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Background  Epstein-Barr virus (EBV) is the major environmental factor associated with Hodgkin's lymphoma (HL), a common lymphoma in young adults. Natural killer (NK) cells are key actors of the innate immune response against viruses. The regulation of NK cell function involves activating and inhibitory Killer cell Immunoglobulin-like receptors (KIRs), which are expressed in variable numbers on NK cells. Various viral and virus-related malignant disorders have been associated with the presence/absence of certain  KIR  genes in case/control studies. We investigated the role of the  KIR  cluster in HL in a family-based association study.    Methodology  We included 90 families with 90 HL index cases (age 16–35 years) and 255 first-degree relatives (parents and siblings). We developed a procedure for reconstructing full genotypic information (number of gene copies) at each  KIR  locus from the standard  KIR  gene content. Out of the 90 collected families, 84 were informative and suitable for further analysis. An association study was then carried out with specific family-based analysis methods on these 84 families.    Principal Findings  Five  KIR  genes in strong linkage disequilibrium were found significantly associated with HL. Refined haplotype analysis showed that the association was supported by a dominant protective effect of  KIR3DS1  and/or  KIR2DS1 , both of which are activating receptors. The odds ratios for developing HL in subjects with at least one copy of  KIR3DS1  or  KIR2DS1  with respect to subjects with neither of these genes were 0.44[95% confidence interval 0.23–0.85] and 0.42[0.21–0.85], respectively. No significant association was found in a tentative replication case/control study of 68 HL cases (age 18–71 years). In the familial study, the protective effect of  KIR3DS1 / KIR2DS1  tended to be stronger in HL patients with detectable EBV in blood or tumour cells.    Conclusions  This work defines a template for family-based association studies based on full genotypic information for the  KIR  cluster, and provides the first evidence that activating KIRs can have a protective role in HL.

Association of Killer Cell Immunoglobulin-Like Receptor Genes with Hodgkin's Lymphoma in a Familial Study