title: Killer Cell Immunoglobulin-Like Receptor-Ligand Matching and Outcomes after Unrelated Cord Blood Transplantation in Acute Myeloid Leukemia.
abstract: The effect of killer cell immunoglobulin-like receptor (KIR)-ligand matching on outcomes after unrelated cord blood (CB) transplantation was studied in 461 patients with acute myeloid leukemia, categorizing KIR ligand for HLA-C groups C1 and C2 and Bw4. Donor-recipient HLA matching considered allele-level matching at HLA-A, -B, -C, and -DRB1. Separate analyses were conducted for 6-7/8 HLA-matched and 3-5/8 HLA-matched transplants because HLA matching confounded KIR-ligand matching (ie, KIR-ligand mismatching was less likely with better HLA matching). All patients received single CB unit and myeloablative conditioning. There were no significant differences in nonrelapse mortality (NRM), relapse, and overall mortality by KIR-ligand match status. However, among recipients of 3-5/8 HLA-matched transplants, NRM (HR, 2.26; P = .008) and overall mortality (HR, 1.78; P = .008) but not relapse were higher with KIR-ligand mismatched (host-versus-graft direction) compared with KIR-ligand matched transplants. These data do not support selecting CB units based on KIR-ligand match status for transplants mismatched at 1 or 2 HLA loci. Although transplants mismatched at 3 or more HLA loci are not recommended, avoiding KIR-ligand mismatching in this setting lowers mortality risks.
authors.affiliation: Eurocord, Hôpital Saint Louis, Paris, France; Churchill Hospital and NHSBT, University of Oxford, Oxford, United Kingdom. Electronic address: vanderson.rocha@ouh.nhs.uk.
authors.forename: Vanderson
authors.initials: V
authors.lastname: Rocha
authors.affiliation: Eurocord, Hôpital Saint Louis, Paris, France; Service d'Hematologie et therapie cellulaire, Hôpital Saint Antoine, Paris, France.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Ruggeri
authors.affiliation: Center for International Blood and Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota.
authors.forename: Stephen
authors.initials: S
authors.lastname: Spellman
authors.affiliation: Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Tao
authors.initials: T
authors.lastname: Wang
authors.affiliation: Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Ronald
authors.initials: R
authors.lastname: Sobecks
authors.affiliation: IRCCS Ospedale Pediatrico Bambino Gesù, Rome and University of Pavia, Pavia, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Locatelli
authors.affiliation: Baylor University Medical Center, Dallas, Texas.
authors.forename: Medhat
authors.initials: M
authors.lastname: Askar
authors.affiliation: Service d'hematologie, La Timone Hospital, University Hospital of Marseille, Marseille, France.
authors.forename: Gerard
authors.initials: G
authors.lastname: Michel
authors.affiliation: BMT Unit, Rome Transplant Network, University "Tor Vergata", Rome, Italy.
authors.forename: William
authors.initials: W
authors.lastname: Arcese
authors.affiliation: Dipartimento di Ematologia, University of Rome, La Sapienza, Rome, Italy.
authors.forename: Anna Paola
authors.initials: AP
authors.lastname: Iori
authors.affiliation: BMT Unit, Royal Perth Hospital, Perth, Australia.
authors.forename: Duncan
authors.initials: D
authors.lastname: Purtill
authors.affiliation: Churchill Hospital and NHSBT, University of Oxford, Oxford, United Kingdom.
authors.forename: Robert
authors.initials: R
authors.lastname: Danby
authors.affiliation: Hematology and Trasnplant Unit, Hospital Universitario La Fe, Valencia, Spain.
authors.forename: Guillermo F
authors.initials: GF
authors.lastname: Sanz
authors.affiliation: Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco.
authors.forename: Eliane
authors.initials: E
authors.lastname: Gluckman
authors.affiliation: Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Mary
authors.initials: M
authors.lastname: Eapen
mesh_terms: D000293:Adolescent; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D005260:Female; D015236:HLA-C Antigens / Q000276:immunology*; D006648:Histocompatibility; D015395:Histocompatibility Antigens Class I; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000628:therapy*; D008024:Ligands; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000628:therapy; D054340:Receptors, KIR / Q000276:immunology*; D012008:Recurrence; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods; D016896:Treatment Outcome; D061349:Unrelated Donors
chemical_list: D015236:HLA-C Antigens; D015395:Histocompatibility Antigens Class I; D008024:Ligands; D054340:Receptors, KIR
keywords: Acute leukemia; Cord blood; KIR ligand; Unrelated transplant