移植
造血干细胞移植
内科学
免疫学
髓系白血病
医学
单倍型
白血病
人类白细胞抗原
HLA-B抗原
移植物抗宿主病
胃肠病学
肿瘤科
基因型
生物
遗传学
抗原
基因
作者
Sarah Cooley,Elizabeth Trachtenberg,Tracy L. Bergemann,Koy Saeteurn,John P. Klein,Chap T. Le,Steven G.E. Marsh,Lisbeth A. Guethlein,Peter Parham,Jeffrey S. Miller,Daniel J. Weisdorf
出处
期刊:Blood
[American Society of Hematology]
日期:2009-01-15
卷期号:113 (3): 726-732
被引量:406
标识
DOI:10.1182/blood-2008-07-171926
摘要
Abstract Survival for patients with acute myeloid leukemia (AML) is limited by treatment-related mortality (TRM) and relapse after unrelated donor (URD) hematopoietic cell transplantation (HCT). Natural killer (NK)–cell alloreactivity, determined by donor killer-cell immunoglobulin-like receptors (KIRs) and recipient HLA, correlates with successful HCT for AML. Hypothesizing that donor KIR genotype (A/A: 2 A KIR haplotypes; B/x: at least 1 B haplotype) would affect outcomes, we genotyped donors and recipients from 209 HLA-matched and 239 mismatched T-replete URD transplantations for AML. Three-year overall survival was significantly higher after transplantation from a KIR B/x donor (31% [95% CI: 26-36] vs 20% [95% CI: 13-27]; P = .007). Multivariate analysis demonstrated a 30% improvement in the relative risk of relapse-free survival with B/x donors compared with A/A donors (RR: 0.70 [95% CI: 0.55-0.88]; P = .002). B/x donors were associated with a higher incidence of chronic graft-versus-host disease (GVHD; RR: 1.51 [95% CI: 1.01-2.18]; P = .03), but not of acute GVHD, relapse, or TRM. This analysis demonstrates that unrelated donors with KIR B haplotypes confer significant survival benefit to patients undergoing T-replete HCT for AML. KIR genotyping of prospective donors, in addition to HLA typing, should be performed to identify HLA-matched donors with B KIR haplotypes.
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