Impact of asymmetric tethering on outcomes after edge-to-edge mitral valve repair for secondary mitral regurgitation

Abstract Background The impact of postero-anterior and medio-lateral mitral valve (MV) tethering patterns on outcomes in patients undergoing transcatheter edge-to-edge repair (M-TEER) for secondary mitral regurgitation (SMR) is unknown. Methods The ratio of the posterior to anterior MV leaflet angle (PLA/ALA) in MV segment 2 was defined as postero-anterior tethering asymmetry. Medio-lateral tethering asymmetry was assessed as the ratio of the medial (segment 3) to lateral (segment 1) MV tenting area. We used receiver-operating characteristics and a Cox regression model to identify cut-off values of asymmetric anteroposterior and medio-lateral tethering for prediction of 2 year all-cause mortality after TMVR. Results Among 178 SMR patients, postero-anterior tethering was asymmetric in 67 patients (37.9%, PLA/ALA ratio > 1.54). Asymmetric medio-lateral tethering (tenting area ratio > 1.49) was observed in 49 patients (27.5%). M-TEER reduced MR to ≤ 2 + in 92.1% of patients; MR reduction was less effective in the presence of asymmetric postero-anterior tethering (p = 0.02). A multivariable Cox regression model identified both types of asymmetric MV tethering to be associated with increased all-cause 2-year mortality (postero-anterior tethering asymmetry: HR = 2.77, CI 1.43–5.38; medio-lateral tethering asymmetry: HR = 2.90, CI 1.54–5.45; p < 0.01). Conclusions Asymmetric postero-anterior and medio-lateral MV tethering patterns are associated with increased 2-year mortality in patients undergoing M-TEER for SMR. A detailed echocardiographic analysis of MV anatomy may help to identify patients who profit most from M-TEER. Graphical abstract

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Asymmetric leaflet tethering is associated with worse outcomes after edge-to-edge mitral valve repair for secondary mitral regurgitation

European Heart Journal ◽

10.1093/eurheartj/ehab724.2218 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

L Stolz ◽

M Orban ◽

D Braun ◽

P Doldi ◽

M Orban ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Cox Regression ◽

Cox Model ◽

Operating Characteristics ◽

Valve Repair ◽

Cox Regression Analysis ◽

Secondary Mitral Regurgitation ◽

The Impact

Abstract Background The impact of mitral valve (MV) tethering patterns on outcomes of patients undergoing transcatheter edge-to-edge mitral valve repair (TEER) for severe secondary mitral regurgitation (SMR) is unknown. Purpose The purpose of this study was to evaluate the impact of asymmetric postero-anterior and medio-lateral MV leaflet tethering on procedural and survival outcomes after TEER for SMR. Methods Symmetry of postero-anterior leaflet tethering was defined as the ratio of the posterior to anterior MV leaflet angle (PLA/ALA) in the central MV segment 2. The ratio of the tenting area between MV segments 3 and 1 (S3/S1 ratio) was defined as medio-lateral tethering symmetry. We used receiver operating characteristics and a proportional Cox model to identify cut-off values of asymmetric postero-anterior and medio-lateral tethering for prediction of two-year survival after TEER. Results 178 patients receiving TEER for SMR were included. Asymmetric postero-anterior tethering was observed in 67 patients (37.6%, PLA/ALA ratio cut-off >1.54). Medio-lateral tethering was asymmetric in 49 patients (27.5%, S3/S1 ratio cut-off >1.49). MR was reduced to MR ≤2+ in 91.6% of patients, while postprocedural MR remained higher in the presence of asymmetric postero-anterior tethering (p=0.01). After adjustment for potential clinical and echocardiographic confounders, multivariable Cox regression analysis confirmed asymmetric postero-anterior tethering (HR=2.77, CI=1.43–5.38, p<0.01) and asymmetric medio-lateral tethering (HR=2.90, CI=1.54–5.45, p<0.01) as independent predictors for two-year survival. Conclusions Asymmetric postero-anterior and medio-lateral MV leaflet tethering patterns independently increase two-year all-cause mortality in patients undergoing TEER for SMR. Detailed echocardiographic patient selection might improve outcomes after TEER. FUNDunding Acknowledgement Type of funding sources: None. Postero-anterior tethering Medio-lateral tethering

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Long Term Outcome Prediction in Stemi/Nstemi Patients By Means of the Model Consisting of Simple Clinical Parameters

Emergency Medical Service ◽

10.36740/emems202103101 ◽

2021 ◽

Vol 8 (3) ◽

pp. 159-170

Author(s):

Paweł Korczyc ◽

Jędrzej Chrzanowski ◽

Arkadiusz Stasiak ◽

Joanna Stasiak ◽

Andrzej Bissinger ◽

...

