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Vittayawacharin P, Kongtim P, Ciurea SO. Future directions in haploidentical hematopoietic stem cell transplantation. Hematology 2024; 29:2366718. [PMID: 38889342 DOI: 10.1080/16078454.2024.2366718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 06/06/2024] [Indexed: 06/20/2024] Open
Abstract
Outcomes of haploidentical hematopoietic stem cell transplantation (haplo-SCT) have improved over time. Graft failure and graft-versus-host disease (GVHD), which were important complications in major human leukocyte antigen (HLA)-disparity stem cell transplantation, have significantly decreased. These improvements have led to an exponential increase in the use of haploidentical donors for transplantation, as well as in the number of publications evaluating haplo-SCT outcomes. Many studies focused on factors important in donor selection, novel conditioning regimens or GVHD prophylaxis, the impact of donor-specific anti-HLA antibodies (DSA), as well as strategies to prevent disease relapse post-transplant. DSA represents an important limitation and multimodality desensitization protocols, including plasma exchange, rituximab, intravenous immunoglobulin and donor buffy coat infusion, can contribute to the successful engraftment in patients with high DSA levels and is currently the standard therapy for highly allosensitized individuals. With regards to donor selection, younger donors are preferred due to lower risk of complications and better transplant outcomes. Moreover, recent studies also showed that younger haploidentical donors may be a better choice than older-matched unrelated donors. Improvement of disease relapse remains a top priority, and several studies have demonstrated that higher natural killer (NK) cell numbers early post-transplant are associated with improved outcomes. Prospective studies have started to assess the role of NK cell administration in decreasing post-transplant relapse. These studies suggest that the incorporation of other cell products post-transplant, including the administration of chimeric antigen receptor T-cells, should be explored in the future.
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Affiliation(s)
- Pongthep Vittayawacharin
- Hematopoietic Stem Cell Transplantation and Cellular Therapy Program, Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, CA, USA
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
| | - Piyanuch Kongtim
- Hematopoietic Stem Cell Transplantation and Cellular Therapy Program, Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, CA, USA
| | - Stefan O Ciurea
- Hematopoietic Stem Cell Transplantation and Cellular Therapy Program, Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, CA, USA
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2
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Wright PA, van de Pasch LAL, Dignan FL, Kichula KM, Pollock NR, Norman PJ, Marchan E, Hill L, Vandelbosch S, Fullwood C, Sheldon S, Hampson L, Tholouli E, Poulton KV. Donor KIR2DL1 Allelic Polymorphism Influences Posthematopoietic Progenitor Cell Transplantation Outcomes in the T Cell Depleted and Reduced Intensity Conditioning Setting. Transplant Cell Ther 2024; 30:488.e1-488.e15. [PMID: 38369017 PMCID: PMC11056303 DOI: 10.1016/j.jtct.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/30/2024] [Accepted: 02/13/2024] [Indexed: 02/20/2024]
Abstract
The majority of established KIR clinical assessment algorithms used for donor selection for hematopoietic progenitor cell transplantation (HPCT) evaluate gene content (presence/absence) of the KIR gene complex. In comparison, relatively little is known about the impact of KIR allelic polymorphism. By analyzing donors of T cell depleted (TcD) reduced intensity conditioning (RIC) HPCT, this study investigated the influence on post-transplant outcome of 2 polymorphic residues of the inhibitory KIR2DL1. The aim of this study was to expand upon existing research into the influence of KIR2DL1 allelic polymorphism upon post-transplant outcome. The effects of allele groups upon transplant outcomes were investigated within a patient cohort using a defined treatment protocol of RIC with TcD. Using phylogenetic data, KIR2DL1 allelic polymorphism was categorized into groups on the basis of variation within codons 114 and 245 (positive or negative for the following groups: KIR2DL1*002/001g, KIR2DL1*003, KIR2DL1*004g) and the identification of null alleles. The influence of these KIR2DL1 allele groups in hematopoietic progenitor cell transplantation (HPCT) donors was assessed in the post-transplant data of 86 acute myelogenous leukemia patients receiving RIC TcD HPCT at a single center. KIR2DL1 allele groups in the donor significantly impacted upon 5-year post-transplant outcomes in RIC TcD HPCT. Donor KIR2DL1*003 presented the greatest influence upon post-transplant outcomes, with KIR2DL1*003 positive donors severely reducing 5-year post-transplant overall survival (OS) compared to those receiving a transplant from a KIR2DL1*003 negative donor (KIR2DL1*003 pos versus neg: 27.0% versus 60.0%, P = .008, pc = 0.024) and disease-free survival (DFS) (KIR2DL1*003 pos versus neg: 23.5% versus 60.0%, P = .004, pc = 0.012), and increasing 5-year relapse incidence (KIR2DL1*003 pos versus neg: 63.9% versus 27.2%, P = .009, pc = 0.027). KIR2DL1*003 homozygous and KIR2DL1*003 heterozygous grafts did not present significantly different post-transplant outcomes. Donors possessing the KIR2DL1*002/001 allele group were found to significantly improve post-transplant outcomes, with donors positive for the KIR2DL1*004 allele group presenting a trend towards improvement. KIR2DL1*002/001 allele group (KIR2DL1*002/001g) positive donors improved 5-year OS (KIR2DL1*002/001g pos versus neg: 56.4% versus 27.2%, P = .009, pc = 0.024) and DFS (KIR2DL1*002/001g pos versus neg: 53.8% versus 25.5%, P = .018, pc = 0.036). KIR2DL1*004 allele group (KIR2DL1*004g) positive donors trended towards improving 5-year OS (KIR2DL1*004g pos versus neg: 53.3% versus 35.5%, P = .097, pc = 0.097) and DFS (KIR2DL1*004g pos versus neg: 50.0% versus 33.9%, P = .121, pc = 0.121), and reducing relapse incidence (KIR2DL1*004g pos versus neg: 33.1% versus 54.0%, P = .079, pc = 0.152). The presented findings suggest donor selection algorithms for TcD RIC HPCT should consider avoiding KIR2DL1*003 positive donors, where possible, and contributes to the mounting evidence that KIR assessment in donor selection algorithms should reflect the conditioning regime protocol used.
