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The transplant characteristics of 849 patients with acute leukaemia were obtained from the Eurocord\/EBMT database. Higher acute (a) GVHD was associated with homozygosity of UCB HLA\u2010C amino acid positions 77 and 80 (NN\/KK) (<jats:italic>p<\/jats:italic>\u2009=\u20090.008). Severe aGVHD was associated with HLA\u2010A pocket B YSAVMENVHY motif (<jats:italic>p<\/jats:italic>\u2009=\u20090.002) and NN and RR genotypes of the HLA\u2010C amino acid positions 77 and 156 (<jats:italic>p<\/jats:italic>\u2009=\u20090.006 and <jats:italic>p<\/jats:italic>\u2009=\u20090.002). Such risk was also increased in case of recipient and UCB mismatches in P4 (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001) and P9 (<jats:italic>p<\/jats:italic>\u2009=\u20090.003) pockets of HLA\u2010DQB1 alleles. For chronic GVHD, the pocket B YYAVMEISNY motif of the HLA\u2010B*15:01 allele and the absence of mismatch between recipient and UCB in the P6 pocket of HLA\u2010DRB1 were associated with a lower risk (<jats:italic>p<\/jats:italic>\u2009=\u20090.0007 and <jats:italic>p<\/jats:italic>\u2009=\u20090.0004). In relapse, both UCB pocket B YFAVMENVHY belonging to HLA\u2010A*32:01 and recipient pocket B YDSVGENYQY motif of the HLA\u2010C*07:01 allele were associated with higher risk (<jats:italic>p<\/jats:italic>\u2009=\u20090.0026 and <jats:italic>p<\/jats:italic>\u2009=\u20090.015). We provide clues on HLA\u2010mediated cellular interactions and their role in the development of GVHD and relapse.<\/jats:p>","DOI":"10.1111\/bjh.19339","type":"journal-article","created":{"date-parts":[[2024,2,21]],"date-time":"2024-02-21T11:34:15Z","timestamp":1708515255000},"page":"1920-1934","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["<scp>HLA<\/scp> peptide\u2010binding pocket diversity modulates immunological complications after cord blood transplant in acute leukaemia"],"prefix":"10.1111","volume":"204","author":[{"given":"Wahid","family":"Boukouaci","sequence":"first","affiliation":[{"name":"Univ Paris Est Cr\u00e9teil, INSERM U955, IMRB  Cr\u00e9teil France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0797-9031","authenticated-orcid":false,"given":"Monica M.","family":"Rivera\u2010Franco","sequence":"additional","affiliation":[{"name":"Eurocord, 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