Keyword(s):

Regression Model ◽

Cox Regression ◽

Everyday Practice ◽

Syntax Score ◽

Clinical Parameters ◽

Observation Study ◽

Cox Regression Model ◽

Long Term Outcome ◽

The Impact

Aim: Our study aimed to identify the clinical variables associated with long-term mortality after MI and to construct a simple, easy to use clinical practice model for the prediction of 5 year mortality after MI. Material and Methods: This is a prospective 5-year observation study of MI patients admitted to the Department of Cardiology at the Copernicus Memorial Hospital in Lodz in 2010 and 2011. The data were collected during hospitalization and again after a period of 1 and 5 years. A multi-factor multi-level Cox regression model was constructed to investigate the impact of clinical factors on long-term survival.results: 92 patients (39 STEMI, 53 NSTEMI) were included in the study and their data were used to construct a Cox regression model with satisfactory fit (R 2 =0.7945). Factors associated with a decrease in 5-year risk are: age (1.06, 95%CI: 1.01-1.11), SYNTAX score (1.05, 95%CI: 1.02-1.08), WBC level (1.16, 95%CI: 1.08-1.26), and glycemia at enrollment (1.01, 95%CI: 1.01-1.01). Higher values of HDL at enrollment were associated with a decrease in 5-year risk (HR=0.97, 95%CI: 0.93-0.99).conclusion: The model we created is a valuable tool that is useful and easy to employ in everyday practice for assessing the 5-year prognosis of patients after MI. What is new: The study presents the new model for prediction of 5-year mortality after myocardial infarction. This model is based on simple clinical parameters and may by applied in everyday practice.

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First and second waves among hospitalised patients with COVID-19 with severe pneumonia: a comparison of 28-day mortality over the 1-year pandemic in a tertiary university hospital in Italy

BMJ Open ◽

10.1136/bmjopen-2021-054069 ◽

2022 ◽

Vol 12 (1) ◽

pp. e054069

Author(s):

Marianna Meschiari ◽

Alessandro Cozzi-Lepri ◽

Roberto Tonelli ◽

Erica Bacca ◽

Marianna Menozzi ◽

...

Keyword(s):

Mortality Rate ◽

Regression Model ◽

Cox Regression ◽

Severe Pneumonia ◽

University Hospital ◽

P Value ◽

Cox Regression Model ◽

Hospitalised Patients ◽

The Impact ◽

Second Wave

ObjectiveThe first COVID-19–19 epidemic wave was over the period of February–May 2020. Since 1 October 2020, Italy, as many other European countries, faced a second wave. The aim of this analysis was to compare the 28-day mortality between the two waves among COVID-19 hospitalised patients.DesignObservational cohort study. Standard survival analysis was performed to compare all-cause mortality within 28 days after hospital admission in the two waves. Kaplan-Meier curves as well as Cox regression model analysis were used. The effect of wave on risk of death was shown by means of HRs with 95% CIs. A sensitivity analysis around the impact of the circulating variant as a potential unmeasured confounder was performed.SettingUniversity Hospital of Modena, Italy. Patients admitted to the hospital for severe COVID-19 pneumonia during the first (22 February–31 May 2020) and second (1 October–31 December 2020) waves were included.ResultsDuring the two study periods, a total of 1472 patients with severe COVID-19 pneumonia were admitted to our hospital, 449 during the first wave and 1023 during the second. Median age was 70 years (IQR 56–80), 37% women, 49% with PaO2/FiO2 <250 mm Hg, 82% with ≥1 comorbidity, median duration of symptoms was 6 days. 28-day mortality rate was 20.0% (95% CI 16.3 to 23.7) during the first wave vs 14.2% (95% CI 12.0 to 16.3) in the second (log-rank test p value=0.03). After including key predictors of death in the multivariable Cox regression model, the data still strongly suggested a lower 28-day mortality rate in the second wave (aHR=0.64, 95% CI 0.45 to 0.90, p value=0.01).ConclusionsIn our hospitalised patients with COVID-19 with severe pneumonia, the 28-day mortality appeared to be reduced by 36% during the second as compared with the first wave. Further studies are needed to identify factors that may have contributed to this improved survival.

