KIR-ligand incompatibility in the graft-versus-host direction improves outcomes after umbilical cord blood transplantation for acute leukemia

R. Willemze, C. A. Rodrigues, M. Labopin, G. Sanz, G. Michel, G. Socié, B. Rio, A. Sirvent, M. Renaud, L. Madero, M. Mohty, C. Ferra, F. Garnier, P. Loiseau, J. Garcia, L. Lecchi, G. Kögler, Y. Beguin, C. Navarrete, T. DevosI. Ionescu, K. Boudjedir, A. L. Herr, E. Gluckman, V. Rocha

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Abstract

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.

Original languageEnglish
Pages (from-to)492-500
Number of pages9
JournalLeukemia
Volume23
Issue number3
DOIs
Publication statusPublished - 2009

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ASJC Scopus subject areas

  • Hematology
  • Cancer Research
  • Anesthesiology and Pain Medicine

Cite this

Willemze, R., Rodrigues, C. A., Labopin, M., Sanz, G., Michel, G., Socié, G., Rio, B., Sirvent, A., Renaud, M., Madero, L., Mohty, M., Ferra, C., Garnier, F., Loiseau, P., Garcia, J., Lecchi, L., Kögler, G., Beguin, Y., Navarrete, C., ... Rocha, V. (2009). KIR-ligand incompatibility in the graft-versus-host direction improves outcomes after umbilical cord blood transplantation for acute leukemia. Leukemia, 23(3), 492-500. https://doi.org/10.1038/leu.2008.365