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Affiliation(s)
- Paul A Wright
- Transplantation Laboratory, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK; Histocompatibility & Immunogenetics Laboratory, Liverpool Clinical Laboratories, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK.
| | | | - Fiona L Dignan
- Clinical Haematology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Katherine M Kichula
- Department of Biomedical Informatics, Anschutz Medical Campus, University of Colorado, Denver, Colorado
| | - Nicholas R Pollock
- Department of Biomedical Informatics, Anschutz Medical Campus, University of Colorado, Denver, Colorado
| | - Paul J Norman
- Department of Biomedical Informatics and Department of Immunology and Microbiology, Anschutz Medical Campus, University of Colorado, Denver, Colorado
| | - Earl Marchan
- Clinical Haematology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Lesley Hill
- Clinical Haematology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | | | - Catherine Fullwood
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, Greater Manchester, UK
| | - Stephen Sheldon
- Transplantation Laboratory, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Lynne Hampson
- Division of Cancer Sciences, University of Manchester, Manchester, Greater Manchester, UK
| | - Eleni Tholouli
- Clinical Haematology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Kay V Poulton
- Transplantation Laboratory, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK; Faculty of Biology, Medicine & Health, University of Manchester, Manchester, Greater Manchester, UK
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3
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Ciurea SO, Kongtim P, Srour S, Chen J, Soebbing D, Shpall E, Rezvani K, Nakkula R, Thakkar A, Troy EC, Cash AA, Behbehani G, Cao K, Schafer J, Champlin RE, Lee DA. Results of a phase I trial with Haploidentical mbIL-21 ex vivo expanded NK cells for patients with multiply relapsed and refractory AML. Am J Hematol 2024; 99:890-899. [PMID: 38444268 DOI: 10.1002/ajh.27281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/27/2024] [Accepted: 02/18/2024] [Indexed: 03/07/2024]
Abstract
Natural killer (NK)-cells have potent anti-tumor effects, yet it remains unclear if they are effective for patients with relapsed acute myeloid leukemia (AML). In a phase I clinical trial, we treated 12 patients (median age 60 years) with refractory AML (median 5 lines of prior therapy, median bone marrow blast count of 47%) with fludarabine/cytarabine followed by 6 infusions of NK-cells expanded from haploidentical donors using K562 feeder cells expressing membrane-bound IL21 and 4-1BBL. Patients received 106-107/kg/dose. No toxicity or graft-versus-host disease (GVHD) was observed and MTD was not reached. Seven patients (58.3%) responded and achieved a complete remission (CR) with/without count recovery. Median time to best response was 48 days. Five responding patients proceeded to a haploidentical transplant from the same donor. After a median follow-up of 52 months, 1-year overall survival (OS) for the entire group was 41.7%, better for patients who responded with CR/CRi (57.14%), and for patients who responded and underwent transplantation (60%). Persistence and expansion of donor-derived NK-cells were identified in patients' blood, and serum IFNγ levels rose concurrently with NK cell infusions. A higher count-functional inhibitory KIR was associated with higher likelihood of achieving CR/CRi. In conclusion, we observed a significant response to ex vivo expanded NK-cell administration in refractory AML patients without adverse effects.
