Optimizing assessment of CD30 expression in Hodgkin lymphoma by controlling for low expression

Since the approval of brentuximab vedotin (BV), assessment of CD30 status by immunohisto-chemistry gained increasing importance in the clinical management of pat i ent s di agnosed wi t h CD30-expressing lymphomas, including classical Hodgkin lymphoma (CHL). Paradoxically, patients with low or no CD30 expression respond to BV. This discrepancy may be due to lack of standardization in CD30 staining methods. In this study, we examined 29 cases of CHL and 4 cases of nodul ar l ymphocyt e-pr edomi nant Hodgkin lymphoma (NLPHL) for CD30 expression using a staining protocol that was designed to detect low CD30 expression levels, and an evaluation system similar to the Allred scoring system used for breast cancer evaluation. For CHL, 10% of cases had low scores and 3% were CD30 negative, with 3 cases in which the majority of tumor cells showed very weak staining. Unexpectedly, one of four cases of NLPHL was positive. We demonstrate intra-patient heterogeneity in CD30 expression levels and staining patterns in tumor cells. Three CHL cases with weak staining may have been missed without the use of control tissue for low expression. Thus, standardization of CD30 immuno-hi st ochemi cal st ai ni ng wi t h use of known l ow-expressing controls may aid in proper CD30 assessment and subsequent therapeutic stratification of patients.