TY - JOUR
T1 - KIR-ligand incompatibility in the graft-versus-host direction improves outcomes after umbilical cord blood transplantation for acute leukemia
AU - Willemze, R.
AU - Rodrigues, C. A.
AU - Labopin, M.
AU - Sanz, G.
AU - Michel, G.
AU - Socié, G.
AU - Rio, B.
AU - Sirvent, A.
AU - Renaud, M.
AU - Madero, L.
AU - Mohty, M.
AU - Ferra, C.
AU - Garnier, F.
AU - Loiseau, P.
AU - Garcia, J.
AU - Lecchi, L.
AU - Kögler, G.
AU - Beguin, Y.
AU - Navarrete, C.
AU - Devos, T.
AU - Ionescu, I.
AU - Boudjedir, K.
AU - Herr, A. L.
AU - Gluckman, E.
AU - Rocha, V.
PY - 2009
Y1 - 2009
N2 - Donor killer cell immunoglobulin-like receptor (KIR)-ligand incompatibility is associated with decreased relapse incidence (RI) and improved leukemia-free survival (LFS) after haploidentical and HLA-mismatched unrelated hematopoietic stem cell transplantation. We assessed outcomes of 218 patients with acute myeloid leukemia (AML n = 94) or acute lymphoblastic leukemia (n = 124) in complete remission (CR) who had received a single-unit unrelated cord blood transplant (UCBT) from a KIR-ligand-compatible or -incompatible donor. Grafts were HLA-A, -B or -DRB1 matched (n = 21) or mismatched (n = 197). Patients and donors were categorized according to their degree of KIR-ligand compatibility in the graft-versus-host direction by determining whether or not they expressed HLA-C group 1 or 2, HLA-Bw4 or HLA-A3/-A11. Both HLA-C/-B KIR-ligand- and HLA-A-A3/-A11 KIR-ligand-incompatible UCBT showed a trend to improved LFS (P = 0.09 and P = 0.13, respectively). Sixty-nine donor-patient pairs were HLA-A, -B or -C KIR-ligand incompatible and 149 compatible. KIR-ligand-incompatible UCBT showed improved LFS (hazards ratio = 2.05, P = 0.0016) and overall survival (OS) (hazards ratio = 2.0, P = 0.004) and decreased RI (hazards ratio = 0.53, P = 0.05). These results were more evident for AML transplant recipients (2-year LFS and RI with or without KIR-ligand incompatibility 73 versus 38% (P = 0.012), and 5 versus 36% (P = 0.005), respectively). UCBT for acute leukemia in CR from KIR-ligand-incompatible donors is associated with decreased RI and improved LFS and OS.
AB - Donor killer cell immunoglobulin-like receptor (KIR)-ligand incompatibility is associated with decreased relapse incidence (RI) and improved leukemia-free survival (LFS) after haploidentical and HLA-mismatched unrelated hematopoietic stem cell transplantation. We assessed outcomes of 218 patients with acute myeloid leukemia (AML n = 94) or acute lymphoblastic leukemia (n = 124) in complete remission (CR) who had received a single-unit unrelated cord blood transplant (UCBT) from a KIR-ligand-compatible or -incompatible donor. Grafts were HLA-A, -B or -DRB1 matched (n = 21) or mismatched (n = 197). Patients and donors were categorized according to their degree of KIR-ligand compatibility in the graft-versus-host direction by determining whether or not they expressed HLA-C group 1 or 2, HLA-Bw4 or HLA-A3/-A11. Both HLA-C/-B KIR-ligand- and HLA-A-A3/-A11 KIR-ligand-incompatible UCBT showed a trend to improved LFS (P = 0.09 and P = 0.13, respectively). Sixty-nine donor-patient pairs were HLA-A, -B or -C KIR-ligand incompatible and 149 compatible. KIR-ligand-incompatible UCBT showed improved LFS (hazards ratio = 2.05, P = 0.0016) and overall survival (OS) (hazards ratio = 2.0, P = 0.004) and decreased RI (hazards ratio = 0.53, P = 0.05). These results were more evident for AML transplant recipients (2-year LFS and RI with or without KIR-ligand incompatibility 73 versus 38% (P = 0.012), and 5 versus 36% (P = 0.005), respectively). UCBT for acute leukemia in CR from KIR-ligand-incompatible donors is associated with decreased RI and improved LFS and OS.
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U2 - 10.1038/leu.2008.365
DO - 10.1038/leu.2008.365
M3 - Article
C2 - 19151783
AN - SCOPUS:62549084678
VL - 23
SP - 492
EP - 500
JO - Leukemia
JF - Leukemia
SN - 0887-6924
IS - 3
ER -