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Affiliation(s)
- Stefan O Ciurea
- Hematopoietic Stem Cell Transplant and Cellular Therapy Program, Division of Hematology/Oncology, The University of California, Orange, California, USA
| | - Piyanuch Kongtim
- Hematopoietic Stem Cell Transplant and Cellular Therapy Program, Division of Hematology/Oncology, The University of California, Orange, California, USA
| | - Samer Srour
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Julianne Chen
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Doris Soebbing
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Elizabeth Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Katayoun Rezvani
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Robin Nakkula
- The Abigail Wexner Research Institute, Columbus, Ohio, USA
| | - Aarohi Thakkar
- The Abigail Wexner Research Institute, Columbus, Ohio, USA
| | - Ella C Troy
- The Abigail Wexner Research Institute, Columbus, Ohio, USA
| | - Alex A Cash
- The Abigail Wexner Research Institute, Columbus, Ohio, USA
| | | | - Kai Cao
- Department of Laboratory Medicine, Division of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Dean A Lee
- The Abigail Wexner Research Institute, Columbus, Ohio, USA
- Division of Hematology, Oncology, and Bone Marrow Transplantation, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
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4
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Krieger E, Qayyum R, Toor A. Increased donor inhibitory KIR are associated with reduced GVHD and improved survival following HLA-matched unrelated donor HCT in paediatric acute leukaemia. Br J Haematol 2024; 204:1935-1943. [PMID: 38442905 PMCID: PMC11090758 DOI: 10.1111/bjh.19356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/30/2024] [Accepted: 02/12/2024] [Indexed: 03/07/2024]
Abstract
Killer immunoglobulin-like receptor (KIR) and KIR-ligand (KIRL) interactions play an important role in natural killer cell-mediated effects after haematopoietic stem cell transplantation (HCT). Previous work has shown that accounting for known KIR-KIRL interactions may identify donors with optimal NK cell-mediated alloreactivity in the adult transplant setting. Paediatric acute leukaemia patients were retrospectively analysed, and KIR-KIRL combinations and maximal inhibitory KIR ligand (IM-KIR) scores were determined. Clinical outcomes were examined using a series of graphs depicting clinical events and endpoints. The graph methodology demonstrated that prognostic variables significant in the occurrence of specific clinical endpoints remained significant for relevant downstream events. KIR-KIRL combinations were significantly predictive for reduced grade 3-4 aGVHD likelihood, in patients transplanted with increased inhibitory KIR gene content and IM-KIR = 5 scores. Improvements were also observed in associated outcomes for both ALL and AML patients, including relapse-free survival, GRFS and overall survival. This study demonstrates that NK cell KIR HLA interactions may be relevant to the paediatric acute leukaemia transplant setting. Reduction in aGVHD suggests KIR effects may extend beyond NK cells. Moving forward clinical trials utilizing donors with a higher iKIR should be considered for URD HCT in paediatric recipients with acute leukaemia to optimize clinical outcomes.
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Affiliation(s)
- Elizabeth Krieger
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, USA
| | - Rehan Qayyum
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Amir Toor
- Lehigh Valley Health Network, Allentown, PA and Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
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5
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Schetelig J, Baldauf H, Heidenreich F, Hoogenboom JD, Spellman SR, Kulagin A, Schroeder T, Sengeloev H, Dreger P, Forcade E, Vydra J, Wagner-Drouet EM, Choi G, Paneesha S, Miranda NAA, Tanase A, de Wreede LC, Lange V, Schmidt AH, Sauter J, Fein JA, Bolon YT, He M, Marsh SGE, Gadalla SM, Paczesny S, Ruggeri A, Chabannon C, Fleischhauer K. Donor KIR genotype based outcome prediction after allogeneic stem cell transplantation: no land in sight. Front Immunol 2024; 15:1350470. [PMID: 38629074 PMCID: PMC11019434 DOI: 10.3389/fimmu.2024.1350470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/04/2024] [Indexed: 04/19/2024] Open
Abstract
Optimizing natural killer (NK) cell alloreactivity could further improve outcome after allogeneic hematopoietic cell transplantation (alloHCT). The donor's Killer-cell Immunoglobulin-like Receptor (KIR) genotype may provide important information in this regard. In the past decade, different models have been proposed aiming at maximizing NK cell activation by activating KIR-ligand interactions or minimizing inhibitory KIR-ligand interactions. Alternative classifications intended predicting outcome after alloHCT by donor KIR-haplotypes. In the present study, we aimed at validating proposed models and exploring more classification approaches. To this end, we analyzed samples stored at the Collaborative Biobank from HLA-compatible unrelated stem cell donors who had donated for patients with acute myeloid leukemia (AML) or myelodysplastic neoplasm (MDS) and whose outcome data had been reported to EBMT or CIBMTR. The donor KIR genotype was determined by high resolution amplicon-based next generation sequencing. We analyzed data from 5,017 transplants. The median patient age at alloHCT was 56 years. Patients were transplanted for AML between 2013 and 2018. Donor-recipient pairs were matched for HLA-A, -B, -C, -DRB1, and -DQB1 (79%) or had single HLA mismatches. Myeloablative conditioning was given to 56% of patients. Fifty-two percent of patients received anti-thymocyte-globulin-based graft-versus-host disease prophylaxis, 32% calcineurin-inhibitor-based prophylaxis, and 7% post-transplant cyclophosphamide-based prophylaxis. We tested several previously reported classifications in multivariable regression analyses but could not confirm outcome associations. Exploratory analyses in 1,939 patients (39%) who were transplanted from donors with homozygous centromeric (cen) or telomeric (tel) A or B motifs, showed that the donor cen B/B-tel A/A diplotype was associated with a trend to better event-free survival (HR 0.84, p=.08) and reduced risk of non-relapse mortality (NRM) (HR 0.65, p=.01). When we further dissected the contribution of B subtypes, we found that only the cen B01/B01-telA/A diplotype was associated with a reduced risk of relapse (HR 0.40, p=.04) while all subtype combinations contributed to a reduced risk of NRM. This exploratory finding has to be validated in an independent data set. In summary, the existing body of evidence is not (yet) consistent enough to recommend use of donor KIR genotype information for donor selection in routine clinical practice.
