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D’Silva SZ, Singh M, Pinto AS. NK cell defects: implication in acute myeloid leukemia. Front Immunol 2023; 14:1112059. [PMID: 37228595 PMCID: PMC10203541 DOI: 10.3389/fimmu.2023.1112059] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/25/2023] [Indexed: 05/27/2023] Open
Abstract
Acute Myeloid Leukemia (AML) is a complex disease with rapid progression and poor/unsatisfactory outcomes. In the past few years, the focus has been on developing newer therapies for AML; however, relapse remains a significant problem. Natural Killer cells have strong anti-tumor potential against AML. This NK-mediated cytotoxicity is often restricted by cellular defects caused by disease-associated mechanisms, which can lead to disease progression. A stark feature of AML is the low/no expression of the cognate HLA ligands for the activating KIR receptors, due to which these tumor cells evade NK-mediated lysis. Recently, different Natural Killer cell therapies have been implicated in treating AML, such as the adoptive NK cell transfer, Chimeric antigen receptor-modified NK (CAR-NK) cell therapy, antibodies, cytokine, and drug treatment. However, the data available is scarce, and the outcomes vary between different transplant settings and different types of leukemia. Moreover, remission achieved by some of these therapies is only for a short time. In this mini-review, we will discuss the role of NK cell defects in AML progression, particularly the expression of different cell surface markers, the available NK cell therapies, and the results from various preclinical and clinical trials.
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Affiliation(s)
- Selma Z. D’Silva
- Transplant Immunology and Immunogenetics Lab, Advanced Centre for Treatment, Education and Research in Cancer (ACTREC), Tata Memorial Centre, Navi Mumbai, India
| | - Meenakshi Singh
- Transplant Immunology and Immunogenetics Lab, Advanced Centre for Treatment, Education and Research in Cancer (ACTREC), Tata Memorial Centre, Navi Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Andrea S. Pinto
- Transplant Immunology and Immunogenetics Lab, Advanced Centre for Treatment, Education and Research in Cancer (ACTREC), Tata Memorial Centre, Navi Mumbai, India
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2
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Pulsipher MA, Ahn KW, Bunin NJ, Lalefar N, Anderson E, Flower A, Cairo MS, Talano JA, Chaudhury S, Kitko CL, Duke JL, Monos D, Leung W, Dvorak CC, Abdel-Azim H. KIR-favorable TCR-αβ/CD19-depleted haploidentical HCT in children with ALL/AML/MDS: primary analysis of the PTCTC ONC1401 trial. Blood 2022; 140:2556-2572. [PMID: 35776909 PMCID: PMC9918850 DOI: 10.1182/blood.2022015959] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/01/2022] [Accepted: 06/17/2022] [Indexed: 11/20/2022] Open
Abstract
We performed a prospective multicenter study of T-cell receptor αβ (TCR-αβ)/CD19-depleted haploidentical hematopoietic cell transplantation (HCT) in children with acute leukemia and myelodysplastic syndrome (MDS), to determine 1-year disease-free survival (DFS) and compare 2-year outcomes with recipients of other donor cell sources. Fifty-one patients aged 0.7 to 21 years were enrolled; donors were killer immunoglobulin-like receptor (KIR) favorable based on ligand mismatch and/or high B content. The 1-year DFS was 78%. Superior 2-year DFS and overall survival (OS) were noted in patients <10 years of age, those treated with reduced toxicity conditioning (RTC) rather than myeloablative conditioning, and children with minimal residual disease <0.01% before HCT. Multivariate analysis comparing the KIR-favorable haploidentical cohort with controls showed similar DFS and OS compared with other donor cell sources. Multivariate analysis also showed a marked decrease in the risk of grades 2 to 4 and 3 to 4 acute graft versus host disease (aGVHD), chronic GVHD, and transplant-related mortality vs other donor cell sources. Ethnic and racial minorities accounted for 53% of enrolled patients, and data from a large cohort of recipients/donors screened for KIR showed that >80% of recipients had a KIR-favorable donor by our definition, demonstrating that this approach is broadly applicable to groups often unable to find donors. This prospective, multicenter study showed improved outcomes using TCR-αβ/CD19-depleted haploidentical donors using RTC for children with acute leukemia and MDS. Randomized trials comparing this approach with matched unrelated donors are warranted. This trial was registered at https://clinicaltrials.gov as #NCT02646839.
