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. 2024 Apr 29;17(1):24.
doi: 10.1186/s13045-024-01548-3.

A higher CD34 + cell dose correlates with better event-free survival after KIR-ligand mismatched cord blood transplantation for childhood acute myeloid leukemia

Hisashi Ishida  1 , Yuta Kawahara  2 , Daisuke Tomizawa  3 , Yasuhiro Okamoto  4 , Asahito Hama  5 , Yuko Cho  6 , Katsuyoshi Koh  7 , Yuhki Koga  8 , Nao Yoshida  5 , Maho Sato  9 , Kiminori Terui  10 , Naoyuki Miyagawa  11 , Akihiro Watanabe  12 , Junko Takita  13 , Ryoji Kobayashi  14 , Masaki Yamamoto  15 , Kenichiro Watanabe  16 , Keiko Okada  17 , Koji Kato  18 , Kimikazu Matsumoto  3 , Moeko Hino  19 , Ken Tabuchi  20 , Hirotoshi Sakaguchi  3
Affiliations

A higher CD34 + cell dose correlates with better event-free survival after KIR-ligand mismatched cord blood transplantation for childhood acute myeloid leukemia

Hisashi Ishida et al. J Hematol Oncol. .

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.

Keywords: Acute myeloid leukemia; Children; Cord blood cell transplantation; KIR-ligand.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Event-free survival according to the infused CD34 + cell dose in the (A) KIR-ligand match group and (B) KIR-ligand mismatch group. The cumulative incidence of (C) relapse and (D) non-relapse mortality according to the infused CD34 + cell dose in the KIR-ligand mismatch group is also shown. EFS, event-free survival; CIR, cumulative incidence of relapse; CINRM, cumulative incidence of non-relapse mortality; CI, confidence interval; NA, not available; KIR, killer immunoglobulin-like receptor
See this image and copyright information in PMC

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