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Affiliation(s)
- Johannes Schetelig
- Department of Internal Medicine I, University Hospital TU Dresden, Dresden, Germany
- Clinical Trials Unit, DKMS Group, Dresden, Germany
| | | | - Falk Heidenreich
- Department of Internal Medicine I, University Hospital TU Dresden, Dresden, Germany
- Clinical Trials Unit, DKMS Group, Dresden, Germany
| | | | - Stephen R. Spellman
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program (NMDP), Minneapolis, MN, United States
| | - Alexander Kulagin
- RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia
| | - Thomas Schroeder
- Klinik für Hämatologie und Stammzelltransplantation, Universitätsklinikum Essen, Essen, Germany
| | - Henrik Sengeloev
- Bone Marrow Transplant Unit, Department of Hematology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Dreger
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Edouard Forcade
- Service Hématologie clinique de Thérapie cellulaire, Centre Hospitalier Universitaire Bordeaux, Université de Bordeaus, Bordeaux, France
| | - Jan Vydra
- Transplant Unit and Intensive Care Unit, Institute of Hematology and Bood Transfusion, Prague, Czechia
| | - Eva Maria Wagner-Drouet
- Center for Cellular Immunotherapy and Stem Cell Transplantation, Third Medical Department, Hematology and Oncology, University Cancer Center Mainz, Mainz, Germany
| | - Goda Choi
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Shankara Paneesha
- Department of Haematology & Stem Cell Transplantation, Birmingham Heartlands Hospital, Birmingham, United Kingdom
| | - Nuno A. A. Miranda
- Department of Hematology, Instituto Português de Oncologia de Lisboa, Lisboa, Portugal
| | - Alina Tanase
- Department of Stem Cell Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | | | | | | | | | - Joshua A. Fein
- Department of Hematology & Medical Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, United States
| | - Yung-Tsi Bolon
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program (NMDP), Minneapolis, MN, United States
| | - Meilun He
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program (NMDP), Minneapolis, MN, United States
| | - Steven G. E. Marsh
- Anthony Nolan Research Institute, Royal Free Hospital, London & Cancer Institute, University College London, London, United Kingdom
| | - Shahinaz M. Gadalla
- National Cancer Institute, Division of Cancer Epidemiology & Genetics, Bethesda, MD, United States
| | - Sophie Paczesny
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, United States
| | | | - Christian Chabannon
- Institut Paoli-Calmettes, Centre de Lutte Contre le Cancer, Marseille, France
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Fein JA, Shouval R, Krieger E, Spellman SR, Wang T, Baldauf H, Fleischhauer K, Kröger N, Horowitz M, Maiers M, Miller JS, Mohty M, Nagler A, Weisdorf D, Malmberg KJ, Toor AA, Schetelig J, Romee R, Koreth J. Systematic evaluation of donor-KIR/recipient-HLA interactions in HLA-matched hematopoietic cell transplantation for AML. Blood Adv 2024; 8:581-590. [PMID: 38052043 PMCID: PMC10837477 DOI: 10.1182/bloodadvances.2023011622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023] Open
Abstract
ABSTRACT In acute myeloid leukemia (AML), donor natural killer cell killer immunoglobulin-like receptors (KIR) and recipient HLA interactions may contribute to the graft-versus-leukemia effect of allogeneic hematopoietic cell transplantation (HCT). Analyses of individual KIR/HLA interactions, however, have yielded conflicting findings, and their importance in the HLA-matched unrelated donor (MUD) setting remains controversial. We systematically studied outcomes of individual donor-KIR/recipient-HLA interactions for HCT outcomes and empirically evaluated prevalent KIR genotypes for clinical benefit. Adult patients with AML (n = 2025) who received HCT with MUD grafts in complete remission reported to the Center for International Blood and Marrow Transplantation were evaluated. Only the donor-2DL2+/recipient-HLA-C1+ pair was associated with reduced relapse (hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.67-0.93; P = .006) compared with donor-2DL2-/recipient-HLA-C1+ pair. However, no association was found when comparing HLA-C groups among KIR-2DL2+-graft recipients. We identified 9 prevalent donor KIR genotypes in our cohort and screened them for association with relapse risk. Genotype 5 (G5) in all recipients and G3 in Bw4+ recipients were associated with decreased relapse risk (HR, 0.52; 95% CI, 0.35-0.78; P = .002; and HR, 0.32; 95% CI, 0.14-0.72; P = .006; respectively) and G2 (HR 1.63, 95% CI, 1.15-2.29; P = .005) with increased relapse risk in C1-homozygous recipients, compared with other patients with the same ligand. However, we could not validate these findings in an external data set of 796 AML transplants from the German transplantation registry. Neither a systematic evaluation of known HLA-KIR interactions nor an empiric assessment of prevalent KIR genotypes demonstrated clinically actionable associations; therefore, these data do not support these KIR-driven strategies for MUD selection in AML.