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Impact of Non-synchronous Diagnostic Ureteroscopy on Intravesical Recurrence in Patients Underwent Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Propensity-Score Matched Analysis

10.21203/rs.2.16696/v1 ◽

2019 ◽

Author(s):

Huamao Ye ◽

Xiang Feng ◽

Yang Wang ◽

Rui Chen ◽

Meimian Hua ◽

...

Keyword(s):

Propensity Score ◽

Regression Model ◽

Urothelial Carcinoma ◽

Cox Regression ◽

Upper Tract Urothelial Carcinoma ◽

Control Group ◽

Radical Nephroureterectomy ◽

Cox Regression Model ◽

Upper Tract ◽

The Impact

Abstract Background: The effect of diagnostic ureteroscopy (DURS) on intravesical recurrence (IVR) after radical nephroureterectomy (RNU) were controversial. To investigate the impact of DURS, we carried out this single-center retrospective study by applying propensity-score matching (PSM) and Cox regression model. Patients and Methods: The data of 160 patients with pTa-pT3 upper tract urothelial carcinoma (UTUC) were analyzed. Eighty-six patients underwent DURS (DURS group) and 74 patients without DURS (control group). The DURS group was further sub-grouped into synchronous DURS group (DURS followed by immediate RNU, n=45) and non-synchronous DURS group (DURS followed by delayed RNU, n=41). Baseline confounders were corrected by PSM. The impact of DURS on IVR was assessed by Kaplan-Meier analysis in PSM cohort and by Cox regression model in the full data set. Results: The median follow-up time was 40.4 months. No difference of the 3-year IVRFS between DURS group and control group (72.6% vs. 65.3%, p=0.263). In subgroup analysis, the 3-year IVR-free survival of non-synchronous DURS group (51.4%) was significantly lower than that of synchronous DURS (78.3%) or control group (72.6%) (p=0.027). Further Cox regression analysis showed that non-synchronous DURS (HR 1.481, 95% CI 1.031-2.127, p=0.034) was independent risk factors for postoperative IVR. Conclusions: Non-synchronous DURS was not recommended for the diagnosis and preoperative evaluation of UTUC, because it could raise the risk of IVR after RNU. For UTUC patients in need of DURS, synchronous DURS could be a safer choice than the non-synchronous DURS in terms of lowering the IVR risk.

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Abstract 15604: Staging Cardiac Damage in Patients With Secondary Mitral Regurgitation

Circulation ◽

10.1161/circ.142.suppl_3.15604 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Gurpreet Singh ◽

Farnaz Namazi ◽

Kensuke Hirasawa ◽

Nina A Ajmone Marsan ◽

Victoria Delgado ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Censored Data ◽

Significant Risk ◽

Left Ventricular ◽

Cardiac Damage ◽

Stage 4 ◽

All Cause Mortality ◽

Secondary Mitral Regurgitation ◽

Stage 1

Introduction: Patients with secondary mitral regurgitation (SMR) often show extra-mitral valvular cardiac damage which can influence the prognosis. SMR can be defined according to stages of extra-mitral valvular cardiac damage. The present study evaluated the prevalence of different stages of extra-mitral valvular cardiac damage and the prognostic implications in moderate and severe SMR patients. Methods: A total of 648 patients with moderate and severe SMR were classified according to the extent of cardiac damage on echocardiography: left ventricular damage (Stage 1), left atrial damage (Stage 2), pulmonary artery vasculature damage (Stage 3) or right ventricular damage (Stage 4). Cox proportional hazards analyses were performed, both on, non-censored and censored data (included till the occurrence of mitral valve intervention). The primary endpoint was all-cause mortality. Results: The prevalence of each stage of the proposed classification was, 10% in Stage 1, 7% in Stage 2, 16% in Stage 3 and 67% in Stage 4. In the censored data, cardiac damage classification was independently associated with all-cause mortality (HR: 1.182, CI :1.019-1.370; P=0.027), and this was mainly driven by Stage 4 (HR: 1.726 CI: 1.034-2.881; p=0.037, Figure 1A). The non-censored data, showed that Stage 3 was independently associated with all-cause mortality (HR: 1.795 CI:1.121-2.876; P= 0.015), whereas Stage 4 showed an increased non-significant risk for all-cause mortality (HR: 1.472 CI:0.973-2.227; P=0.067, Figure 1B). Conclusions: A new proposed staging classification for moderate and severe SMR showed, that cardiac damage staging was independently associated with all-cause mortality in patients censored for mitral valve intervention, and this was mainly determined by RV dysfunction.

