Is there an impact of killer cell immunoglobulin-like receptors and KIR-ligand incompatibilities on outcomes after unrelated cord blood stem cell transplantation?
Donor killer cell immunoglobulin-like receptor (KIR) ligand incompatibility in the graft-versus-host direction is associated with decreased relapse incidence and improved disease-free survival after haploidentical and human leucocyte antigen (HLA)-mismatched unrelated, haematopoietic stem cell transplantation. However, review of all published studies of allogeneic HLA-matched or mismatched stem cell transplantation shows that the results on the relationship between donor-recipient KIR(-ligand) (in)compatibility and outcomes are highly variable, ranging from highly beneficial to detrimental. Reasons for these differences may include the methodology to determine KIR(-ligand) incompatibility, the disease distribution and the transplant protocol or donor type. Two retrospective studies on the effects of KIR-ligand incompatibility in unrelated cord blood transplantation (UCBT) for haematological malignancies have resulted in conflicting results. The Eurocord study showed a favourable effect of KIR-ligand mismatching on relapse incidence and leukaemia-free survival, whereas the Minneapolis study showed no effect on these end points and a detrimental effect on incidence of graft-versus-host disease (GvHD). In patients with non-malignant disorders, KIR-ligand (in)compatibility between donor and recipient was not associated with outcomes in a recent Eurocord analysis. Therefore, the role of natural killer (NK) cell alloreactivity in UCBT is far from clear. It is too early to use a donor-recipient KIR(-ligand) algorithm for selection of a cord blood donor.
Willemze
Roel
R
Department of Hematology, Leiden University Medical Center, the Netherlands. R.Willemze@lumc.nl
Ruggeri
Annalisa
A
Purtill
Duncan
D
Rodrigues
Celso Arrais
CA
Gluckman
Eliane
E
Rocha
Vanderson
V
D036101:Cord Blood Stem Cell Transplantation; D018572:Disease-Free Survival; D006086:Graft vs Host Disease / Q000276:immunology* / Q000401:mortality / Q000517:prevention & control; D006680:HLA Antigens / Q000276:immunology; D006648:Histocompatibility / Q000276:immunology*; D006650:Histocompatibility Testing / Q000379:methods; D006801:Humans; D015994:Incidence; D007938:Leukemia / Q000276:immunology / Q000401:mortality / Q000628:therapy; D008024:Ligands; D054340:Receptors, KIR / Q000276:immunology*; D015996:Survival Rate; D014019:Tissue Donors; D014184:Transplantation, Homologous
D006680:HLA Antigens; D008024:Ligands; D054340:Receptors, KIR