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Blood, 28 May 2009, Vol. 113, No. 22, pp. 5628-5634. Prepublished online as a Blood First Edition Paper on March 27, 2009; DOI 10.1182/blood-2008-12-197467. This Article Full Text (PDF) Supplemental Tables All Versions of this Article: blood-2008-12-197467v1 113/22/5628    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Brunstein, C. G. Articles by Miller, J. S. Search for Related Content PubMed PubMed Citation Articles by Brunstein, C. G. Articles by Miller, J. S. Social Bookmarking                   What's this?  Previous Article  |  Next Article  Submitted December 31, 2008 Accepted March 12, 2009 Negative effect of KIR alloreactivity in recipients of umbilical cord blood transplantation depends on transplantation conditioning intensity Claudio G. Brunstein, John E. Wagner, Daniel J. Weisdorf, Sarah Cooley, Harriet Noreen, Juliet N. Barker, Todd DeFor, Michael R. Verneris, Bruce R. Blazar, and Jeffrey S. Miller* Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, United States * Corresponding author; email: mille011{at}umn.edu. We examined the clinical impact of killer-immunoglobulin receptor-ligand (KIR-L) mismatch in 257 recipients of single (n=91) or double (n=166) unit umbilical cord blood (UCB) grafts following myeloablative (n=155) or reduced intensity (n=102) conditioning regimens. Analyses of double unit grafts considered the KIR-L match status of the dominant engrafting unit. After myeloablative conditioning, KIR-L mismatch had no effect on grade III-IV acute acute graft-versus-host disease (GVHD), transplant-related mortality (TRM), relapse and survival. In contrast, following reduced intensity conditioning, KIR-L mismatch between the engrafted unit and the recipient resulted in significantly higher rates of grade III-IV acute GVHD (42% [CI, 27-59) vs. 13% [CI, 5-21], p < .01) and TRM (27% [CI, 12-42%] vs. 12% [CI, 5-19%], p=.03) with inferior survival (32% [CI, 15-59%] vs. 52% [CI, 47-67%], p=.03). Multivariate analysis identified KIR-L mismatch as the only predictive factor associated with the development of grade III-IV acute GVHD (RR 1.8, CI [1.1-2.9]; p=.02) and demonstrated a significant association between KIR-L mismatch and increased risk of death (RR 1.8, 95%CI, 1.0-3.1, p=.05). Our results do not support the selection of UCB units based on KIR-L status and suggest that KIR-L mismatching should be avoided in reduced intensity UCB transplantation. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: J. J. van Rood, C. E. Stevens, J. Smits, C. Carrier, C. Carpenter, and A. Scaradavou Reexposure of cord blood to noninherited maternal HLA antigens improves transplant outcome in hematological malignancies PNAS, November 24, 2009; 106(47): 19952 - 19957. [Abstract] [Full Text] [PDF]

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