Increased infection-related mortality in KIR-ligand-mismatched unrelated allogeneic hematopoietic stem-cell transplantation.
Recently, attention has been focused on the role of killer cell immunoglobulin-like receptor (KIR)-ligand incompatibility between donor and recipient in allogeneic hematopoietic stem-cell transplantation (ASCT). Although KIR-ligand mismatch is clearly associated with improved survival in haploidentical ASCT for acute myeloid leukemia, its role in unrelated human leukocyte antigen-mismatched ASCT is more controversial. Here we present a retrospective analysis of KIR-ligand-matched (n=167) and mismatched (n=23) unrelated ASCTs for hematologic malignancies performed at a single center. We observed that KIR-ligand mismatch was associated with increased transplantation-related mortality (P=0.02), leading to decreased overall survival (P=0.01). The increased transplantation-related mortality was a consequence of a higher rate of infections (P=0.01), whereas incidence of graft-versus-host disease and leukemic relapse did not differ significantly between the two groups. These results suggest that the presence of donor-derived, alloreactive natural killer cells may interfere with immunity to infection in the early posttransplantation period.
Department of Laboratory Medicine, Division of Clinical Immunology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Marie
M
Schaffer
Karl-Johan
KJ
Malmberg
Olle
O
Ringdén
Hans-Gustaf
HG
Ljunggren
Mats
M
Remberger
D000328:Adult; D006086:Graft vs Host Disease / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D007694:Killer Cells, Natural / Q000276:immunology*; D008024:Ligands; D008875:Middle Aged; D009894:Opportunistic Infections / Q000401:mortality*; D011971:Receptors, Immunologic / Q000276:immunology*; D054340:Receptors, KIR; D012189:Retrospective Studies; D014184:Transplantation, Homologous
D008024:Ligands; D011971:Receptors, Immunologic; D054340:Receptors, KIR