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Affiliation(s)
- Michael A. Pulsipher
- Division of Hematology and Oncology, Intermountain Primary Children’s Hospital, Huntsman Cancer Institute at the University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT
- Section of Transplantation and Cellular Therapy, Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Kwang W. Ahn
- Center for International Blood and Marrow Transplant Research, Milwaukee, WI
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Nancy J. Bunin
- Division of Oncology, Center for Childhood Cancer Research and Cancer Immunotherapy Program, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Nahal Lalefar
- Department of Pediatrics, UCSF Benioff Children’s Hospital, Oakland, CA
| | - Eric Anderson
- Rady Children’s Hospital San Diego and UC San Diego School of Medicine, San Diego, CA
| | | | | | - Julie-An Talano
- Division of Pediatric Hematology-Oncology, Medical College of Wisconsin, Milwaukee, WI
| | | | - Carrie L. Kitko
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Jamie L. Duke
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania and Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Dimitrios Monos
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania and Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Wing Leung
- Department of Pediatrics, Duke-National University Singapore (NUS), Singapore
- University of Hong Kong, Hong Kong
| | - Christopher C. Dvorak
- Division of Pediatric Allergy, Immunology and Bone Marrow Transplantation, UCSF Benioff Children’s Hospital, University of California San Francisco, San Francisco, CA
| | - Hisham Abdel-Azim
- Section of Transplantation and Cellular Therapy, Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA
- Loma Linda University, School of Medicine Cancer Center, Children Hospital and Medical Center, Loma Linda, CA
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3
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Stenger W, Künkele A, Niemann M, Todorova K, Pruß A, Schulte JH, Eggert A, Oevermann L. Donor selection in a pediatric stem cell transplantation cohort using PIRCHE and HLA-DPB1 typing. Pediatr Blood Cancer 2020; 67:e28127. [PMID: 31850671 DOI: 10.1002/pbc.28127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 11/24/2019] [Accepted: 11/25/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND New strategies to optimize donor selection for hematopoietic stem cell transplantation (HSCT) have mainly been evaluated in adults, but the disease spectrum requiring HSCT differs significantly in children and has consequences for the risk of complications, such as graft-versus-host disease (GvHD). PROCEDURES Here we evaluated whether HLA-DPB1 and Predicted Indirectly ReCognizable HLA-Epitope (PIRCHE) matching can improve donor selection and minimize risks specific for a pediatric cohort undergoing HSCT in Berlin between 2014 and 2016. RESULTS The percentage of HLA-DPB1-mismatched HSCT in the pediatric cohort was in line with the general distribution among matched unrelated donor HSCT. Nonpermissive HLA-DPB1 mismatches were not associated with a higher incidence of GvHD, but the incidence of relapse was higher in patients undergoing HSCT from HLA-DPB1-matched transplantations. High PIRCHE-I scores were associated with a significantly higher risk for developing GvHD in patients undergoing HSCT from nine of ten matched unrelated donors. This finding persisted after including HLA-DPB1 into the PIRCHE analysis. CONCLUSIONS Implementing PIRCHE typing in the donor selection process for HSCT in children could particularly benefit children with nonmalignant diseases and support further validation of PIRCHE-based donor selection in a larger number of children treated at different sites.