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Affiliation(s)
- Joshua A. Fein
- Depatment of Hematology and Medical Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
| | - Roni Shouval
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elizabeth Krieger
- Children’s Hospital of Richmond, Virginia Commonwealth University, Richmond, VA
| | - Stephen R. Spellman
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Tao Wang
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Henning Baldauf
- Clinical Trials Unit, DKMS Bone Marrow Registry, Tübingen, Germany
| | | | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Mary Horowitz
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Martin Maiers
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Jeffrey S Miller
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN
| | - Mohamad Mohty
- Department of Hematology, Saint Antoine Hospital, Sorbonne University, Paris, France
| | - Arnon Nagler
- Division of Hematoloy, Chaim Sheba Medical Center, Tel HaShomer, Israel
| | - Daniel Weisdorf
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN
| | - Karl-Johan Malmberg
- Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Amir A. Toor
- Topper Cancer Institute, Lehigh Valley Health Network, Allentown, PA
| | - Johannes Schetelig
- Clinical Trials Unit, DKMS Bone Marrow Registry, Tübingen, Germany
- Medizinische Klinik I, University Hospital TU Dresden, Dresden, Germany
| | - Rizwan Romee
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA
| | - John Koreth
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA
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7
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van der Burg LLJ, de Wreede LC, Baldauf H, Sauter J, Schetelig J, Putter H, Böhringer S. Haplotype reconstruction for genetically complex regions with ambiguous genotype calls: Illustration by the KIR gene region. Genet Epidemiol 2024; 48:3-26. [PMID: 37830494 DOI: 10.1002/gepi.22538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 09/06/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023]
Abstract
Advances in DNA sequencing technologies have enabled genotyping of complex genetic regions exhibiting copy number variation and high allelic diversity, yet it is impossible to derive exact genotypes in all cases, often resulting in ambiguous genotype calls, that is, partially missing data. An example of such a gene region is the killer-cell immunoglobulin-like receptor (KIR) genes. These genes are of special interest in the context of allogeneic hematopoietic stem cell transplantation. For such complex gene regions, current haplotype reconstruction methods are not feasible as they cannot cope with the complexity of the data. We present an expectation-maximization (EM)-algorithm to estimate haplotype frequencies (HTFs) which deals with the missing data components, and takes into account linkage disequilibrium (LD) between genes. To cope with the exponential increase in the number of haplotypes as genes are added, we add three components to a standard EM-algorithm implementation. First, reconstruction is performed iteratively, adding one gene at a time. Second, after each step, haplotypes with frequencies below a threshold are collapsed in a rare haplotype group. Third, the HTF of the rare haplotype group is profiled in subsequent iterations to improve estimates. A simulation study evaluates the effect of combining information of multiple genes on the estimates of these frequencies. We show that estimated HTFs are approximately unbiased. Our simulation study shows that the EM-algorithm is able to combine information from multiple genes when LD is high, whereas increased ambiguity levels increase bias. Linear regression models based on this EM, show that a large number of haplotypes can be problematic for unbiased effect size estimation and that models need to be sparse. In a real data analysis of KIR genotypes, we compare HTFs to those obtained in an independent study. Our new EM-algorithm-based method is the first to account for the full genetic architecture of complex gene regions, such as the KIR gene region. This algorithm can handle the numerous observed ambiguities, and allows for the collapsing of haplotypes to perform implicit dimension reduction. Combining information from multiple genes improves haplotype reconstruction.
