Reduced risk for molecular disease in patients with chronic myeloid leukemia after transplantation from a KIR-mismatched donor.
BACKGROUND
To examine how killer-cell immunoglobulin-like receptor (KIR) ligand incompatibilities effect molecular relapse (MR), we compared the occurrence of bcr-abl-positive reverse-transcriptase polymerase chain reaction (RT-PCR) results in 236 CML patients (pts) after human leukocyte antigen (HLA)-identical (n=158) (group 1), HLA class I antigen mismatched and KIR-ligand compatible (n=49) (group 2), and HLA class I antigen mismatched and KIR-ligand incompatible (n=29) (group 3) hematopoietic stem-cell transplantation.


METHODS
We performed a retrospective single-center study. MR was evaluated using the real-time RT-PCR method for the detection of bcr-abl transcripts.


RESULTS
In the first group, 133 of 158 (84%) pts were in the first chronic phase of CML, and the corresponding figures were 33 of 49 (67%) pts in group 2 and 19 of 29 (64%) in group 3 (P<0.05). MR occurred in 1 of 29 (3%) pts in group 3 compared with 62 of 158 (39%) pts in group 1 and in 11 of 49 (22%) pts in group 2 (P<0.001). A hematologic relapse developed in 20 of 158 (13%) pts in group 1, 2 of 49 (4%) pts in group 2, and in 0 of 29 (0%) pts in group 3 (P<0.05). Multivariate analysis confirmed that KIR mismatches are a strong independent predictor for the occurrence of MR after transplantation (P<0.02). The 5-year overall survival rate did not vary greatly between the three groups (67% in group 1, 52% in group 2, and 66% in group 3).


CONCLUSIONS
These results suggest that KIR-ligand incompatibility is an important prognostic factor in the occurrence of MR after transplantation for CML.
Elmaagacli
Ahmet H
AH
Department of Bone Marrow Transplantation, University Hospital of Essen, Hufelandstrasse 55, 45122 Essen, Germany. ahmet.elmaagacli@uni-essen.de
Ottinger
Hellmut
H
Koldehoff
Michael
M
Peceny
Rudolf
R
Steckel
Nina K
NK
Trenschel
Rudolf
R
Biersack
Harald
H
Grosse-Wilde
Hans
H
Beelen
Dietrich W
DW
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D016044:Fusion Proteins, bcr-abl / Q000235:genetics; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000276:immunology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011971:Receptors, Immunologic / Q000235:genetics* / Q000276:immunology*; D054340:Receptors, KIR; D012008:Recurrence; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D035781:Siblings; D033581:Stem Cell Transplantation; D014019:Tissue Donors; D014184:Transplantation, Homologous / Q000276:immunology*
D011971:Receptors, Immunologic; D054340:Receptors, KIR; D016044:Fusion Proteins, bcr-abl