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Affiliation(s)
- Wiebke Stenger
- Department of Pediatric Oncology and Hematology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Annette Künkele
- Department of Pediatric Oncology and Hematology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,German Cancer Consortium (DKTK), Berlin, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Kremena Todorova
- Center for Transfusion Medicine and Cell Therapies Berlin, Berlin, Germany
| | - Axel Pruß
- Center for Transfusion Medicine and Cell Therapies Berlin, Berlin, Germany
| | - Johannes H Schulte
- Department of Pediatric Oncology and Hematology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,German Cancer Consortium (DKTK), Berlin, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Angelika Eggert
- Department of Pediatric Oncology and Hematology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,German Cancer Consortium (DKTK), Berlin, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lena Oevermann
- Department of Pediatric Oncology and Hematology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,German Cancer Consortium (DKTK), Berlin, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
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4
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Escudero A, Martínez-Romera I, Fernández L, Valentín J, González-Vicent M, Vicario JL, Madero-Jarabo R, Diaz MÁ, Pérez-Martínez A. Donor KIR Genotype Impacts on Clinical Outcome after T Cell-Depleted HLA Matched Related Allogeneic Transplantation for High-Risk Pediatric Leukemia Patients. Biol Blood Marrow Transplant 2018; 24:2493-2500. [PMID: 30145228 DOI: 10.1016/j.bbmt.2018.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/13/2018] [Indexed: 12/20/2022]
Abstract
Preliminary data suggest that ex vivo T cell-depleted matched related donor (MRD) hematopoietic stem cell transplantation (HSCT) is feasible and confers a clinically beneficial reduction in graft-versus-host disease. Classically, T cell-depleted grafts were associated with reduction of the graft-versus-leukemia (GVL) effect because of delayed T cell immune reconstitution. However, natural killer (NK) cell alloreactivity is also critical for an early GVL effect as well as for lymphocyte immune reconstitution. Here, we study the role of NK cells in MRD T cell-depleted HSCT, which is still poorly understood. Given that MRD ligands for inhibitory killer cell immunoglobulin-like receptors (KIRs) are matched, we focused on activating KIR receptors. We retrospectively analyzed KIR genotyping in patients and MRDs in 40 ex vivo T cell-depleted pediatric HSCTs. The log-rank test and Cox proportional risk test were performed to correlate genotype with clinical outcome (relapse rate, disease-free survival, and overall survival) and immune reconstitution. The statistical analysis revealed poorer overall survival when donors have a KIR-B content score of ≥2, a best/better subtype, or present the KIR2DS1 gene. The patient's relapse rate was higher when donors present the KIR2DL5A gene, as well as a poorer probability of disease-free survival when the donor is classified with a best/better subtype. Regarding immune reconstitution, donor KIR haplotype A or the presence of inhibitory KIR genes promote best recovery of T lymphocytes, whereas donor KIR haplotype B or the presence of activating KIR genes confer better expansion of NK cells. These findings suggest that the selection of MRDs with an inhibitory KIR phenotype improve T cell expansion as well as the clinical outcome after pediatric ex vivo T cell-depleted HSCT.
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Affiliation(s)
- Adela Escudero
- Traslational Research in Pediatric Oncology, Hematopoietic Stem Cell Transplantation, Cell Therapy, INGEMM-IdiPAZ, La Paz University Hospital, Madrid, Spain
| | | | - Lucía Fernández
- Hematological Research Program, Cancer Research National Centre, Madrid, Spain
| | - Jaime Valentín
- Traslational Research in Pediatric Oncology, Hematopoietic Stem Cell Transplantation, Cell Therapy, INGEMM-IdiPAZ, La Paz University Hospital, Madrid, Spain
| | - Marta González-Vicent
- Department of Hemato-Oncology and Stem Cell Transplantation, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | | | - Miguel Ángel Diaz
- Department of Hemato-Oncology and Stem Cell Transplantation, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Antonio Pérez-Martínez
- Traslational Research in Pediatric Oncology, Hematopoietic Stem Cell Transplantation, Cell Therapy, INGEMM-IdiPAZ, La Paz University Hospital, Madrid, Spain; Department of Pediatric Hemato-Oncology and Stem Cell Transplantation, La Paz University Hospital. Madrid, Spain.
