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We conducted a multicenter retrospective study including 388 patients with AML, representing a disease-specific cohort undergoing first HCT across six Scandinavian centers to evaluate the prognostic role of early T-cell chimerism assessed at three months post-HCT. Mixed T-cell chimerism (MTC) was defined as\u2009&lt;\u200995% donor-derived CD3\u2009+\u2009T cells. Among patients alive and relapse-free at 12\u00a0months, three-month MTC was associated with a significantly higher 5-year cumulative incidence of relapse compared with complete T-cell chimerism (29% vs 17%, p\u2009=\u20090.024) and inferior 5-year RFS (62% vs 74%, p\u2009=\u20090.017). In contrast, pre-HCT measurable residual disease (MRD) was primarily associated with early relapse and showed a weaker association with relapse beyond 12\u00a0months. Exploratory analyses suggested that the adverse impact of pre-HCT MRD-positivity was most pronounced among patients with MTC. These findings indicate a temporal distinction in relapse dynamics, in which residual disease burden drives early relapse, whereas impaired immune reconstitution is associated with late relapse. Early T-cell chimerism may therefore identify patients at increased risk of late relapse and could contribute to improved post-HCT risk stratification.<\/jats:p>","DOI":"10.1038\/s41598-026-69047-8","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T05:34:22Z","timestamp":1788500062000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mixed T-cell chimerism at 3 months predicts late relapse in acute myeloid leukemia after allogeneic stem cell transplantation"],"prefix":"10.1038","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1868-432X","authenticated-orcid":false,"given":"Mikael","family":"Lisak","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malin","family":"Nicklasson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Palmason","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stina","family":"Wichert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders Eivind","family":"Myhre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trym","family":"D\u00f8viken","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecila","family":"Isaksson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0303-1350","authenticated-orcid":false,"given":"Kristina","family":"Carlson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan","family":"T\u00f6rl\u00e9n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per-Ola","family":"Andersson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan-Erik","family":"Johansson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Hansson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"69047_CR1","doi-asserted-by":"publisher","first-page":"4371","DOI":"10.1182\/blood-2008-03-077974","volume":"112","author":"HJ Kolb","year":"2008","unstructured":"Kolb, H. 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