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Endostatin Is an Independent Risk Factor of Graft Loss after Kidney Transplant

American Journal of Nephrology ◽

10.1159/000507824 ◽

2020 ◽

Vol 51 (5) ◽

pp. 373-380

Author(s):

Chang Chu ◽

Ahmed A. Hasan ◽

Mohamed M.S. Gaballa ◽

Shufei Zeng ◽

Yingquan Xiong ◽

...

Keyword(s):

Risk Factors ◽

Kidney Transplant ◽

Cox Regression ◽

Graft Loss ◽

Kidney Graft ◽

Operating Characteristics ◽

Baseline Serum ◽

Collagen Xviii ◽

All Cause Mortality ◽

The Impact

Background: Endostatin is a 20-kDa C-terminal fragment of collagen XVIII, known for its ability to inhibit the proliferation of capillary endothelial cells. Previous studies suggested that circulating endostatin independently predicts incident chronic kidney disease. However, the impact of endostatin on graft loss level in kidney transplant recipients (KTRs) remains unknown. Methods: We conducted a prospective observational cohort study in 574 maintenance KTRs. Patients were followed for kidney graft loss and all-cause mortality during a median follow-up of 48 months. Serum-, and urine-samples and clinical data were collected at baseline. Serum Endostatin concentration was analyzed by an ELISA. Results: Among 574 patients, 37 patients had graft loss and 62 patients died. For graft loss, the optimal cut-off value based on receiver operating characteristics analysis (area under the curve 0.79, 95% CI 0.71–0.86, p < 0.001) of endostatin was 147.3 pmol/L. Kaplan-Meier curves revealed that higher serum endostatin concentrations positively correlated with graft loss (p < 0.001). Multivariable Cox regression analyses showed that baseline endostatin concentrations were significantly associated with graft loss after adjusting for graft loss risk factors (adjusted hazard ratio [HR] 8.34; 95% CI 2.19–31.72; p = 0.002). The adjusted HRs for classical graft loss risk factors such as baseline estimated glomerular filtration rate and urinary protein excretion were lower (1.91 and 5.44, respectively). In contrast to graft loss, baseline endostatin concentrations were not associated with all-cause mortality. Conclusion: Increased serum endostatin at baseline is independently associated with the risk of graft loss in KTRs.

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Development of Prognostic Signature Based on Pan-cancer Proteomics

10.21203/rs.3.rs-30886/v1 ◽

2020 ◽

Author(s):

Weiguo Huang ◽

Wanqing Weng ◽

Yukai Xiang ◽

Hongqi Shi

Keyword(s):