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5
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Sahin U, Dalva K, Gungor F, Ustun C, Beksac M. Donor-recipient killer immunoglobulin like receptor (KIR) genotype matching has a protective effect on chronic graft versus host disease and relapse incidence following HLA-identical sibling hematopoietic stem cell transplantation. Ann Hematol 2018; 97:1027-1039. [DOI: 10.1007/s00277-018-3274-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 02/02/2018] [Indexed: 01/08/2023]
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6
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Killer cell Immunoglobulin-like Receptors (KIRs) and hematopoietic stem cell transplantation outcomes. A review of the literature. Meta Gene 2017. [DOI: 10.1016/j.mgene.2016.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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7
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Sahin U, Demirer T. Future Perspectives for Haploidentical SCT. STEM CELL BIOLOGY AND REGENERATIVE MEDICINE 2017. [DOI: 10.1007/978-3-319-65319-8_13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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8
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Exploitation of natural killer cells for the treatment of acute leukemia. Blood 2016; 127:3341-9. [PMID: 27207791 DOI: 10.1182/blood-2015-12-629055] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 01/04/2016] [Indexed: 02/06/2023] Open
Abstract
Natural killer (NK) cells play an important role in surveillance and elimination of malignant cells. Their spontaneous cytotoxicity was first demonstrated in vitro against leukemia cell lines, and NK cells might play a crucial role in the therapy of leukemia. NK cell activity is controlled by an array of germ line-encoded activating and inhibitory receptors, as well as modulating coreceptors. This biologic feature can be exploited in allogeneic cell therapy, and the recognition of "missing-self" on target cells is crucial for promoting NK cell-mediated graft-versus-leukemia effects. In this regard, NK cells that express an inhibitory killer immunoglobulin-like receptor (iKIR) for which the respective major histocompatibility complex class I ligand is absent on leukemic target cells can exert alloreactivity in vitro and in vivo. Several models regarding potential donor-patient constellations have been described that have demonstrated the clinical benefit of such alloreactivity of the donor-derived NK cell system in patients with adult acute myeloid leukemia and pediatric B-cell precursor acute lymphoblastic leukemia after allogeneic stem cell transplantation. Moreover, adoptive transfer of mature allogeneic NK cells in the nontransplant or transplant setting has been shown to be safe and feasible, whereas its effectivity needs further evaluation. NK cell therapy can be further improved by optimal donor selection based on phenotypic and genotypic properties, by adoptive transfer of NK cells with ex vivo or in vivo cytokine stimulation, by the use of antibodies to induce antibody-dependent cellular cytotoxicity or to block iKIRs, or by transduction of chimeric antigen receptors.
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9
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Killer Cell Immunoglobulin-Like Receptor Ligand Mismatching: To Match or Mismatch? Biol Blood Marrow Transplant 2016; 22:192-194. [DOI: 10.1016/j.bbmt.2015.11.1101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 11/25/2015] [Indexed: 11/18/2022]
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10
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Abstract
For the majority of hematologic malignancies allogeneic hematopoietic cell transplantation (HCT) is the only curative treatment option. Sibling donors have been the standard for adult patients. Since there is not a suitable family donor for all patients, the need for alternative donors for HCT is great. Fortunately, the availability of unrelated volunteer donor registries has expanded over the years and the results of HCT with matched unrelated donors (MUD) are comparable to the results with matched related donors (MRD). Nevertheless, there are many patients lacking a well-matched donor. To increase the applicability of transplantation, alternative donors such as mismatched unrelated donors (MMURD), cord blood stem cell products and haploidentical related donors have been widely used. This review seeks to give insights into the use of MMUD donors for HCT and summarize the existing data.
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Affiliation(s)
- Henning Sebastian Schäfer
- Department of Hematology, Oncology and Stem Cell Transplantation, Albert-Ludwigs University Medical Center, Freiburg, Germany
| | - Jürgen Finke
- Department of Hematology, Oncology and Stem Cell Transplantation, Albert-Ludwigs University Medical Center, Freiburg, Germany.
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11
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Identification and utilization of donor and recipient genetic variants to predict survival after HCT: are we ready for primetime? Curr Hematol Malig Rep 2015; 10:45-58. [PMID: 25700678 PMCID: PMC4352187 DOI: 10.1007/s11899-014-0246-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Overall survival following hematopoietic cell transplantation (HCT) has improved over the past two decades through better patient selection and advances in HLA typing, supportive care, and infection prophylaxis. Nonetheless, mortality rates are still unsatisfactory and transplant-related mortality remains a major cause of death after unrelated allogeneic HCT. Since there are no known pre-HCT, non-HLA biologic predictors of survival following transplant, for over a decade, scientists have been investigating the role of non-HLA germline genetic variation in survival and treatment-related mortality after HCT. Variation in single nucleotide polymorphisms (SNPs) has the potential to impact chemotherapy, radiation, and immune responses, leading to different post-HCT survival outcomes. In this paper, we address the current knowledge of the contribution of genetic variation to survival following HCT and discuss study design and methodology for investigating HCT survival on a genomic scale.
