Specific combinations of donor and recipient KIR-HLA genotypes predict for large differences in outcome after cord blood transplantation.


Journal Article

The ability of cord blood transplantation (CBT) to prevent relapse depends partly on donor natural killer (NK) cell alloreactivity. NK effector function depends on specific killer-cell immunoglobulin-like receptors (KIR) and HLA interactions. Thus, it is important to identify optimal combinations of KIR-HLA genotypes in donors and recipients that could improve CBT outcome. We studied clinical data, KIR and HLA genotypes, and NK-cell reconstitution in CBT patients (n = 110). Results were validated in an independent cohort (n = 94). HLA-KIR genotyping of recipient germline and transplanted cord blood (CB) grafts predicted for large differences in outcome. Patients homozygous for HLA-C2 group alleles had higher 1-year relapse rate and worse survival after CBT than did HLA-C1/C1 or HLA-C1/C2 (HLA-C1/x) patients: 67.8% vs 26.0% and 15.0% vs 52.9%, respectively. This inferior outcome was associated with delayed posttransplant recovery of NK cells expressing the HLA-C2-specific KIR2DL1/S1 receptors. HLA-C1/x patients receiving a CB graft with the combined HLA-C1-KIR2DL2/L3/S2 genotype had lower 1-year relapse rate (6.7% vs 40.1%) and superior survival (74.2% vs 41.3%) compared with recipients of grafts lacking KIR2DS2 or HLA-C1 HLA-C2/C2 patients had lower relapse rate (44.7% vs 93.4%) and better survival (30.1% vs 0%) if they received a graft with the combined HLA-C2-KIR2DL1/S1 genotype. Relapsed/refractory disease at CBT, recipient HLA-C2/C2 genotype, and donor HLA-KIR genotype were independent predictors of outcome. Thus, we propose the inclusion of KIR genotyping in graft selection criteria for CBT. HLA-C1/x patients should receive an HLA-C1-KIR2DL2/L3/S2 CB graft, while HLA-C2/C2 patients may benefit from an HLA-C2-KIR2DL1/S1 graft.

Full Text

Duke Authors

Cited Authors

  • Sekine, T; Marin, D; Cao, K; Li, L; Mehta, P; Shaim, H; Sobieski, C; Jones, R; Oran, B; Hosing, C; Rondon, G; Alsuliman, A; Paust, S; Andersson, B; Popat, U; Kebriaei, P; Muftuoglu, M; Basar, R; Kondo, K; Nieto, Y; Shah, N; Olson, A; Alousi, A; Liu, E; Sarvaria, A; Parmar, S; Armstrong-James, D; Imahashi, N; Molldrem, J; Champlin, R; Shpall, EJ; Rezvani, K

Published Date

  • July 14, 2016

Published In

Volume / Issue

  • 128 / 2

Start / End Page

  • 297 - 312

PubMed ID

  • 27247137

Pubmed Central ID

  • 27247137

Electronic International Standard Serial Number (EISSN)

  • 1528-0020

Digital Object Identifier (DOI)

  • 10.1182/blood-2016-03-706317


  • eng

Conference Location

  • United States