Retrospective Cohort Study of the Effects of Donor KIR genotype on the reactivation of cytomegalovirus (CMV) after myeloablative allogeneic hematopoietic stem cell transplant.

Description

This data set contains 64 consecutive patients who underwent T-cell replete, matched sibling donor reduced-intensity conditioning allogeneic hematopoietic stem cell transplant. The primary risk factor of interest was the number of activating killer immunoglobulin-like receptors (aKIRs: 1-4 vs. 5-6). (more details after variable information).

Usage

cytomegalovirus

Format

A data frame with 64 observations and 26 variables

ID

Patient ID, numeric, range: 1-64

age

Recipient age at transplant, numeric, range: 29-67

sex

Recipient sex, numeric, range: 0 (male) - 1(female)

race

Recipient race, numeric, range: 0 (white) - 1 (african-american)

diagnosis

type: character, levels: 13

diagnosis.type

Category of cancer diagnosis, numeric, range: 0 (myeloid) - 1 (lymphoid)

time.to.transplant

Time from cancer diagnosis to transplant (months), numeric, range: 1.84-173.8

prior.radiation

Prior radiation therapy, numeric, range: 0 (no) - 1 (yes)

prior.chemo

Number of prior chemotherapy regimens, numeric, range: 0-8

prior.transplant

Prior stem cell transplant, numeric, range: 0 (no) - 1 (yes)

recipient.cmv

Recipient cytomegalovirus seropositive status, numeric, range: 0 (negative) - 1 (positive)

donor.cmv

Donor cytomegalovirus seropositive status, numeric, range: 0 (negative) - 1 (positive)

donor.sex

Donor sex, numeric, range: 0 (female) - 1 (male)

TNC.dose

Total nucleated cell dose (x 10^8/kg), numeric, range: 2.06- 21.0

CD34.dose

Total CD34+ (stem) cell dose (x 10^8/kg), numeric, range: 2.04- 12.5

CD3.dose

Total CD3+ (T) cell dose (x 10^8/kg), numeric, range: 1.08- 8.2

CD8.dose

Total CD8+ cell dose (x 10^8/kg), numeric, range: 0.16- 3.2

TBI.dose

Total body irradiation dosage (centiGrays), numeric, range:200.00-400.0

C1/C2

HLA-Cw group, numeric, range: 0 (heterozygous) - 1 (homozygous)

aKIRs

Number of donor activating killer immunoglobulin-like receptors (hypothesized Predictor), numeric, range: 1.00- 6.0

cmv

cytomegalovirus reactivation posttransplant (hypothesized Outcome), numeric, range: 0 (No) - 1 (Yes)

time.to.cmv

Time to cytomegalovirus reactivation (months), numeric, range: 0.43- 84.5

agvhd

Acute level 2-4 graft versus host disease, numeric, range: 0 (no) - 1 (yes)

time.to.agvhd

Time to acute level 2-4 graft versus host disease (months), numeric, range: 0.66- 85.2

cgvhd

Chronic graft versus host disease, numeric, range: 0 (no) - 1 (yes)

time.to.cgvhd

Time to chronic graft versus host disease (months), numeric, range: 0.82- 65.1

Details

A number of demographic, baseline and transplant characteristics were also collected. The primary outcome is presence of and time to cytomegalovirus reactivation. The dataset is cleaned and relatively complete. There are no outliers or data problems.

Background

Hematopoietic stem cell transplantation (HSCT) is the transplantation of multipotent hematopoietic stem cells, from bone marrow, peripheral blood, or umbilical cord blood. It is a medical procedure most often performed for patients with certain cancers of the blood or bone marrow, such as multiple myeloma or leukemia. Allogeneic HSCT involves two people: the (healthy) donor and the (patient) recipient. Allogeneic HSC donors must have a tissue (HLA) type that matches the recipient.
In myeloablative allogeneic HSCT, chemotherapy or irradiation is given immediately prior to a transplant (the conditioning regimen) with the purpose of eradicating the patient's disease prior to the infusion of HSC and to suppress immune reactions. The bone marrow can be ablated (destroyed) with dose- levels that cause minimal injury to other tissues. For many patients who are at high risk for transplant-related mortality with myeloablative allogeneic HSCT, reduced- intensity conditioning allogeneic hematopoietic stem cell transplant has proven effective. Although the reduced-intensity conditioning allogeneic HSCT may avoid many of the organ toxicities associated with myeloablative conditioning, the risk for developing graft-versus-host disease and infection including cytomegalovirus remains significant.
Cytomegalovirus (CMV) is a common virus that can infect almost anyone. Once infected, your body retains the virus for life. Most people don't know they have CMV because it rarely causes problems in healthy people. But if pregnant or having a weakened immune system, CMV is cause for concern. For people with compromised immunity, such as after allogeneic HSCT, CMV infection can be fatal. Natural killer (NK) and T cells provide protection against CMV reactivation. The reactivity of NK cells and some T-cell subsets are regulated by the interaction of killer immunoglobulin-like receptors (KIRs) with target cell HLA class 1 molecules. The donor activating KIR genotype has been implicated as a contributing factor for CMV reactivation after myeloablative allogeneic HSCT.

Study Objective

This study investigates whether donor KIR genotype influences reactivation of CMV after T-cell replete, matched sibling donor reduced-intensity conditioning allogeneic HSCT.

Subjects and Variables

The study included 64 consecutive patients who underwent T-cell replete, matched sibling donor reduced-intensity conditioning allogeneic hematopoietic stem cell transplant between January 16, 2000 and April 24, 2007 at the Cleveland Clinic. Human leucocyte antigen (HLA) typing on donors and recipients was performed to allow assessment of killer immunoglobulin-like receptor ligands (KIRs). To allow for comparison with previous studies, donors were categorized as having 1-4 or 5-6 activating killer immunoglobulin-like receptor genes (aKIRs).
CMV reactivation was defined as any detection of cytomegalovirus DNA in the blood; the lower detection limit for this assay was 600 copies/mL.

The initial population consisted of 865 men who had undergone radical prostatectomy and received transfusion during or within 30 days of the surgical procedure at Cleveland Clinic and had available PSA follow-up data. Of these patients, 110 were excluded from the analysis because they received a combination of allogeneic and autologous blood products. Of the remaining 755 patients, 405 (54%) received solely allogeneic and 350 patients (46%) received solely autologous RBC units. Of the 405 patients who received allogeneic RBC transfusion, 89 were excluded because their transfused RBC age distribution included more than one of the terciles. Thus, this dataset consists of the 316 patients who received solely allogeneic blood products and could be classified into an RBC age exposure group.

Source

Sobecks et al. 'Cytomegalovirus Reactivation After Matched Sibling Donor Reduced-Intensity Conditioning Allogeneic Hematopoietic Stem Cell Transplant Correlates With Donor Killer Immunoglobulin-like Receptor Genotype'. Exp Clin Transplant 2011; 1: 7-13.