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12
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Wu X, Yao Y, Bao X, Zhou H, Tang X, Han Y, Ma X, Liu Y, Chen J, Zhou H, Jing S, Gu B, Xu Y, Sun A, He J, Wu D. KIR2DS4 and Its Variant KIR1D Are Associated with Acute Graft-versus-Host Disease, Cytomegalovirus, and Overall Survival after Sibling-Related HLA-Matched Transplantation in Patients with Donors with KIR Gene Haplotype A. Biol Blood Marrow Transplant 2015; 22:220-225. [PMID: 26476204 DOI: 10.1016/j.bbmt.2015.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 10/04/2015] [Indexed: 10/22/2022]
Abstract
Outcomes for hematopoietic stem cell transplantation (HSCT) in various donor and recipient killer immunoglobulin-like receptor (KIR) genotypes have been studied extensively. The associations between KIR2DS4 and its variant KIR1D with outcomes of HSCT from a sibling-related HLA-matched donor with KIR haplotype A have not been explored, however. To study this, we genotyped donor-recipient pairs and divided 165 recipients of HSCT from a KIR gene haplotype A donor into 3 groups: 2DS4+/2DS4+ (2 intact KIR2DS4 alleles), 2DS4+/1D+ (heterozygous), and 1D+/1D+ (homozygous for the deletion variant KIR1D). No difference in the recovery of neutrophils and platelets among the 3 groups was observed. The cumulative incidence of grade III-IV acute graft-versus-host disease (aGVHD) within day +100 was 28.94% in the 2DS4+/2DS4+ group, 14.11% in the 2DS4+/1D+ group, and 44.44% in the 1D+/1D+ group (P = .0159). Multivariate analysis identified 1D+/1D+ as an independent risk factor for aGVHD (hazard ratio [HR], 4.221; 95% confidence interval [CI], 1.470 to 12.124; P = .007). In contrast, the cumulative incidences of chronic GVHD, 3-year cumulative relapse, and treatment-related mortality did not differ significantly among the 3 groups. The rate of cytomegalovirus (CMV) reactivation was 46.96% in the 2DS4+/2DS4+ group, 20.16% in the 2DS4+/1D+ group, and 53.25% in the 1D+/1D+ group (P = .0017). Multivariate analysis identified 2DS4+/1D+ as an independent protective factor for CMV reactivation (HR, 0.268; 95% CI, 0.125 to 0.574; P = .001). Although overall survival (OS) did not differ among the groups in the first year, the 2DS4(+)/2DS4(+) group had significantly better OS than the other groups after 1 year (P = .0361). In patients with advanced-stage disease, the 3-year probability of disease-free survival was 51.06% in the 2DS4+/2DS4+ group, 34.01% in the 2DS4+/1D+ group, and 0% in the 1D+/1D+ group (P = .0314). Collectively, our data suggest that the KIR 2DS4/1D allelic variance is associated with the outcome of sibling-related HLA-matched HSCT, and that donor subclassification of KIR 2DS4/1D alleles should be considered in this setting.
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Affiliation(s)
- Xiaojin Wu
- Department of Hematology, Jiangsu Institute of Hematology, Collaborative Innovation Center of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yao Yao
- Department of Hematology, Jiangsu Institute of Hematology, Collaborative Innovation Center of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaojing Bao
- Department of Hematology, Jiangsu Institute of Hematology, Collaborative Innovation Center of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China; HLA Laboratory, Jiangsu Institute of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Huifeng Zhou
- Department of Hematology, Jiangsu Institute of Hematology, Collaborative Innovation Center of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaowen Tang
- Department of Hematology, Jiangsu Institute of Hematology, Collaborative Innovation Center of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yue Han
- Department of Hematology, Jiangsu Institute of Hematology, Collaborative Innovation Center of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiao Ma
- Department of Hematology, Jiangsu Institute of Hematology, Collaborative Innovation Center of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuejun Liu
- Department of Hematology, Jiangsu Institute of Hematology, Collaborative Innovation Center of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jia Chen
- Department of Hematology, Jiangsu Institute of Hematology, Collaborative Innovation Center of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haixia Zhou
- Department of Hematology, Jiangsu Institute of Hematology, Collaborative Innovation Center of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Song Jing
- Department of Hematology, Jiangsu Institute of Hematology, Collaborative Innovation Center of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bing Gu
- Department of Hematology, Jiangsu Institute of Hematology, Collaborative Innovation Center of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yang Xu
- Department of Hematology, Jiangsu Institute of Hematology, Collaborative Innovation Center of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Aining Sun
- Department of Hematology, Jiangsu Institute of Hematology, Collaborative Innovation Center of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jun He
- Department of Hematology, Jiangsu Institute of Hematology, Collaborative Innovation Center of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China; HLA Laboratory, Jiangsu Institute of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China.
