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Differential clinical impact of HLA-DPA1~DPB1 linkage mismatches in 14/14-matched unrelated donor HSCT: a multicenter retrospective study from CMDP revealing age- and disease-specific risk patterns

Bone Marrow Transplantation (2026)Cite this article

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Optimal HLA matching is critical for allogeneic hematopoietic stem cell transplantation (HSCT) outcomes [1]. Guidelines for donor selection underscore the clinical significance of HLA-DPB1 for post-transplant outcomes [2, 3]. However, the independent and combined impacts of HLA-DPA1 mismatches, especially in linkage with DPB1, remain understudied. Previous studies found DPA1 alone did not alter DPB1 TCE matching-related risks [4], yet our single-center study noted that 70% of 14/14 HLA-matched (general 10/10 plus DQA1 and DRB3/4/5 matched) unrelated pairs had simultaneous DPA1~DPB1 mismatches and had different impact on survival [5]. As an authorized high-resolution confirmatory typing laboratory of the China Marrow Donor Program (CMDP), we conducted this retrospective multicenter study collaboratively with CMDP to explore the independent/combined effects of DPA1/DPB1 mismatches on 14/14-matched URD-HSCT outcomes, stratified by disease category and age group.

This retrospective multicenter study includes 453 donor-recipient pairs who underwent HLA 14/14-matched unrelated donor HSCT for acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), myelodysplastic syndrome (MDS), or aplastic anemia (AA) between January 2016 and April 2022. Transplant and follow-up data were obtained from the CMDP. High-resolution HLA typing for 11 HLA loci was performed using a hybrid capture-based next-generation sequencing method (AlloSeq Tx17 on MiSeqDx) as described before [5].

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Fig. 1: Impact of common HLA-DPA1~DPB1 linkage mismatches and DPB1 allelic mismatch types on transplant outcomes.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

The study was supported by the National Natural Science Foundation of China (No. 82070180), Collaborative Innovation Center of Hematology, Soochow University (SX21100121). We would like to thank CMDP Head Office and Expert Committee for their support to this research.

Funding

The study was supported by the National Natural Science Foundation of China (No. 82070180), Collaborative Innovation Center of Hematology, Soochow University (SX21100121).

Author information

Author notes

  1. These authors contributed equally: Tengteng Zhang, Xiaojing Bao.

  2. These authors jointly supervised this work: Dan Du, Jun He.

Authors and Affiliations

  1. Department of HLA Laboratory, National Clinical Research Center for Hematologic Diseases (NCRCH), Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China

    Tengteng Zhang, Xiaojing Bao, Xiaoni Yuan, Yang Li, Xue Jiang, Tianjie Yang & Jun He

  2. China Marrow Donor Program, Beijing, China

    Ying Han & Dan Du

Authors
  1. Tengteng Zhang
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  2. Xiaojing Bao
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  5. Yang Li
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Contributions

HJ designed and directed the project and provided critical suggestions during the revision of the manuscript. DD directed the project, provided transplant center data, reviewed the follow-up information and the results. ZTT participated in project design and data collection, performed the statistical analysis, and wrote the manuscript. BXJ contributed to the guidance of the manuscript structure, reviewed the data, and revised the manuscript. HY contributed to this work by supervising and assisting in the screening and verification of follow-up data. YXN contributed to the data review and interpretation of the results. LY, JX, and YYJ participated in the sequencing experiments and data analysis. All authors discussed the results and contributed to the approval of the submitted version of the manuscript. ZTT and BXJ contributed equally as co-first authors. HJ and DD jointly supervised this work.

Corresponding authors

Correspondence to Dan Du or Jun He.

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Competing interests

The authors declare no competing interests.

Ethics approval

All studies involving blood samples and human participants were reviewed and approved by the local Institutional Review Board (Approval Number:2020 Ethics Approval (Declaration) No. 322, Approval Date: March 25, 2020). This study was conducted in accordance with the ethical standards of the institutional research committee and following the declaration of Helsinki. All recipients provided written informed consent for their participation in the study.

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Zhang, T., Bao, X., Han, Y. et al. Differential clinical impact of HLA-DPA1~DPB1 linkage mismatches in 14/14-matched unrelated donor HSCT: a multicenter retrospective study from CMDP revealing age- and disease-specific risk patterns. Bone Marrow Transplant (2026). https://doi.org/10.1038/s41409-026-02835-y

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