This prospective study recruited 64 CHL patients from 2017 to 2022 at the Faculty of Medicine, Zagazig University Hospital. A biopsy sample was used to detect Epstein Barr nuclear antigen 1 (EBNA-1) and PD-L1, COX-2, and Bcl-xL immunohistochemistry. Patients were followed up every three months during the first two years and then every six months in the following three years. Clinical follow-up included physical examination, CT scan, and PET-CT scan.