| | - Depei Wu
- Department of Hematology, Jiangsu Institute of Hematology, Collaborative Innovation Center of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China.
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13
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Wu S, Zeng YJ, Zhang C, Deng TX, Xu YQ, Zhang X. The role of the killer cell immunoglobulin-like receptor (KIR) "missing self" model in unrelated donor HSCT: a meta-analysis. Transplant Proc 2015; 47:558-65. [PMID: 25769607 DOI: 10.1016/j.transproceed.2015.01.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 01/10/2015] [Accepted: 01/28/2015] [Indexed: 12/29/2022]
Abstract
Some studies have found that donor-recipient killer cell immunoglobulin g-like receptor (KIRs) ligand compatibility or incompatibility influences the prognosis of hematopoietic stem cell transplantation between unrelated individuals, although the conclusions of these studies are controversial. We performed a meta-analysis concerning unrelated donor transplantation with donor-recipient KIRs compatible or incompatible. A higher 5-year overall survival rate (odds ratio [OR] = 1.93, 95% confidence interval [CI] = 1.03 to 3.61, P = .04) was found in KIR-mismatched transplantations; however, no difference was observed in the incidence of grade 2 to 4 acute graft-vs-host disease (OR = 0.94, 95% CI = 0.71 to 1.24, P = .64), 5-year relapse rate (OR = 1.05, CI = 0.75 to 1.47, P = .77), or transplantation/treatment-related mortality (OR = 0.61, CI = 0.15 to 2.51, P = .50). Our meta-analysis confirmed that incompatibility in KIR ligands favors 5-year overall survival rate but has no effect on the incidence of grade 2 to 4 acute graft-vs-host disease, relapse, or transplantation/treatment-related mortality.
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Affiliation(s)
- S Wu
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, People's Republic of China
| | - Y J Zeng
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, People's Republic of China
| | - C Zhang
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, People's Republic of China
| | - T X Deng
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, People's Republic of China
| | - Y Q Xu
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, People's Republic of China
| | - X Zhang
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, People's Republic of China.
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14
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Young JAH, Weisdorf DJ. Infections in Recipients of Hematopoietic Stem Cell Transplants. MANDELL, DOUGLAS, AND BENNETT'S PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES 2015. [PMCID: PMC7152282 DOI: 10.1016/b978-1-4557-4801-3.00312-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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15
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Hematopoietic stem cell transplantation donor sources in the 21st century: choosing the ideal donor when a perfect match does not exist. Blood 2014; 124:334-43. [DOI: 10.1182/blood-2014-02-514760] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Abstract
Most patients who require allogeneic stem cell transplantation do not have a matched sibling donor, and many patients do not have a matched unrelated donor. In an effort to increase the applicability of transplantation, alternative donors such as mismatched adult unrelated donors, haploidentical related donors, and umbilical cord blood stem cell products are frequently used when a well matched donor is unavailable. We do not yet have the benefit of randomized trials comparing alternative donor stem cell sources to inform the choice of donor; however, the existing data allow some inferences to be made on the basis of existing observational and phase 2 studies. All 3 alternative donor sources can provide effective lymphohematopoietic reconstitution, but time to engraftment, graft failure rate, graft-versus-host disease, transplant-related mortality, and relapse risk vary by donor source. These factors all contribute to survival outcomes and an understanding of them should help guide clinicians when choosing among alternative donor sources when a matched related or matched unrelated donor is not available.
