De Novo Skin Xerosis in Cord Blood Transplantation is Associated with Distinct Histopathology and Treatment Response: First Literature Report of Cord Dermatosis

Abstract

overall survival (OS) compared to unrelated donors (UD) in patients with high-risk acute leukemia (AL) and residual disease prior to HCT. Patients and Methods: We present a retrospective casecontrolled study of first alloHCT for high-risk AL by the Spanish HCT Group. Ninety-four recipients of HCT with single CB units plus CD34+ selected cells from third-party donors (Haplo-Cord, HC), where compared (1:2) with 188 recipients of UD HCT matched for age, gender, WHO diagnosis, disease status at HCT, time from diagnosis to HCT, prior auto-HCT, TBI use in conditioning and year of HCT. HC cases included 57 men (61%), median age 34 years (16-64), 51 AML and 43 ALL, 49 in first CR, 16 in CR2 and 29 more advanced, including 23 with detectable disease. Six had a prior autologous HCT. Median time from diagnosis to alloHCT was 8.3 months (2-66). Results: With a median follow-up of 85 months for survivors, 113 patients were alive, 44 in the HC group (47%) and 79 controls (42%; n.s.). NRM at 6 years (y) was comparable in both groups: HC 33.0% (95CI: 24.7-44.0) vs controls 34.4% (95CI: 28.1-42.0; n.s.). Overall, HC had a statistical trend towards a better OS than controls at 6 y (47.7%, 95CI: 37.6-57.8, vs 37.0%, 95CI: 29.9-44.0; P = .079), which may associate with their cumulative incidence of relapse (24.5%, 95CI: 17.2-34.9, vs 30.7%, 95CI: 24.7-38.2; P = .135). Next, we performed the analysis in patient subsets stratified according to their risk of relapse. In patients with low risk of relapse transplanted in CR1 or CR2 there were no differences in outcomes between HC and matched UD controls. However, patients that underwent alloHCT in more advanced disease (AD, CR3 or later, partial remission or refractory disease), had significantly better outcomes following HC HCT. OS rate at 6 y in patients with AD in the HC group was 31,0% (CI 14.2-47.9) vs 13.0% (CI 3.3-22.8) in UD group (P = .046). PFS rate at 6 y in patients with AD disease in the HC group was 24.1% (CI 8.6-39.7) vs 13.0% in UD group (P = .046). Relapse rate at 6 y in patients with AD in the HC group was 37.9% ) vs 47.8% ) in the UD group (P = .069). Conclusions: With the increase availability and use of alternative donors for alloHCT, data to inform donor choice are needed. It is unlikely that any single type of alternative donor will be the best choice for all patients lacking a matched related donor. Our data with HC HCT, in line with recent findings by Milano et al, contribute to the evidence to suggest that unrelated CB might be a preferable donor choice for patients with AL and a high-risk of relapse.