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HLA class I molecules participate in natural killer cell regulation by acting as ligands for inhibitory killer cell Ig-like receptors (KIRs). One individual may express one or more inhibitory KIR lacking the corresponding HLA ligand. The role of this 'missing KIR ligand' constellation in hematopoietic SCT (HSCT) remains controversial and depends on incompletely defined transplant variables. We have retrospectively analyzed the effects of missing HLA-C group 1/2 and Bw4 KIR ligands in the recipients on the outcome in 382 HSCT, comparing 118 BMT to 264 PBSC transplants (PBSCT). In the multivariate Cox analysis of PBSCT, poor PFS was observed in homozygous HLA-C group 2 (C2/2) recipients (risk ratio (RR), 1.59; P=0.026). In contrast, C2 homozygosity was not unfavorable after BMT (RR, 0.68; P=0.16). C2 homozygous recipients (n=68) had better PFS after BMT than after PBSCT (RR, 0.17; P=0.001), due to fewer relapses (RR, 0.27; P=0.018). Missing Bw4 favorably influenced PFS after BMT (RR, 0.56; P=0.04), but not after PBSCT. These data suggest opposite effects of missing KIR ligands in BMT vs PBSCT. Larger studies are required to reassess whether BMT should be preferred to PBSCT as an option for C2/C2 recipients. [ABSTRACT FROM AUTHOR]

Invasive fungal infections (IFI) remain a leading cause of morbidity and mortality in immunocompromised patients. Despite major improvements, it often remains difficult to obtain accurate diagnosis in neutropenic patients. Timely initiation of antifungal treatment in this high-risk population is mandatory to improve survival. Today, clinicians have a choice among a growing armamentarium of novel antifungal agents. Agents such as "veteran" amphotericin B deoxycholate (d-AMB) have been replaced with lipid formulations, and new generation triazoles as well as novel class echinocandins finally offer opportunities to improve prognosis with less systemic toxicity. Clinical decision-making depends on several guidelines, published studies and not least on economic considerations. The current review summarises up-to-date treatment recommendations of the DGHO/AGIHO, and ECIL-3, as well as the recently published 2010 Clinical Practice Guidelines of the IDSA. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses a study on the significance of pre transplant non-invasive transient elastography as predictor for post-transplant liver toxicity.