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Affiliation(s)
| | - Liesbeth C de Wreede
- Biomedical Data Sciences, LUMC, Leiden, The Netherlands
- DKMS, Dresden/Tübingen, Germany
| | | | | | - Johannes Schetelig
- DKMS, Dresden/Tübingen, Germany
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Hein Putter
- Biomedical Data Sciences, LUMC, Leiden, The Netherlands
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Byrnes CP, Hastings A, Lacej I, Palanicawandar R, Olavarria E, Anand A. A retrospective analysis to evaluate if KIR B haplotype donors associate with a reduced risk of relapse in patients with haematological malignancies following haploidentical transplantation at the Blood and Bone Marrow Transplant Unit at Hammersmith Hospital ICHNHST. HLA 2024; 103:e15214. [PMID: 37712429 DOI: 10.1111/tan.15214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 04/06/2023] [Accepted: 06/02/2023] [Indexed: 09/16/2023]
Abstract
Relapse is a major cause of treatment failure in haploidentical haematopoietic progenitor cell transplant (HPCT) with PTCy. Natural killer cells suppress graft versus host disease and mediate the graft versus leukaemia effect, driven by killer cell immunoglobulin-like receptors (KIRs). Emerging research suggests that donor KIR genotype may influence graft outcome in haploidentical transplants with varying impacts between patient cohorts. This study investigates whether donors with greater KIR B motifs associate with outcomes such as greater relapse-free survival (RFS), overall survival (OS), nonrelapse mortality (NRM), acute graft versus host disease (GvHD) and infection. The study cohort included 98 haploidentical donor-recipient (D/R) pairs (myeloablative n = 37, RIC n = 61) with various haematological malignancies, receiving primary T-cell replete haploidentical HSCT with PTCγ. Following KIR SSO genotyping, donors are categorised into neutral (n = 63) or better and best (n = 35), based on KIR B motif content. Kaplan-Meier and Cox regression survival functions are performed to investigate associations with outcomes. Our results show that the better and best category has significantly poorer RFS (p = 0.013; hazard ratio [HR] 3.16, 95% CI 1.21-8.24: p = 0.018). The greater risk of relapse associated with poorer OS (p = 0.011; HR 2.24, 95% CI 1.18-4.24: p = 0.01) in the better and best category. The competing KIR receptor-ligand and missing licensing proof models failed to predict transplant outcomes. Here, we show neutral donors associate with favourable outcomes in T-cell replete haplo-HPCT with PTCγ after categorisation using the KIR B content model, due to the increased risk of relapse associated with the use of better and best donors.
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Affiliation(s)
- Christopher Paul Byrnes
- Histocompatibility and Immunogenetics laboratory, Infection & Immunity sciences, North West London Pathology, Imperial College Healthcare NHS Trust, London, UK
- School of Medical Sciences, University of Manchester, Manchester, UK
| | | | - Ira Lacej
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Eduardo Olavarria
- Department of Haematology, Imperial College Healthcare NHS Trust, London, UK
| | - Arthi Anand
- Histocompatibility and Immunogenetics laboratory, Infection & Immunity sciences, North West London Pathology, Imperial College Healthcare NHS Trust, London, UK
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9
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Lan X, Wu J, Liao Z, Wu Y, Hu R. Prevalence of symptoms in children with acute lymphoblastic leukaemia: a systematic review and meta-analysis. BMC Cancer 2023; 23:1113. [PMID: 37968600 PMCID: PMC10648628 DOI: 10.1186/s12885-023-11581-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 10/28/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Children with acute lymphoblastic leukaemia (ALL) experience multiple symptoms that occur in complicated patterns and negatively affect patient outcomes. To date, no systematic review has been performed on the prevalence of symptoms in children with ALL. OBJECTIVE The study aimed to report and analyse the prevalence of symptoms in children with ALL during treatment. METHODS A systematic search was conducted in eight databases (PubMed, Ovid Embase, Web of Science, CINAHL, PsycINFO, China WanFang Database, China Science and Technology Journal Database, and China National Knowledge Infrastructure) for studies published between January 1, 2000, and August 12, 2023. The methodological quality of the included studies was evaluated and a meta-analysis was performed to pool the prevalence of symptoms. RESULTS In total, 17 studies were included, from which 34 symptoms were identified. The symptom prevalence ranged between 1.5 and 91.0% and the most frequent symptoms observed were fatigue, lack of energy, dry mouth, lack of appetite, sweating, and feeling irritable, which occurred in at least 60% of the patients. CONCLUSIONS Symptoms remain highly prevalent in paediatric patients with ALL, which provides support for the need for symptom assessment in the clinical setting. Specific intervention is urgently needed to mitigate the symptoms in children with ALL and help them cope with the symptom burden.
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Affiliation(s)
- Xiaoyan Lan
- School of Nursing, Fujian Medical University, No. 1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou, 350108, Fujian Province, China
| | - Junjun Wu
- School of Nursing, Fujian Medical University, No. 1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou, 350108, Fujian Province, China
| | - Zhenling Liao
- School of Nursing, Fujian Medical University, No. 1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou, 350108, Fujian Province, China
| | - Yong Wu
- Department of Haematology, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, China.
| | - Rong Hu
- School of Nursing, Fujian Medical University, No. 1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou, 350108, Fujian Province, China.
