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.
Department of Bone Marrow Transplantation, University Hospital of Essen, Hufelandstrasse 55, 45122 Essen, Germany. ahmet.elmaagacli@uni-essen.de
Ahmet H
AH
Elmaagacli
Hellmut
H
Ottinger
Michael
M
Koldehoff
Rudolf
R
Peceny
Nina K
NK
Steckel
Rudolf
R
Trenschel
Harald
H
Biersack
Hans
H
Grosse-Wilde
Dietrich W
DW
Beelen
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