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Scheper W, Gründer C, Straetemans T, Sebestyen Z, Kuball J. Hunting for clinical translation with innate-like immune cells and their receptors. Leukemia 2013; 28:1181-90. [DOI: 10.1038/leu.2013.378] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/02/2013] [Accepted: 12/04/2013] [Indexed: 12/20/2022]
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Sohn SK, Moon JH. Adoptable strategic approaches to improve outcomes of allogeneic peripheral blood stem cell transplantations from unrelated donors. Transfusion 2013; 54:1673-80. [PMID: 24261633 DOI: 10.1111/trf.12503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 10/21/2013] [Accepted: 10/22/2013] [Indexed: 11/27/2022]
Abstract
While previous studies have shown comparable clinical results for related and unrelated bone marrow transplantation (BMT), the transplantation outcomes for related and unrelated peripheral blood stem cell transplantation (PBSCT) may not follow the same pattern due to a higher incidence of graft-versus-host disease (GVHD)-related morbidity and mortality in the case of long-term survival after unrelated PBSCT. Thus, given the higher possibility of an impaired quality of life due to severe GVHD in long-term survivors who receive unrelated PBSCT, the selection of the stem cell source needs to be decided very carefully. In addition, strategic approaches, such as the extended use of immunosuppressant as a GVHD prophylaxis, the use of antithymocyte globulins (ATGs), choosing a younger donor, and optimizing the CD34+ cell dose, need to be adopted to improve the transplantation outcomes by minimizing GVHD-related morbidity and mortality in an unrelated PBSCT setting. This review article provides a comparison of BMT and PBSCT, and related and unrelated PBSCT, plus introduces several adoptable strategies to improve the outcomes of unrelated PBSCT.
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Affiliation(s)
- Sang Kyun Sohn
- Department of Hematology/Oncology, Kyungpook National University Hospital, Daegu, South Korea
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Tran IT, Sandy AR, Carulli AJ, Ebens C, Chung J, Shan GT, Radojcic V, Friedman A, Gridley T, Shelton A, Reddy P, Samuelson LC, Yan M, Siebel CW, Maillard I. Blockade of individual Notch ligands and receptors controls graft-versus-host disease. J Clin Invest 2013; 123:1590-604. [PMID: 23454750 DOI: 10.1172/jci65477] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Accepted: 01/03/2013] [Indexed: 12/12/2022] Open
Abstract
Graft-versus-host disease (GVHD) is the main complication of allogeneic bone marrow transplantation. Current strategies to control GVHD rely on global immunosuppression. These strategies are incompletely effective and decrease the anticancer activity of the allogeneic graft. We previously identified Notch signaling in T cells as a new therapeutic target for preventing GVHD. Notch-deprived T cells showed markedly decreased production of inflammatory cytokines, but normal in vivo proliferation, increased accumulation of regulatory T cells, and preserved anticancer effects. Here, we report that γ-secretase inhibitors can block all Notch signals in alloreactive T cells, but lead to severe on-target intestinal toxicity. Using newly developed humanized antibodies and conditional genetic models, we demonstrate that Notch1/Notch2 receptors and the Notch ligands Delta-like1/4 mediate all the effects of Notch signaling in T cells during GVHD, with dominant roles for Notch1 and Delta-like4. Notch1 inhibition controlled GVHD, but led to treatment-limiting toxicity. In contrast, Delta-like1/4 inhibition blocked GVHD without limiting adverse effects while preserving substantial anticancer activity. Transient blockade in the peritransplant period provided durable protection. These findings open new perspectives for selective and safe targeting of individual Notch pathway components in GVHD and other T cell-mediated human disorders.