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10
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Moyer AM, Hashmi SK, Kroning CM, Patnaik M, Litzow M, Gastineau DA, Hogan WJ, Jacob EK, Kreuter JD, Wakefield LL, Gandhi MJ. Clinical impact of KIR haplotypes in 10/10 HLA-matched unrelated donor-recipient pairs undergoing allogeneic hematopoietic stem cell transplantation. Leuk Lymphoma 2023; 64:671-678. [PMID: 36448323 DOI: 10.1080/10428194.2022.2151838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
To evaluate the impact of killer immunoglobulin-like receptor (KIR) genotyping in allogeneic hematopoietic stem cell transplantation for myeloid disorders at our institution, retrospective KIR genotyping was performed on 77 patients and their 10/10 matched unrelated donors. In a multivariate model including donor age, HLA-DPB1 permissiveness, and presence of donor KIR B/x, an association with overall survival was observed (p = .047). Within the model, increasing donor age increased risk (RR 1.03 [1.00-1.06]/year, p = .046), while donor KIR and HLA-DPB1 permissiveness were not associated with risk (RR 0.51 [0.26-1.03] and RR 0.68 [0.34-1.36]). Grouping recipients by conditioning regimen or limiting the analysis to recipients of peripheral blood stem cells, no association between donor KIR and survival or relapse was identified. No significant associations were observed between overall survival, relapse, grade III-IV acute, or chronic graft versus host disease and presence of KIR B (B/x), quantity of donor KIR B haplotype motifs, or centromeric KIR type (all p > .05).
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Affiliation(s)
- Ann M Moyer
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Cynthia M Kroning
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Mark Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Dennis A Gastineau
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Eapen K Jacob
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Justin D Kreuter
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Laurie L Wakefield
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Manish J Gandhi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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11
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Zou J, Kongtim P, Srour SA, Greenbaum U, Schetelig J, Heidenreich F, Baldauf H, Moore B, Saengboon S, Carmazzi Y, Rondon G, Ma Q, Rezvani K, Shpall EJ, Champlin RE, Ciurea SO, Cao K. Donor selection for KIR alloreactivity is associated with superior survival in haploidentical transplant with PTCy. Front Immunol 2022; 13:1033871. [PMID: 36311784 PMCID: PMC9606393 DOI: 10.3389/fimmu.2022.1033871] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
With the continuous increase in the use of haploidentical donors for transplantation, the selection of donors becomes increasingly important. Haploidentical donors have been selected primarily based on clinical characteristics, while the effects of killer cell immunoglobulin-like receptors (KIRs) on outcomes of haploidentical-hematopoietic stem cell transplantation (haplo-HSCT) with post-transplant cyclophosphamide (PTCy) remain inconclusive. The present study aimed to thoroughly evaluate the effect of KIRs and binding ligands assessed by various models, in addition to other patient/donor variables, on clinical outcomes in haplo-HSCT. In a cohort of 354 patients undergoing their first haplo-HSCT, we found that a higher Count Functional inhibitory KIR score (CF-iKIR) was associated with improved progression-free survival (adjusted hazard ratio [HR], 0.71; P = .029) and overall survival (OS) (HR, 0.66; P = .016), while none of the other models predicted for survival in these patients. Moreover, using exploratory classification and regression tree analysis, we found that donor age <58 years combined with cytomegalovirus-nonreactive recipient was associated with the best OS, whereas donor age >58 years was associated with the worst OS. In the rest of our cohort (80%), cytomegalovirus-reactive recipients with a donor <58 years old, a higher CF-iKIR was associated with superior OS. The 3-year OS rates were 73.9%, 54.1% (HR, 1.84; P = .044), 44.5% (HR, 2.01; P = .003), and 18.5% (HR, 5.44; P <.001) in the best, better, poor, and worse donor groups, respectively. Our results suggest that KIR alloreactivity assessed by CF-iKIR score can help optimize donor selection in haplo-HSCT.
