Reed–Sternberg (RS) cells are the hallmark malignant cells diagnostic of classical Hodgkin lymphoma (CHL).
Key Characteristics for BCOP Preparation:
- Morphology: They are distinguished by their large size and a classic binucleated structure. Under a microscope, their bilobed nucleus typically provides a characteristic “owl’s eyes” appearance.
- Cell of Origin: These cells are derived from monoclonal pre-apoptotic germinal center B-lymphocytes.
- Immunophenotype: In CHL, these cells consistently express CD30 and CD15 but are CD45 negative. While they are B-cell in origin, only 10–20% express standard B-cell markers like CD19, CD20, or CD79a.
- Genetics and Susceptibility: Reed–Sternberg cells overexpress PD-L1 ligands in 65–100% of cases due to amplification of chromosome 9p24.1. This susceptibility makes the disease highly responsive to checkpoint inhibitors like nivolumab and pembrolizumab in the relapsed setting.
- Viral Association: Approximately 20–40% of Reed–Sternberg cells contain the Epstein-Barr virus (EBV) genome.
Clinical Distinction:
It is critical for pharmacists to note that Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) lacks Reed–Sternberg cells. Instead, it is characterized by “popcorn cells” which are usually CD20 positive and CD30 negative, explaining why NLPHL is treated with rituximab and cannot be treated with brentuximab vedotin.
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