TY - JOUR
T1 - Donor Killer Cell Immunoglobulin-Like Receptor Genotype Does Not Improve Graft-versus-Leukemia Responses in Chronic Lymphocytic Leukemia after Unrelated Donor Transplant
T2 - A Center for International Blood and Marrow Transplant Research Analysis
AU - Bachanova, Veronika
AU - Weisdorf, Daniel J.
AU - Wang, Tao
AU - Marsh, Steven G.E.
AU - Cereb, Nezih
AU - Haagenson, Michael D.
AU - Spellman, Stephen R.
AU - Lee, Stephanie J.
AU - Guethlein, Lisbeth A.
AU - Parham, Peter
AU - Miller, Jeffrey S.
AU - Cooley, Sarah A.
N1 - Publisher Copyright:
© 2019 American Society for Blood and Marrow Transplantation
PY - 2019/5
Y1 - 2019/5
N2 - Allogeneic hematopoietic cell transplantation (alloHCT)remains the sole curative therapy for patients with chronic lymphocytic leukemia (CLL), leading to 40% to 45% long-term survival. The impact of donor killer immunoglobulin-like receptor (KIR)genotype on outcomes of unrelated donor (URD)alloHCT for CLL is unknown. We examined 573 adult URD CLL recipient pairs. KIR genotype (presence/absence)was determined for each donor, and comprehensive modeling of interactions with recipient HLA class I loci (KIR ligands)was used to evaluate their effect on relapse and survival. Recipients had a median age of 56 years, and most were not in remission (65%). Both 8/8 HLA-matched (81%)or 7/8 HLA matched grafts (19%)were studied. Factors associated with improved overall survival (OS)were reduced-intensity conditioning (hazard ratio [HR]of death,.76)and good performance status (HR,.46), whereas alloHCT in nonremission (HR, 1.96)and mismatched donors (HR, 2.01)increased mortality. No models demonstrated a relationship between donor KIR genotype and transplant outcomes. Cox regression models comparing donors with A/A versus B/x KIR haplotypes and those with KIR gene content scores of 0 versus 1 versus ≥2 yielded similar rates of nonrelapse mortality, relapse, acute graft-versus-host disease (GVHD), and chronic GVHD and the same progression-free survival and OS. Relapse risk was not different for grafts from donors with KIR3DL1 transplanted into HLA C1/1 versus C2 recipients. This large analysis failed to demonstrate an association between URD KIR genotype and transplant outcome for patients with CLL, and thus KIR genotyping should not be used as a donor selection criterion in this setting.
AB - Allogeneic hematopoietic cell transplantation (alloHCT)remains the sole curative therapy for patients with chronic lymphocytic leukemia (CLL), leading to 40% to 45% long-term survival. The impact of donor killer immunoglobulin-like receptor (KIR)genotype on outcomes of unrelated donor (URD)alloHCT for CLL is unknown. We examined 573 adult URD CLL recipient pairs. KIR genotype (presence/absence)was determined for each donor, and comprehensive modeling of interactions with recipient HLA class I loci (KIR ligands)was used to evaluate their effect on relapse and survival. Recipients had a median age of 56 years, and most were not in remission (65%). Both 8/8 HLA-matched (81%)or 7/8 HLA matched grafts (19%)were studied. Factors associated with improved overall survival (OS)were reduced-intensity conditioning (hazard ratio [HR]of death,.76)and good performance status (HR,.46), whereas alloHCT in nonremission (HR, 1.96)and mismatched donors (HR, 2.01)increased mortality. No models demonstrated a relationship between donor KIR genotype and transplant outcomes. Cox regression models comparing donors with A/A versus B/x KIR haplotypes and those with KIR gene content scores of 0 versus 1 versus ≥2 yielded similar rates of nonrelapse mortality, relapse, acute graft-versus-host disease (GVHD), and chronic GVHD and the same progression-free survival and OS. Relapse risk was not different for grafts from donors with KIR3DL1 transplanted into HLA C1/1 versus C2 recipients. This large analysis failed to demonstrate an association between URD KIR genotype and transplant outcome for patients with CLL, and thus KIR genotyping should not be used as a donor selection criterion in this setting.
KW - Allogeneic transplantation
KW - Chronic lymphocytic leukemia
KW - Genotype
KW - KIR
KW - NK cells
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UR - http://www.scopus.com/inward/citedby.url?scp=85061161761&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2018.12.763
DO - 10.1016/j.bbmt.2018.12.763
M3 - Article
C2 - 30594542
AN - SCOPUS:85061161761
SN - 1083-8791
VL - 25
SP - 949
EP - 954
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 5
ER -