Early phase peripheral blood eosinophilia predicts lower overall and non-relapse mortality after single-unit cord blood transplantation

Abstract Background Peripheral blood eosinophilia has been associated with the development of graft-versus-host disease (GVHD) and survival after allogeneic hematopoietic cell transplantation (HCT). However, the impacts of eosinophilia on cord blood transplantation (CBT) outcomes remain unclear. Objectives To examine the associations between eosinophilia and overall survival, relapse incidence, non-relapse mortality, and acute and chronic GVHD after single-unit CBT for adults. Study Design We retrospectively analyzed the data for 225 adult patients who received single-unit CBT at our institute between March 2004 and March 2020. Results The cumulative incidence of eosinophilia, defined as an absolute eosinophil count of ≥500 ×  106/L in peripheral blood, was 48.9% (95% confidence interval: 42.2–55.2%) at 60 days after CBT. Recipient cytomegalovirus seronegative status and higher cryopreserved cord blood CD34+ cell dose were significantly associated with a higher incidence of eosinophilia after CBT. Among patients who achieved neutrophil recovery, neutrophil recovery was significantly earlier in patient with eosinophilia compared to those without eosinophilia (P = 0.016). Serum levels of interleukin-5 at 4 weeks were significantly higher in patients with eosinophilia compared with those without eosinophilia (P = 0.041). Multivariate analysis, in which the development of eosinophilia was treated as a time-dependent covariate, showed that eosinophilia was significantly associated with lower overall mortality (hazard ratio [HR]: 0.58; P = 0.034) and non-relapse mortality (HR: 0.41; P = 0.029), but not relapse incidence or development of acute or chronic GVHD. Conclusions Our data suggested that early phase eosinophilia is a predictor of favorable outcomes in adult patients undergoing single-unit CBT.