| Objective:To study the significance of KIR gene detection in microtransplantation and to understand how to apply KIR in microtransplantation.Background:"Microtransplantation" expands the application population of HLA-incompatible hematopoietic stem cell transplantation.Because the patient’s immune function is retained,the graft forms a donor micro-chimera(microchimerism,<2.5%)in the recipient,producing an induction-specific anti-leukemia or tumor effect(GVL or GVT),and because there is no Different from traditional hematopoietic stem cell transplantation(HSCT),the pretreatment with immunosuppression does not prevent graft-versus-host disease(GVHD),and does not form a complete donor-type chimera,thus avoiding the clinically common GVHD.,providing new treatment options for patients with leukemia or other cancers.NK cells are the earliest reconstituted lymphocyte population after allogeneic hematopoietic stem cell transplantation.In the study of the relationship between NK cells and leukemia,it was found that the heterologous reactivity of NK cells has an important influence on hematopoietic stem cell transplantation.Killer cell immunoglobulin-like receptor(KIR)is a type of receptor expressed on the surface of NK cells and some T cells,which has an important effect on the function of NK cells.After microtransplantation,the disease cannot be continuously controlled,and multiple and repeated procedural infusions are required.The advantages and disadvantages of this series may be related to the expression of NK cells and their KIR..Methods:This paper introduces the characteristics of traditional hematopoietic stem cell transplantation,the characteristics of micro-transplantation,NK cells and KIR,and retrospectively analyzes the influence of KIR gene analysis on patients during leukemia.The retrospective study included a total of 30 patients with acute myeloid leukemia in a single center.Patients had their own donors.The donors and their families signed informed consent for micro-transplant therapy and agreed to micro-transplant therapy.Both the donor and the patient were asked to take HLA and KIR before the micro-transplantation.All donors were mobilized by G-CSF,and all recipients were treated with micro-transplantation more than once.Univariate analysis of the relationship between KIR and treatment-related factors and overall prognosis in the first micro-transplantation,summed up and reached relevant conclusions.A total of 30 patients were included in the study.There were 13 patients in the initial state before micro-transplantation(no induction chemotherapy or other treatment for tumor cells before micro-transplantation),12 patients who had achieved initial remission(CR)after non-initiation but multiple induction chemotherapy.Five patients who did not achieve CR or relapse after multiple treatments after multiple chemotherapy.Male to female ratio 1:1.The average age is 56 years,the median age is 60 years,the oldest is 78 years old,and the youngest is 16 years old.Thirty patients were diagnosed with AML and no acute promyelocytic leukemia.Results:In terms of cellular components infused,the number of infused mononuclear cells(MNC)was 1.81±0.57×108/kg(1 person missing data),the number of infused CD34+ cells was 1.90±0.94×106/kg,and the number of CD3+ cells infused was infused.At 0.80 ± 0.33 × 108 / kg,the number of infused NK cells was 1.75 ± 1.44 × 107 / kg.Hematopoietic recovery time after infusion of cells: white blood cell count recovery time was 9 ± 3.80 days(1 person data was missing),platelet recovery time was 13.44 ± 4.68 days(3 person data missing).The proportion of patients who had obtained CR before transplantation was 33.3%,and the CR rate after one micro-transplant was 73.3%.As of the end of follow-up,the 1-year OS rate was 73.3%,the 2-year OS rate was 43.3%,and the 3-year OS rate was 20%.In terms of KIR haplotypes,there were 19 pairs of donors with the same haplotype,9 pairs of different donors and recipients,and 2 pairs missing,accounting for 63.3%,30%,and 6.7% of 30 donors and recipients,respectively.Whether the Fisher test and the first micro-transplantation remission relationship showed p=0.452>0.05,no statistical significance;survival curve showed p=0.926>0.05,no statistical significance;Mann-Whitney test suggested its correlation with white blood cell recovery time p = 0.05,statistically significant,and platelet recovery time p = 0.940,no statistical significance.The recovery time of leukocytes in the same group of haplotypes was 10.05±3.87 days,and the recovery time of leukocytes in different groups was 6.88±3.23 days.The results of the initial treatment of 13 patients were similar to the overall 30 patients.In terms of KIR haplotypes,there were 19 pairs of donors with the same haplotype,9 pairs of different donors and recipients,and 2 pairs missing,accounting for 63.3%,30%,and 6.7% of 30 donors and recipients,respectively.Whether the Fisher test and the first micro-transplantation remission relationship showed p=0.452>0.05,no statistical significance;survival curve showed p=0.926>0.05,no statistical significance;Mann-Whitney test suggested its correlation with white blood cell recovery time p = 0.05,statistically significant,and platelet recovery time p = 0.940,no statistical significance.The recovery time of leukocytes in the same group of haplotypes was 10.05±3.87 days,and the recovery time of leukocytes in different groups was 6.88±3.23 days.The results of the initial treatment of 13 patients were similar to the overall 30 patients..Among the 13 newly diagnosed patients,the donor and recipient had 2DS1 gene(the proportion of donors was 53%,and the proportion of recipients was 38.5%).Whether the first microtransplant treatment was relieved by Fisher test showed p=0.641,p =0.731,not statistically significant;donor and recipient presence 2DS1 vs.OS relationship survival function comparison showed p=0.007<0.05,p=0.023<0.05,both statistically significant;Mann-Whitney test suggested that it was associated with hematopoiesis Recovery time relationship: donors had white blood cell recovery time and platelet recovery time of p=0.943,p=0.705,the recipient’s white blood cell recovery time and platelet recovery time were p=0.712,p=0.714.None of them were statistically significant.Conclusion:1.In patients with acute myeloid leukemia,the KIR haplotypes of donors and recipients may be related to the recovery of hematopoietic function after micro-transplantation,which is statistically significant(p=0.05),which affects the recovery time of leukocytes after microtransplantation.The different KIR haplotypes may shorten the recovery time compared to the same haplotypes,in other words,that promote the recovery of hematopoietic function after micro-transplantation.2.In the microtransplantation of patients with newly diagnosed acute myeloid leukemia,the presence of 2DS1 gene in donors or recipients may be related to patient survival,which is statistically significant(p=0.007,p=0.023).So 2DS1 may improve prognosis,and that the survival period is extended. |
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