Original Investigation

Mismatched Unrelated vs Matched Related Donor Transplant With Posttransplant Cyclophosphamide Among Patients With Blood Cancers

JAMA Network Open 10.1001/jamanetworkopen.2026.23265

July 20, 2026 at 11:00 AM EDT

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For patients with high-risk hematologic malignant tumors, are relapse rates after mismatched unrelated donor (MMUD) transplant using posttransplant cyclophosphamide lower than those after matched related donor (MRD) transplant?In this cohort study of 1038 patients, the relapse rate was significantly lower after MMUD (36%) vs MRD (56%) transplant among those with high-risk disease. Disease-free survival was not significantly different.For patients with aggressive disease, MMUD grafts may offer enhanced relapse protection, suggesting donor selection should align with disease risk rather than relying solely on historical hierarchies.

Corresponding Author: Rohtesh S. Mehta, MD, MPH, MS, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 0423, Houston, TX 77030 (rmehta1@mdanderson.org).

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