Regression Model ◽

Prognostic Model ◽

Cox Regression ◽

Cancer Prognosis ◽

Differentially Expressed ◽

Differentially Expressed Proteins ◽

Proteomics Data ◽

Operating Characteristics ◽

Cox Regression Model ◽

Pan Cancer

Abstract Background: Utilizing genomic data to predict cancer prognosis was insufficient. Proteomics can improve our understanding of the etiology and progression of cancer and improve the assessment of cancer prognosis. Based on CPTAC (Clinical Proteomic Tumor Analysis Consortium) which has generated extensive proteomics data of the vast majority of tumors, we can perform a proteomic pan-carcinoma analysis.Methods: The proteomics data and clinical features of cancer patients were collected from CPTAC. We screened 69 differentially expressed proteins with R software. GO and KEGG analysis were performed to clarify the function of these proteins. The DEPs-based prognostic model was identified by least absolute shrinkage and selection operator (LASSO)-Cox regression model. The time-dependent receiver operating characteristics analysis was used to evaluate the ability of the prognostic model to predict overall survival.Results: A total of 69 differentially expressed proteins were screened in five different types of cancers: hepatocellular carcinoma (HCC), lung adenocarcinoma (LUAD), children's brain tumor tissue consortium (CBTTC), clear cell renal cell carcinoma (CCRC) and uterine corpus endometrial carcinoma (UCEC). Furthermore, the differentially expressed proteins were related to cell metabolism, cell proliferation and extracellular matrix. Then 24 DEPs-based classifiers for predicting OS was developed by LASSO-Cox regression model in training cohort, which was validated in validation cohort. Conclusions: In the present study, we identified DEPs-based survival-predictor model to predict most cancers. We are the first group to utilize proteomics to construct a pan-cancer prognosis model, which could accurately and effectively predict the survival rate of most cancers.

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Impact of old age on resectable colorectal cancer outcomes

PeerJ ◽

10.7717/peerj.6350 ◽

2019 ◽

Vol 7 ◽

pp. e6350 ◽

Cited By ~ 1

Author(s):

Jianfei Fu ◽

Hang Ruan ◽

Hongjuan Zheng ◽

Cheng Cai ◽

Shishi Zhou ◽

...

Keyword(s):

Colorectal Cancer ◽

Regression Model ◽

Old Age ◽

Older Patients ◽

Cox Regression ◽

External Validation ◽

Seer Database ◽

Cancer Specific Survival ◽

Cox Regression Model ◽

The Impact

Objective This study was performed to identify a reasonable cutoff age for defining older patients with colorectal cancer (CRC) and to examine whether old age was related with increased colorectal cancer-specific death (CSD) and poor colorectal cancer-specific survival (CSS). Methods A total of 76,858 eligible patients from the surveillance, epidemiology, and end results (SEER) database were included in this study. The Cox proportional hazard regression model and the Chow test were used to determine a suitable cutoff age for defining the older group. Furthermore, a propensity score matching analysis was performed to adjust for heterogeneity between groups. A competing risk regression model was used to explore the impact of age on CSD and non-colorectal cancer-specific death (non-CSD). Kaplan–Meier survival curves were plotted to compare CSS between groups. Also, a Cox regression model was used to validate the results. External validation was performed on data from 1998 to 2003 retrieved from the SEER database. Results Based on a cutoff age of 70 years, the examined cohort of patients was classified into a younger group (n = 51,915, <70 years of old) and an older group (n = 24,943, ≥70 years of old). Compared with younger patients, older patients were more likely to have fewer lymph nodes sampled and were less likely to receive chemotherapy and radiotherapy. When adjusted for other covariates, age-dependent differences of 5-year CSD and 5-year non-CSD were significant in the younger and older groups (15.84% and 22.42%, P < 0.001; 5.21% and 14.21%, P < 0.001). Also an age of ≥70 years remained associated with worse CSS comparing with younger group (subdistribution hazard ratio, 1.51 95% confidence interval (CI) [1.45–1.57], P < 0.001). The Cox regression model as a sensitivity analysis had a similar result. External validation also supported an age of 70 years as a suitable cutoff, and this older group was associated with having reduced CSS and increased CSD. Conclusions A total of 70 is a suitable cutoff age to define those considered as having elderly CRC. Elderly CRC was associated with not only increased non-CSD but also with increased CSD. Further research is needed to provide evidence of whether cases of elderly CRC should receive stronger treatment if possible.

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Prognostic factors for metastatic colorectal cancer with and without bevacizumab therapy.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e14163 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e14163-e14163

Author(s):

Ikenna Osuorji ◽

Greg Dyson ◽

Durga Yerasuri ◽

Philip Agop Philip ◽

Anthony Frank Shields ◽

...