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Affiliation(s)
- Jun Zou
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- *Correspondence: Jun Zou, ; Stefan O. Ciurea,
| | - Piyanuch Kongtim
- Division of Hematology/Oncology, Department of Medicine, Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange, CA, United States
- Center of Excellence in Applied Epidemiology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Samer A. Srour
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Uri Greenbaum
- Department of Hematology, Soroka University Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Johannes Schetelig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
- DKMS gemeinnützige GmbH, Tübingen, Germany
| | - Falk Heidenreich
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
- DKMS gemeinnützige GmbH, Tübingen, Germany
| | | | - Brandt Moore
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Supawee Saengboon
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Yudith Carmazzi
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Gabriela Rondon
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Qing Ma
- Department of Hematopoietic Biology and Malignancy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Katayoun Rezvani
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Elizabeth J. Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Richard E. Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Stefan O. Ciurea
- Division of Hematology/Oncology, Department of Medicine, Chao Family Comprehensive Cancer Center, University of California, Irvine, Orange, CA, United States
- *Correspondence: Jun Zou, ; Stefan O. Ciurea,
| | - Kai Cao
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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12
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Relevance of Polymorphic KIR and HLA Class I Genes in NK-Cell-Based Immunotherapies for Adult Leukemic Patients. Cancers (Basel) 2021; 13:cancers13153767. [PMID: 34359667 PMCID: PMC8345033 DOI: 10.3390/cancers13153767] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 11/30/2022] Open
Abstract
Simple Summary Immunotherapies are promising approaches to curing different acute leukemias. Natural killer (NK) cells are lymphocytes that are efficient in the elimination of leukemic cells. NK-cell-based immunotherapies are particularly attractive, but the landscape of the heterogeneity of NK cells must be deciphered. This review provides an overview of the polymorphic KIR and HLA class I genes that modulate the NK cell repertoire and how these markers can improve the outcomes of patients with acute leukemia. A better knowledge of these genetic markers that are linked to NK cell subsets that are efficient against hematological diseases will optimize hematopoietic stem-cell donor selection and NK immunotherapy design. Abstract Since the mid-1990s, the biology and functions of natural killer (NK) cells have been deeply investigated in healthy individuals and in people with diseases. These effector cells play a particularly crucial role after allogeneic hematopoietic stem-cell transplantation (HSCT) through their graft-versus-leukemia (GvL) effect, which is mainly mediated through polymorphic killer-cell immunoglobulin-like receptors (KIRs) and their cognates, HLA class I ligands. In this review, we present how KIRs and HLA class I ligands modulate the structural formation and the functional education of NK cells. In particular, we decipher the current knowledge about the extent of KIR and HLA class I gene polymorphisms, as well as their expression, interaction, and functional impact on the KIR+ NK cell repertoire in a physiological context and in a leukemic context. In addition, we present the impact of NK cell alloreactivity on the outcomes of HSCT in adult patients with acute leukemia, as well as a description of genetic models of KIRs and NK cell reconstitution, with a focus on emergent T-cell-repleted haplo-identical HSCT using cyclosphosphamide post-grafting (haplo-PTCy). Then, we document how the immunogenetics of KIR/HLA and the immunobiology of NK cells could improve the relapse incidence after haplo-PTCy. Ultimately, we review the emerging NK-cell-based immunotherapies for leukemic patients in addition to HSCT.
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13
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Prospective KIR genotype evaluation of hematopoietic cell donors is feasible with potential to benefit patients with AML. Blood Adv 2021; 5:2003-2011. [PMID: 33843984 DOI: 10.1182/bloodadvances.2020002701] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 02/22/2021] [Indexed: 11/20/2022] Open
Abstract
Donor KIR and recipient HLA combinations that minimize inhibition and favor activation of the NK repertoire are associated with improved outcomes after allogeneic hematopoietic cell transplantation (HCT) in patients with myeloid neoplasia. We prospectively evaluated a weighted donor ranking algorithm designed to prioritize HLA-compatible unrelated donors (URDs) with weak inhibitory KIR3DL1/HLA-Bw4 interaction, followed by donors with nontolerized activating KIR2DS1, and finally those with KIR centromeric B haplotype. During donor evaluation, we performed KIR genotyping and ranked 2079 URDs for 527 subjects with myelodysplastic syndrome (MDS) or acute myelogenous leukemia (AML). Among all patients, 394 (75%) had at least 1 KIR-advantageous donor, and 263 (50%) underwent HCT. In patients with AML, KIR3DL1 weak inhibition provided protection from relapse. Compared with KIR3DL1-Weak Inhibiting donors, KIR3DL1-Noninteracting donors were associated with increased risk of relapse (HR, 2.97; 95% CI, 1.33-6.64; P = .008) and inferior event-free survival (EFS; HR, 2.14; 95% CI, 1.16-3.95; P = .015). KIR3DL1-Strong Inhibiting donors were associated with HR, 1.65 (95% CI, 0.66-4.08; P = .25) for AML relapse and HR, 1.6 (95% CI, 0.81-3.17; P = .1) for EFS when compared with the use of KIR3DL1-weak inhibiting donors. Donor KIR2DS1/HLA-C1 status and centromeric KIR haplotype-B content were not associated with decreased risk of AML relapse. There was no benefit to KIR-based donor selection in patients with MDS. This study demonstrates that donor KIR typing is feasible, and prioritization of donors with certain KIR3DL1 genotypes may confer a protection from relapse after HCT in patients with AML.
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