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ABSTRACT: The alloreactivity of natural killer cell and certain subsets of T lymphocyte are regulated by the interaction between killer immunoglobulin-like receptors (KIRs) of donor cells and human leukocyte antigen (HLA)-class I molecules on target cells. The interaction has been shown to influence the outcome of allogeneic haematopoietic stem cell transplantation (HSCT). Homozygous C1 or C2 and heterozygous C1/C2 were divided by HLA-Cw typing and they influenced the outcome of HSCT.
The purpose of the study was to analyse the impact of interaction between recipient HLA-Cw and donor KIR on outcome.
The genotypes of recipient HLA-Cw ligands and donor KIRs were correlated with the clinical outcomes of 52 patients who received HLA-matched, sibling donor HSCT for myeloid malignancies.
The incidence of chronic graft versus host disease (GVHD) was significantly lower in C1 or C2 homozygotes than in C1/C2 heterozygotes (p = 0.000). Higher overall survival (OS) and disease-free survival (DFS) rates were observed in C1 or C2 homozygotes than in C1/C2 heterozygotes (OS, 81% ± 8% vs 54% ± 10%, p = 0.034; DFS, 81% ± 8% vs 54% ± 10%, p = 0.024). A lower incidence of chronic GVHD and higher OS and DFS were observed in the HLA-KIR mismatched group (chronic GVHD, p = 0.007; OS, 84% ± 7% vs 47% ± 13%, p = 0.003; DFS, 84% ± 7% vs 47% ± 13%, p = 0.002).
The interaction between recipient HLA ligand and donor KIR had a significant impact on the outcome of patients receiving matched sibling HSCT. C1/C2 heterozygotes or HLA-KIR matched patients may benefit from additional intensified therapy with better outcome.
Schweizerische medizinische Wochenschrift 01/2013; 143. · 1.68 Impact Factor
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J Huang,
D-H Zou,
Z-J Li,
M-W Fu,
Y Xu,
Y-Z Zhao,
J-Y Qi,
S-Z Feng,
B-C Liu,
D Lin,
Y-C Mi, M-Z Han,
J-X Wang,
L-G Qiu
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ABSTRACT: Application of auto-SCT in the post-remission therapy for adolescents and young adults (AYAs) with ALL is controversial. We analyzed the outcomes of 79 AYAs (15-24 years) with ALL who received our designed total therapy protocol with auto-SCT in first CR from 1990 to 2009. The estimated OS and EFS at 5 years for the cohort were 62.8±5.9 and 61.5±5.7%. The cumulative non-relapse mortality and relapse rate at 5 years for the cohort were 7.2±3.1 and 33.6±5.8%. Time to CR >4 weeks was the only independent unfavorable factor associated with OS, EFS and relapse in multivariate analysis. Patients in standard risk (SR) group and high risk (HR) group had better OS (78.3±7.4, 63.8±10.2 vs 38.1±11.6%) and EFS (78.0±7.4, 63.4±9.4 vs 32.4±11.3%), and lower relapse rate (15.9±6.5, 31.5±9.5 vs 65.7±11.8%) compared with patients in very high risk (VHR) group. Our data confirmed that auto-SCT-based total therapy might be an optional treatment strategy for AYAs with ALL in SR. Patients in HR also could get benefit from such schedule. But for those in VHR, allogenetic SCT is still the prior recommendation for the frequent recurrence after auto-SCT.
Bone marrow transplantation 12/2011; 47(8):1087-94. · 3.00 Impact Factor
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ABSTRACT: Patients undergoing myeloablative allogeneic haematopoietic stem cell transplantation (HSCT) have a higher incidence of acute kidney injury (AKI). RIFLE is a newly developed classification for AKI that includes three grades of severity - AKI-R, AKI-I, AKI-F.
The purpose of this study was to analyse retrospectively major risk factors for AKI at the time of myeloablative allo-HSCT and to use the RIFLE criteria to predict mortality in myeloablative allo-HSCT.
Renal function was evaluated in 143 patients with allo-HSCT by RIFLE criteria in order to assess the incidence, risk factors and mortality rate of various degrees of AKI.
The results of this study showed that patients with hepatic veno-occlusive disease (HVOD) have a higher incidence of AKI-F than those without HVOD (P = 0.002). The incidence of AKI-I and AKI-F in patients with grade III-IV acute graft-versus-host disease (aGVHD) and increased total bilirubin was significantly higher than in those without (P = 0.001, P <0.001). HVOD was an independent risk factor of AKI-F (OR 5.058, 95% CI 1.317-19.424, P = 0.018), and increased total bilirubin was an independent risk factor for AKI-F (OR 5.126, 95% CI 1.403-18.998, P = 0.014). Worsening RIFLE category was associated with increased mortality of the patients in the 100 days post-transplant (P = 0.003). In addition, 180-day survival of patients in different AKI classes was significantly different (P = 0.0095).
AKI is common in patients with myeloablative allo-HSCT and is associated with increased risk of death. The RIFLE criteria appear to be an important tool for stratification of these patients on the basis of death risk.
Schweizerische medizinische Wochenschrift 01/2011; 141:w13225. · 1.68 Impact Factor
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P Zhang,
E-L Jiang,
D-L Yang,
Z-S Yan,
Y Huang,
J-L Wei,
M Wang,
Q-L Ma,
Q-G Liu,
D-H Zou,
Y He,
L-G Qiu,
S-Z Feng, M-Z Han
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ABSTRACT: Invasive fungal infections (IFI) are frequent complications of allogeneic hematopoietic stem cell transplantation (SCT) and major causes of a poor prognosis. Analysis of risk factors and prognosis of IFI are important for the control of IFI.
We retrospectively reviewed the medical records of all allogeneic SCT recipients from January 2000 to December 2007. For the homogeneity of analysis, only 286 patients with no history of IFI were included.
Fifty-five cases of IFI were identified, corresponding to cumulative incidence of 19.8%. Different overall survival rates were recorded in patients with or without IFI (20.3% vs. 55.3%, P=0.004). Multivariate analysis identified 2 risk factors of IFI: use of high-dose steroid and cytomegalovirus infections, and risk stratification can classify the patients into 3 subgroups with different incidences of IFI (9.2%, 25.4%, and 34.1%, P=0.0007). Further analysis confirmed use of steroid as a risk factor of inferior prognosis in IFI cases (0 vs. 57.1%, P<0.0001), which was due to higher rates of IFI-related mortality (64.7% vs. 23.9%, P=0.018).
Post-transplant IFI was an unfavorable prognostic factor of the SCT recipients, and risk stratification can identify patients with high risk of IFI. Use of steroid played an important role in the pathogenesis as well as prognosis of IFI.
Transplant Infectious Disease 02/2010; 12(4):316-21. · 2.22 Impact Factor
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Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi 01/1999; 19(12):663-6.
