文章：

KIR配体不相容对无ATG脐带血移植治疗急性白血病完全缓解临床结果的影响

Effects of KIR ligand incompatibility on clinical outcomes of umbilical cord blood transplantation without ATG for acute leukemia in complete remission

原文发布日期：2013-11-29

DOI: 10.1038/bcj.2013.62

类型: Original Article

开放获取: 是

英文摘要：

To clarify the effect of killer cell immunoglobulin-like receptor (KIR) ligand incompatibility on outcomes of acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) patients in complete remission after single cord blood transplantation (CBT), we assessed the outcomes of CBT registered in the Japan Society for Hematopoietic Cell Transplantation (JSHCT) database. A total of 643 acute leukemia (357 AML and 286 ALL) patient and donor pairs were categorized according to their KIR ligand incompatibility by determining whether or not they expressed HLA-C, Bw4 or A3/A11 by DNA typing. A total of 128 patient–donor pairs were KIR ligand-incompatible in the graft-versus-host (GVH) direction and 139 patient–donor pairs were incompatible in the host-versus-graft (HVG) direction. Univariate and multivariate analyses showed no significant differences between the KIR ligand-incompatible and compatible groups in the GVH direction for both AML and ALL patients of overall survival, disease-free survival, relapse incidence, non-relapse mortality and acute GVH disease. However, KIR incompatibility in the HVG direction ameliorated engraftment in ALL patients (hazard ratio 0.66, 95% confidence interval 0.47–0.91, P=0.013). Therefore, there were no effects of KIR ligand incompatibility in the GVH direction on single CBT outcomes for acute leukemia patients without anti-thymocyte globulin use. However, it is necessary to pay attention to KIR incompatibility in the HVG direction for engraftment.

摘要翻译： 

为阐明杀伤细胞免疫球蛋白样受体（KIR）配体不匹配对单份脐血移植（CBT）后完全缓解的急性髓系白血病（AML）和急性淋巴细胞白血病（ALL）患者预后的影响，我们评估了日本造血细胞移植学会（JSHCT）数据库中登记的CBT结局。通过DNA分型检测HLA-C、Bw4或A3/A11表达情况，将643对急性白血病（357例AML和286例ALL）供受者按KIR配体不匹配状态进行分类。其中128对供受者在移植物抗宿主（GVH）方向存在KIR配体不匹配，139对在宿主抗移植物（HVG）方向存在不匹配。单因素与多因素分析显示，在GVH方向上，无论是AML还是ALL患者，KIR配体不匹配组与匹配组在总生存期、无病生存期、复发率、非复发死亡率及急性GVH疾病方面均无显著差异。然而，HVG方向的KIR不匹配可改善ALL患者的植入（风险比0.66，95%置信区间0.47-0.91，P=0.013）。因此，在未使用抗胸腺细胞球蛋白的急性白血病患者中，GVH方向的KIR配体不匹配对单份CBT结局无影响，但需关注HVG方向的KIR不匹配对植入的影响。

原文链接：

Effects of KIR ligand incompatibility on clinical outcomes of umbilical cord blood transplantation without ATG for acute leukemia in complete remission