Improved outcomes of single-unit cord blood transplantation for acute myeloid leukemia by killer immunoglobulin-like receptor 2DL1-ligand mismatch

Hisayuki Yokoyama, Minoru Kanaya, Tomoki Iemura, Masahiro Hirayama, Satoshi Yamasaki, Tadakazu Kondo, Naoyuki Uchida, Satoshi Takahashi, Masatsugu Tanaka, Makoto Onizuka, Yukiyasu Ozawa, Yasuji Kozai, Tetsuya Eto, Yasuhiro Sugio, Atsushi Hamamura, Toshiro Kawakita, Nobuyuki Aotsuka, Satoru Takada, Atsushi Wake, Takafumi KimuraTatsuo Ichinohe, Yoshiko Atsuta, Masamitsu Yanada, Satoko Morishima

Research output: Contribution to journalArticlepeer-review

Abstract

The impact of the killer immunoglobulin-like receptor (KIR)-ligand mismatch between donor and recipient in hematopoietic stem cell transplantation is controversial. Recently, it has been suggested that their effect on cord blood transplantation (CBT) differs among types of mismatched KIR–ligand and graft-versus-host disease (GVHD) prophylaxis. To investigate their role in acute myeloid leukemia (AML), mismatch of KIR2DL1, KIR3DL1, and KIR3DL2-ligand (HLA-C2, Bw4, and A3/11) were retrospectively assessed in patients undergoing CBT with GVHD prophylaxis comprising a calcineurin inhibitor plus methotrexate (CNI/MTX) or mycophenolate mofetil (CNI/MMF). In patients who received CNI/MTX, a favorable effect of KIR-ligand mismatch on relapse was noted in HLA-C2 mismatched cases (24.8% at 3 years post-CBT [no HLA-C2 mismatch, n = 1602] vs. 15.4% [HLA-C2 mismatch, n = 161], P = 0.0116). In this group, overall survival (OS) was also superior (68.2%, P = 0.0083) compared to the other group (55.0%). Multivariate analysis results supported these findings (hazard ratio [HR] 0.61 for relapse, P = 0.017 and HR 0.72 for OS, P = 0.016). However, the KIR-ligand mismatch effect was not observed in patients with KIR-ligand mismatch types other than HLA-C2 and those using CNI/MMF for GVHD prophylaxis. These results suggest that HLA-C2 mismatch in CBT using CNI/MTX as GVHD prophylaxis may improve the outcomes of patients with AML.

Original languageEnglish
Pages (from-to)1171-1179
Number of pages9
JournalBone Marrow Transplantation
Volume57
Issue number7
DOIs
Publication statusPublished - Jul 2022

All Science Journal Classification (ASJC) codes

  • Hematology
  • Transplantation

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