Eosinophilia predicts better overall survival after acute graft-versus-host-disease

Abstract

The prognostic significance of eosinophilia after allogeneic hematopoietic SCT (HSCT) and the relationship between eosinophilia and acute GVHD are not well studied. We retrospectively analyzed 201 adult patients who underwent their first allogeneic HSCT. Seventy-three (36%) patients developed eosinophilia within the first 100 days after HSCT. Eosinophilia was observed more frequently among those patients with acute GVHD than those without it (48 vs 25%, P ¼ 0.009). However, it was associated with milder acute GVHD and lower incidence of gut and liver acute GVHD. Among patients with acute GVHD, the 3-year OS for patients with and without eosinophilia was 63.4 and 47.2% (P ¼ 0.02), respectively, and 3-year nonrelapse mortality (NRM) was 20.2 and 37.5% (P ¼ 0.01), respectively. Multivariate analysis confirmed that eosinophilia was associated with a better OS (P ¼ 0.03) and lower NRM (P ¼ 0.046) in patients with acute GVHD, whereas it was not associated with a higher relapse rate (P ¼ 0.45). In contrast, eosinophilia was not associated with outcomes in those patients without acute GVHD. In conclusion, eosinophilia was associated with milder acute GVHD and better prognosis among patients with acute GVHD. The pathophysiology behind eosinophilia after allogeneic HSCT remains to be investigated.

Eosinophilia, Regardless of Degree, is Related to Better Outcomes after Allogeneic Hematopoietic Stem Cell Transplantation

“…To our knowledge, four studies indicate better outcome after allo-HCT if eosinophilia is present (3)(4)(5)(6). Two previous studies reported that eosinophilia after allo-SCT correlated with lower relapse rates (3,5), and three studies showed that eosinophilia after allo-SCT was associated with lower NRM (4)(5)(6).…”

“…The median time of onset of Eo+ was 47 days (range: 21-1,026) after allo-HCT, but eosinophilia tended to occur later after CBT (81.5 days) than after BMT and PBSCT (42 and 43.5 days, respectively) (p=0.05). The median maximum eosinophil count of Eo+ was 1,403×10 6 /L (range: 516-10,010×10 6 ), and there was no difference among those with BMT, PBSCT, or CBT (1,280, 1,210 and 1,740×10 6 , respectively, p=0.47). Of 144 patients, 51 patients (35%) died during the follow-up period and the median follow-up period of survivors was 1,072 days (range: 129-2,737) after the landmark day.…”

“…Better overall survival (OS) in patients with eosinophilia after allo-HCT was shown to be a result of the lower relapse rates (3), lower non-relapse mortality (NRM) (4), and both lower relapse rates and NRM (5). Recently, another study reported that eosinophilia still affected transplant outcomes in the subgroup of patients with acute graft-versus-host disease (GVHD) (6), but no effect was seen in those patients that underwent cord blood transplantation (7). Previous studies reported that activated tissue eosinophils were implicated in the pathogenesis of GVHD (8,9).…”

“…related to better outcomes in allogeneic hematopoietic cell transplantation (allo-HCT) (3)(4)(5)(6). Better overall survival (OS) in patients with eosinophilia after allo-HCT was shown to be a result of the lower relapse rates (3), lower non-relapse mortality (NRM) (4), and both lower relapse rates and NRM (5).…”

Non-atopic IgE and eosinophil cationic protein after allogeneic hematopoietic stem cell transplantation in children

“…Although elevated eosinophil counts have been reported in adults with chronic GvHD, no correlation with outcome could be shown [4]. However, in adults with acute GvHD after HSCT, elevated eosinophils were associated with a better overall survival [19]. Frankovich et al [12] have reported an association of asthma and atopic history and non-infectious pulmonary complications after autologous HSCT in pediatric Hodgkin patients [11].…”