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T-cell epitope\u2013based models classify HLA-DPB1 mismatches by permissiveness and have been associated with differential risks of GVHD, relapse, and NRM. However, most studies were conducted before the routine use of post-transplant cyclophosphamide (PTCy) as GVHD prophylaxis for unrelated donor (UD) SCT. We retrospectively analyzed 541 adults undergoing 8\/8 UD SCT with PTCy prophylaxis, categorized as DP-matched (DP-M,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009176), permissive mismatch (DP-P,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009219), non-permissive graft-versus-host (DP-NP-GVH,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200982), or host-versus-graft (DP-NP-HVG,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200964). Outcomes were compared across groups with stratification by disease risk and remission\/MRD status. Two-year relapse incidence was lower with DP-P versus DP-M (18% vs 28%; HR 0.6, 95% CI 0.4\u20130.9,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.03), most pronounced in high-risk AML\/MDS, where relapse rates approached those of lower-risk disease. This effect persisted after adjustment for remission and MRD status. GVHD incidence was unaffected by DPB1 status. OS and PFS did not differ significantly; age and comorbidity were dominant predictors of NRM. In UD SCT with PTCy, DPB1-permissive mismatching reduces relapse in high-risk AML\/MDS without increasing GVHD or NRM, supporting DP-P mismatching as an actionable donor-selection criterion.\n                  <\/jats:p>","DOI":"10.1038\/s41375-026-02907-4","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T11:52:37Z","timestamp":1773057157000},"page":"934-945","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Reduced relapse in high risk acute myeloid leukemia and myelodysplastic neoplasms with permissive HLA-DPB1 mismatches and post-transplant cyclophosphamide"],"prefix":"10.1038","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-5524-5077","authenticated-orcid":false,"given":"Portia","family":"Smallbone","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5039-021X","authenticated-orcid":false,"given":"Kai","family":"Cao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rima M.","family":"Saliba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yudith","family":"Carmarzzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7648-4377","authenticated-orcid":false,"given":"Gheath","family":"Al-Atrash","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Alvarez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela","family":"Rondon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Warren B.","family":"Fingrut","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1649-7651","authenticated-orcid":false,"given":"Yosra M.","family":"Aljawai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1669-0355","authenticated-orcid":false,"given":"Amanda L.","family":"Olson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2498-8573","authenticated-orcid":false,"given":"Amin M.","family":"Alousi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George L.","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark R.","family":"Tanner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Zou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8984-3420","authenticated-orcid":false,"given":"Jeremy L.","family":"Ramdial","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4314-5037","authenticated-orcid":false,"given":"Richard E.","family":"Champlin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth J.","family":"Shpall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1264-5968","authenticated-orcid":false,"given":"Bet\u00fcl","family":"Oran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"key":"2907_CR1","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1200\/JCO.2009.21.8073","volume":"28","author":"Z Lim","year":"2010","unstructured":"Lim Z, Brand R, Martino R, Van Biezen A, Finke J, Bacigalupo A, et al. 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