM, IHC& Rt-PCR) associated significantly with poor response to treatment, decreased  CD20  expression, reduced OS and PFS rates ( p  < 0.001 for all). CD68 expression (by Rt-PCR only) associated significantly with advanced disease stage ( p  = 0.04). The age of the patients, high  CD20  expression & high  CD68+  macrophage number were independent prognostic factors for OS ( p = 0.02,  p  = 0.008 &  p  = 0.009; respectively). However, the age of the patient, high CD20, and high CD68+ macrophage expression (by FCM&IHC) were independent prognostic factors for DFS ( p . = 0.004,  p . = 0.01,  p . = 0.007 and  p . = 0.01; respectively).    Conclusion   CD68  + TAM expression (by Rt-PCR, FCM and/or IHC) can identify patients with poor response to treatment and reduced survival rates (OS& PFS). Assessment of  CD68  + positive macrophages by FCM is superior to other methods (Rt-PCR and IHC) as a prognostic factor for DFS and OS rates.

The role of CD68+ macrophage in classical Hodgkin lymphoma patients from Egypt