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Acute Leukemias

KIR-ligand incompatibility in the graft-versus-host direction improves outcomes after umbilical cord blood transplantation for acute leukemia

Leukemia volume 23, pages 492–500 (2009)Cite this article

A Corrigendum to this article was published on 11 March 2009

Abstract

Donor killer cell immunoglobulin-like receptor (KIR)-ligand incompatibility is associated with decreased relapse incidence (RI) and improved leukemia-free survival (LFS) after haploidentical and HLA-mismatched unrelated hematopoietic stem cell transplantation. We assessed outcomes of 218 patients with acute myeloid leukemia (AML n=94) or acute lymphoblastic leukemia (n=124) in complete remission (CR) who had received a single-unit unrelated cord blood transplant (UCBT) from a KIR-ligand-compatible or -incompatible donor. Grafts were HLA-A, -B or -DRB1 matched (n=21) or mismatched (n=197). Patients and donors were categorized according to their degree of KIR-ligand compatibility in the graft-versus-host direction by determining whether or not they expressed HLA-C group 1 or 2, HLA-Bw4 or HLA-A3/-A11. Both HLA-C/-B KIR-ligand- and HLA-A-A3/-A11 KIR-ligand-incompatible UCBT showed a trend to improved LFS (P=0.09 and P=0.13, respectively). Sixty-nine donor–patient pairs were HLA-A, -B or -C KIR-ligand incompatible and 149 compatible. KIR-ligand-incompatible UCBT showed improved LFS (hazards ratio=2.05, P=0.0016) and overall survival (OS) (hazards ratio=2.0, P=0.004) and decreased RI (hazards ratio=0.53, P=0.05). These results were more evident for AML transplant recipients (2-year LFS and RI with or without KIR-ligand incompatibility 73 versus 38% (P=0.012), and 5 versus 36% (P=0.005), respectively). UCBT for acute leukemia in CR from KIR-ligand-incompatible donors is associated with decreased RI and improved LFS and OS.

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Acknowledgements

This study was supported by DRRIC (delegation de la recherche clinique), Université de Paris VII. RW, CAR, EG and VR designed the study, were the principal investigators and wrote the paper; ML was responsible for confirming the statistical analysis; II, KB, AH and FG were responsible for data collection and quality control of the Eurocord Database; GS, GM, GS, BR, AS, MR, LM, MM and JMR were each responsible for >5 cord blood stem cell transplantations in this study; FG, JG, LL, GK, YB, CN and MB represented the Cord Blood Banks that delivered each >5% of the cord blood units in this study. All authors read the paper, gave suggestions and approved its content. A complete list of the participating transplant centers and cord blood banks participating in this study can be found on the Leukemia website.

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Author notes

  1. R Willemze, C A Rodrigues, M Labopin, G Sanz, G Michel, G Socié, B Rio, A Sirvent, M Renaud, L Madero, M Mohty, C Ferra, F Garnier, P Loiseau, J Garcia, L Lecchi, G Kögler, Y Beguin, C Navarrete, T Devos, I Ionescu, K Boudjedir, A-L Herr, E Gluckman and V Rocha: Other participating authors are listed in Acknowledgements.

Authors and Affiliations

  1. Clinical Research Unit, Eurocord Office, APHP, Hôpital Saint Louis, Université de Paris VII, Paris, France

    R Willemze, C A Rodrigues, F Garnier, I Ionescu, K Boudjedir, A-L Herr, E Gluckman & V Rocha

  2. Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands

    R Willemze

  3. Acute Leukemia Working Party, EBMT-Paris Office, Hôpital Saint Antoine AP-HP, Université Pierre et Marie Curie Paris 6,, Paris, France

    M Labopin & V Rocha

  4. Servicio de Hematologie, Hospital Universitario La Fe, Valencia, Spain

    G Sanz

  5. Service d’Oncologie Pédiatrique, Hôpital d’Enfants de la Timone, Marseille, France

    G Michel

  6. Department of Hematology and Bone Marrow Transplantation, Hôpital Saint Louis and Université de Paris VII, Denis Diderot, Paris, France,

    G Socié, P Loiseau & V Rocha

  7. Service d’Hématologie, Hôtel Dieu, Paris, France

    B Rio

  8. Hématologie Clinique, Hôpital de l′Archet 1, Nice, France

    A Sirvent

  9. Department of Hematology, Hôpital La Miletrie, Poitiers, France

    M Renaud

  10. Department of Pediatrics, Nino Jesus Children's Hospital, Madrid, Spain

    L Madero

  11. Department of Hematology, Hôtel Dieu, Nantes, France,

    M Mohty

  12. Department of Hematology, Hospital Universitari Germans Trias I Pujol, Barcelona, Spain

    C Ferra

  13. French Network of Cord Blood Banks, Paris, France,

    F Garnier

  14. Cord Blood Bank, Barcelona, Spain

    J Garcia

  15. Cord Blood Bank and GRACE, Milano, Italy

    L Lecchi

  16. Eurocord José Carreras Stammzellbank, Düsseldorf, Germany

    G Kögler

  17. Cord Blood Bank, Liège, Belgium

    Y Beguin

  18. NHS Cord Blood Bank, London, UK

    C Navarrete

  19. De Leuvense Navelstrengbloedbank, Leuven, Belgium

    T Devos

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  1. R Willemze
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on behalf of Eurocord-Netcord and Acute Leukaemia Working Party of the EBMT, Paris (F)

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Correspondence to R Willemze.

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Supplementary Information accompanies the paper on the Leukemia website (http://www.nature.com/leu)

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Willemze, R., Rodrigues, C., Labopin, M. et al. KIR-ligand incompatibility in the graft-versus-host direction improves outcomes after umbilical cord blood transplantation for acute leukemia. Leukemia 23, 492–500 (2009). https://doi.org/10.1038/leu.2008.365

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