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Affiliation(s)
- Ivy T Tran
- Life Sciences Institute, University of Michigan, Ann Arbor, Michigan 48109, USA
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Besser MJ, Shoham T, Harari-Steinberg O, Zabari N, Ortenberg R, Yakirevitch A, Nagler A, Loewenthal R, Schachter J, Markel G. Development of allogeneic NK cell adoptive transfer therapy in metastatic melanoma patients: in vitro preclinical optimization studies. PLoS One 2013; 8:e57922. [PMID: 23483943 PMCID: PMC3587427 DOI: 10.1371/journal.pone.0057922] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 01/27/2013] [Indexed: 11/19/2022] Open
Abstract
Natural killer (NK) cells have long been considered as potential agents for adoptive cell therapy for solid cancer patients. Until today most studies utilized autologous NK cells and yielded disappointing results. Here we analyze various modular strategies to employ allogeneic NK cells for adoptive cell transfer, including donor-recipient HLA-C mismatching, selective activation and induction of melanoma-recognizing lysis receptors, and co-administration of antibodies to elicit antibody-dependent cell cytotoxicity (ADCC). We show that NK cell activation and induction of the relevant lysis receptors, as well as co-administration of antibodies yield substantial anti-cancer effects, which are functionally superior to HLA-C mismatching. Combination of the various strategies yielded improved effects. In addition, we developed various clinically-compatible ex vivo expansion protocols that were optimized according to fold expansion, purity and expression of lysis receptors. The main advantages of employing allogeneic NK cells are accessibility, the ability to use a single donor for many patients, combination with various strategies associated with the mechanism of action, e.g. antibodies and specific activation, as well as donor selection according to HLA or CD16 genotypes. This study rationalizes a clinical trial that combines adoptive transfer of highly potent allogeneic NK cells and antibody therapy.
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Affiliation(s)
- Michal J. Besser
- Ella Institute of Melanoma, Sheba Medical Center, Tel Hashomer, Israel
- Department of Clinical Microbiology and Immunology, Sackler Faculty of Medicine, Tel Aviv University, GreenOnyx, Israel
| | | | - Orit Harari-Steinberg
- Ella Institute of Melanoma, Sheba Medical Center, Tel Hashomer, Israel
- Pediatric Stem Cell Research Institute, Sheba Medical Center, Tel Hashomer, Israel
| | - Naama Zabari
- Ella Institute of Melanoma, Sheba Medical Center, Tel Hashomer, Israel
- Department of Clinical Microbiology and Immunology, Sackler Faculty of Medicine, Tel Aviv University, GreenOnyx, Israel
| | - Rona Ortenberg
- Ella Institute of Melanoma, Sheba Medical Center, Tel Hashomer, Israel
- Department of Clinical Microbiology and Immunology, Sackler Faculty of Medicine, Tel Aviv University, GreenOnyx, Israel
| | - Arkadi Yakirevitch
- Department of Otolaryngology and Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel
| | - Arnon Nagler
- Division of Hematology, Sheba Medical Center, Tel Hashomer, Israel
| | - Ron Loewenthal
- Tissue Typing Laboratory, Sheba Medical Center, Tel Hashomer, Israel
| | - Jacob Schachter
- Ella Institute of Melanoma, Sheba Medical Center, Tel Hashomer, Israel
| | - Gal Markel
- Ella Institute of Melanoma, Sheba Medical Center, Tel Hashomer, Israel
- Department of Clinical Microbiology and Immunology, Sackler Faculty of Medicine, Tel Aviv University, GreenOnyx, Israel
- Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel
- * E-mail:
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Koepsell SA, Miller JS, McKenna DH. Natural killer cells: a review of manufacturing and clinical utility. Transfusion 2013; 53:404-10. [PMID: 22670662 DOI: 10.1111/j.1537-2995.2012.03724.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Scott A Koepsell
- Department of Laboratory Medicine and Pathology, Division of Transfusion Medicine, University of Minnesota Medical School, Saint Paul, USA
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Role of killer immunoglobulin-like receptor and ligand matching in donor selection. BONE MARROW RESEARCH 2012. [PMID: 23193479 PMCID: PMC3502759 DOI: 10.1155/2012/271695] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Despite all efforts to improve HLA typing and immunosuppression, it is still impossible to prevent severe graft versus host disease (GVHD) which can be fatal. GVHD is not always associated with graft versus malignancy and can prevent stem cell transplantation from reaching its goals. Overall T-cell alloreactivity is not the sole mechanism modulating the immune defense. Innate immune system has its own antigens, ligands, and mediators. The bridge between HLA and natural killer (NK) cell-mediated reactions is becoming better understood in the context of stem cell transplantation. Killer immunoglobulin-like receptors (KIRs) constitute a wide range of alleles/antigens segregated independently from the HLA alleles and classified into two major haplotypes which imprints the person's ability to suppress or to amplify T-cell alloreactivity. This paper will summarize the impact of both activating and inhibitory KIRs and their ligands on stem cell transplantation outcome. The ultimate goal is to develop algorithms based on KIR profiles to select donors with maximum antileukemic and minimum antihost effects.
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