Keyword(s):

Colorectal Cancer ◽

Platelet Count ◽

Regression Model ◽

Median Survival ◽

Cox Regression ◽

Hazard Ratio ◽

Colorectal Disease ◽

Cox Regression Model ◽

Platelet Counts ◽

The Impact

e14163 Background: Metastatic colorectal disease is generally incurable and treatment is palliative with the intent to balance toxicity with quality of life. Coin 3 trial showed that pre-chemotherapy platelet counts > 400,000 per μL were associated with poor survival when intermittent chemotherapy was used, whereas patients with lower platelet counts did not have any significant difference between the intermittent and continuous chemotherapy arms. Methods: We reviewed retrospectively 775 stage IV colorectal cancer patients at Karmanos Cancer Center over a 10 year period to see if high platelet count was associated with a poor outcome irrespective of treatment. Our analysis included 480 patients with adenocarcinoma who had not received chemotherapy prior to referral, and where information on the baseline platelet count, race, and age was available. We also analyzed the impact of race, age and bevacizumab use. We used Cox regression model for analysis. Results: Among the patients 48.3% were African American (AA) and 51.7% were Caucasians (C). 34.4 % had had PLT > 400,000 per μL. For those with lower platelet counts the median survival was 26.2 months in the C and 14.1 months in the AA groups respectively. Patients with platelet above 400,000 had a median survival of 15.2 months for C and 12.6 months for AA. Cox regression analysis, showed hazard ratios for outcome of death were; 1.16(1.07-1.26) p<0.001 for age (per 10 yrs), 1.60(1.31-1.94) [AA versus C(ref)] p< 0.001 for race and 1.35(1.10-1.65)[>400 versus <] p<0.004 for platelet count. In subset analysis, 296(61.7%) patients who received chemotherapy had data regarding use of bevacizumab (B). Among the 31.7% who received B, the median survival was 25.6 months compared to14.1 months in the no B arm. A Cox regression model using B as a stratification variable showed that the impact of race {hazard ratio = 1.32 (1.02-1.69) p =0.03} and platelet count {hazard ratio = 1.27(0.97-1.65) p =0.08} were much less. Conclusions: Pre-chemotherapy Platelet count< 400,000, C race and younger age are associated with improved survival. Use of bevacizumab may mitigate the impact of these factors.

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External validation of models for KIR2DS1/KIR3DL1-informed selection of hematopoietic cell donors fails

Blood ◽

10.1182/blood.2019002887 ◽

2020 ◽

Vol 135 (16) ◽

pp. 1386-1395 ◽

Cited By ~ 7

Author(s):

Johannes Schetelig ◽

Henning Baldauf ◽

Falk Heidenreich ◽

Carolin Massalski ◽

Sandra Frank ◽

...

Keyword(s):

Regression Model ◽

Cell Transplantation ◽

Hematopoietic Cell Transplantation ◽

Cox Regression ◽

Wald Test ◽

Hematopoietic Cell ◽

Cox Regression Model ◽

Genotype Information ◽

The Impact ◽

Risk Of Relapse

Abstract Several studies suggest that harnessing natural killer (NK) cell reactivity mediated through killer cell immunoglobulin-like receptors (KIRs) could reduce the risk of relapse after allogeneic hematopoietic cell transplantation. Based on one promising model, information on KIR2DS1 and KIR3DL1 and their cognate ligands can be used to classify donors as KIR-advantageous or KIR-disadvantageous. This study was aimed at externally validating this model in unrelated donor hematopoietic cell transplantation. The impact of the predictor on overall survival (OS) and relapse incidence was tested in a Cox regression model adjusted for patient age, a modified disease risk index, Karnofsky performance status, donor age, HLA match, sex match, cytomegalovirus match, conditioning intensity, type of T-cell depletion, and graft type. Data from 2222 patients with acute myeloid leukemia or myelodysplastic syndrome were analyzed. KIR genes were typed by using high-resolution amplicon-based next-generation sequencing. In univariable analyses and subgroup analyses, OS and the cumulative incidence of relapse of patients with a KIR-advantageous donor were comparable to patients with a KIR-disadvantageous donor. The adjusted hazard ratio from the multivariable Cox regression model was 0.99 (Wald test, P = .93) for OS and 1.04 (Wald test, P = .78) for relapse incidence. We also tested the impact of activating donor KIR2DS1 and inhibition by KIR3DL1 separately but found no significant impact on OS and the risk of relapse. Thus, our study shows that the proposed model does not universally predict NK-mediated disease control. Deeper knowledge of NK-mediated alloreactivity is necessary to predict its contribution to graft-versus-leukemia reactions and to eventually use KIR genotype information for donor selection.

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