Journal Scan / Research · April 20, 2022 Leukocyte Adhesion and Rolling in Skin With Patient Outcomes After Hematopoietic Cell Transplantation Using Noninvasive Reflectance Confocal Videomicroscopy JAMA Dermatology

TAKE-HOME MESSAGE

• In this prospective single-center cohort study, patients with a history of hematopoietic cell transplantation (HCT) for hematologic cancer underwent noninvasive skin videomicroscopy to quantify leukocyte-endothelial interactions and determine their association with relapse, relapse-free survival, and overall survival. The adherent and rolling leukocytes per hour were able to better predict relapse and survival than the revised Disease Risk Index.

• A new method of quantifying leukocyte-endothelial interactions provides more accurate prognostic information than the current best-prediction models for patients with a history of HCT.

–  Joshua R. Ortego, MD

Abstract 

IMPORTANCE

Hematopoietic cell transplantation (HCT) is a potential cure for hematologic cancer but is associated with a risk of relapse and death. Dynamic biomarkers to predict relapse and inform treatment decisions after HCT are a major unmet clinical need.

OBJECTIVE

To identify a quantitative characteristic of leukocyte-endothelial interactions after HCT and test its associations with patient outcomes.

DESIGN, SETTING, AND PARTICIPANTS

In this prospective single-center cohort study from June 2017 to January 2020, patients of any age, sex, race, and ethnicity who had HCT for hematologic cancer were referred by health care professionals as either suspected of having symptoms or not having symptoms of acute graft-vs-host disease between 25 and 161 days after HCT. Patients underwent noninvasive skin videomicroscopy. Videos of dermal microvascular flow were recorded with a reflectance confocal microscope. Two blinded observers (J.R.P. and Z.Z.) counted leukocytes adherent to and rolling along the vessel wall per hour (A&R). Of 57 enrolled patients, 1 relapsed before imaging and was excluded, resulting in 56 patients included in analyses.

MAIN OUTCOMES AND MEASURES

Relapse of cancer, relapse-free survival, and overall survival.

RESULTS

Among the 56 patients (median age, 59 years; 38 [68%] male) who underwent imaging a median of 40 days after HCT, 21 had high A&R and 35 had low A&R. After correcting for the revised Disease Risk Index, patients with high A&R had higher rates of relapse (hazard ratio [HR], 4.24; 95% CI, 1.32-13.58; P = .02), reduced relapse-free survival (HR, 3.29; 95% CI, 1.26-8.55; P = .02), and reduced overall survival (HR, 3.06, 95% CI, 1.02-9.19; P = .05). These associations were preserved after correcting for possible confounders, steroid treatment, and acute graft-vs-host disease status. In the prognostic adequacy calculation by using Cox models, the new imaging biomarker (A&R) accounted for 82% to 95% of the prognostic information to predict each outcome. By contrast, the best existing clinical predictor routinely available, the revised Disease Risk Index, accounted for 10% to 28% of the prognostic information in the same model.

CONCLUSIONS AND RELEVANCE

In this cohort study, leukocyte-endothelial interactions, visualized directly in skin after HCT, were associated with the patient outcomes of relapse, relapse-free survival, and overall survival. Assessing this dynamic marker could help patients at high risk for relapse who may benefit from interventions, such as early withdrawal of immunosuppression.

JAMA Dermatology

Association of Leukocyte Adhesion and Rolling in Skin With Patient Outcomes After Hematopoietic Cell Transplantation Using Noninvasive Reflectance Confocal Videomicroscopy

JAMA Dermatol 2022 Mar 26;[EPub Ahead of Print], I Saknite, JR Patrinely, Z Zhao, H Chen, A Beeghly-Fadiel, TK Kim, M Jagasia, M Byrne, ER Tkaczyk 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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