Improved outcomes of single-unit cord blood transplantation for acute myeloid leukemia by killer immunoglobulin-like receptor 2DL1-ligand mismatch.
Improved outcomes of single-unit cord blood transplantation for acute myeloid leukemia by killer immunoglobulin-like receptor 2DL1-ligand mismatch.
复制标题
通过杀伤性免疫球蛋白样受体 2DL1 配体错配改善单单位脐带血移植治疗急性髓系白血病的结果。
DOI：
10.1038/s41409-022-01700-y
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Morishima S.
中科院分区：
文献类型：
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作者：
Yokoyama H;Kanaya M;Iemura T;Hirayama M;Yamasaki S;Kondo T;Uchida N;Takahashi S;Tanaka M;Onizuka M;Ozawa Y;Kozai Y;Eto T;Sugio Y;Hamamura A;Kawakita T;Aotsuka N;Takada S;Wake A;Kimura T;Ichinohe T;Atsuta Y;Yanada M;Morishima S.
杀伤免疫球蛋白样受体（KIR）配体不匹配对造血干细胞移植的影响是有争议的。最近，有研究表明它们对脐带血移植（CBT）的作用在不同类型的错配kirr配体和移植物抗宿主病（GVHD）预防中是不同的。为了研究它们在急性髓性白血病（AML）中的作用，回顾性评估了接受CBT的患者中KIR2DL1、KIR3DL1和kir3dl2配体（HLA-C2、Bw4和A3/11）的错配，这些患者采用钙调磷酸酶抑制剂加甲氨蝶呤（CNI/MTX）或霉酚酸酯（CNI/MMF）进行GVHD预防。在接受CNI/MTX治疗的患者中，kir配体错配对HLA-C2错配病例的复发有良好的影响（cbt后3年24.8%[无HLA-C2错配，n= 1602] vs. 15.4% [HLA-C2错配，n= 161]，P= 0.0116）。总生存率（OS） （68.2%，P= 0.0083）也优于另一组（55.0%）。多因素分析结果支持这些发现（复发的风险比[HR] 0.61，P= 0.017； OS的风险比[HR] 0.72，P= 0.016）。然而，除了HLA-C2和使用CNI/MMF预防GVHD的患者外，kir -配体错配类型的患者未观察到kir -配体错配效应。这些结果表明，使用CNI/MTX作为GVHD预防的CBT中HLA-C2失配可能改善AML患者的预后。
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.