학술논문
A higher CD34 + cell dose correlates with better event-free survival after KIR-ligand mismatched cord blood transplantation for childhood acute myeloid leukemia
Document Type
article
Author
Hisashi Ishida; Yuta Kawahara; Daisuke Tomizawa; Yasuhiro Okamoto; Asahito Hama; Yuko Cho; Katsuyoshi Koh; Yuhki Koga; Nao Yoshida; Maho Sato; Kiminori Terui; Naoyuki Miyagawa; Akihiro Watanabe; Junko Takita; Ryoji Kobayashi; Masaki Yamamoto; Kenichiro Watanabe; Keiko Okada; Koji Kato; Kimikazu Matsumoto; Moeko Hino; Ken Tabuchi; Hirotoshi Sakaguchi
Source
Journal of Hematology & Oncology, Vol 17, Iss 1, Pp 1-5 (2024)
Subject
Language
English
ISSN
1756-8722
Abstract
Abstract Although killer Ig-like receptor ligands (KIR-L) mismatch has been associated with alloreactive natural killer cell activity and potent graft-versus-leukemia (GVL) effect among adults with acute myeloid leukemia (AML), its role among children with AML receiving cord blood transplantation (CBT) has not been determined. We conducted a retrospective study using a nationwide registry of the Japanese Society for Transplantation and Cellular Therapy. Patients who were diagnosed with de novo non-M3 AML and who underwent their first CBT in remission between 2000 and 2021 at under 16 years old were included. A total of 299 patients were included; 238 patients were in the KIR-L match group, and 61 patients were in the KIR-L mismatch group. The cumulative incidence rates of neutrophil recovery, platelet engraftment, and acute/chronic graft-versus-host disease did not differ significantly between the groups. The 5-year event-free survival (EFS) rate was 69.8% in the KIR-L match group and 74.0% in the KIR-L mismatch group (p = 0.490). Stratification by CD34 + cell dose into four groups revealed a significant correlation between CD34 + cell dose and EFS in the KIR-L mismatch group (p = 0.006) but not in the KIR-L match group (p = 0.325). According to our multivariate analysis, KIR-L mismatch with a high CD34 + cell dose (≥ median dose) was identified as an independent favorable prognostic factor for EFS (hazard ratio = 0.19, p = 0.029) and for the cumulative incidence of relapse (hazard ratio = 0.09, p = 0.021). Our results suggested that higher CD34 + cell doses are crucial for achieving a potent GVL effect in the context of KIR-L-mismatched CBT.