Pre-Transplant Marital Status and Hematopoietic Cell Transplantation Outcomes

Abstract

Background
 Evidence regarding the impact of pre-hematopoietic cell transplantation (HCT) marital status on post-HCT outcomes is conflicting.
 Methods
 We identified patients, ≥40-years within the Center for International Blood and Marrow Transplant Research registry who received a HCT between January 2008 and December 2015. Pre-HCT marital status was declared as either 1) Married/living with a partner, 2) Single/never married, 3) Separated/divorced, and 4) Widowed. We performed multivariable analysis to determine the association of marital stsatus with post-HCT outcomes.
 Results
 We identified 10,226 allogeneic and 5,714 autologous HCT patients with a median follow-up of 37 months (range 1-102) and 40 months (range 1-106) respectively. There was no association between marital status and OS in both allogeneic (p=0.58) and autologous (p=0.17) settings. However, marital status was associated with grade 2-4 acute GVHD (p<0.001) and chronic GVHD (p=0.04). There was an increased risk of grade 2-4 acute GVHD in separated patients compared with married patients [HR 1.13, 95%CI (1.03-1.24)], while single patients had a reduced risk of grade 2-4 acute GVHD [HR 0.87, 95%CI (0.77-0.98)]. The risk of chronic GVHD was lower in widowed patients [HR 0.82, 95%CI (0.67-0.99)] compared with married patients.
 Conclusions
 OS post-HCT is not influenced by marital status, but there are associations between marital status and grade 2-4 acute and chronic GVHD. Future research should consider measuring social support using validated scales, patient and caregiver reports of caregiver commitment, and assess health-related quality of life together with health-care utilization to better appreciate the impact of marital status and social support.

It Takes a Team to Make It Through: The Role of Social Support for Survival and Self-Care After Allogeneic Hematopoietic Stem Cell Transplant

“…Our findings suggest that lay caregivers and healthcare providers each serve the patients in different ways. Moreover, the different sources and networks of social support in Study 2 (see Figure 1 ) suggest that information on marital status misses the contribution of other lay caregivers, which may explain why these studies found no link between marital status and survival ( Gerull et al, 2017 ; Sato et al, 2018 ; Tay et al, 2020 ). More nuanced measures of support than marital status should be considered for future research.…”

“…An unpublished dissertation with a large sample did not find an association between support and survival ( N = 272 patients, 83% after alloHCT, 17% after autologous transplant; Artherholt, 2007 ). Three additional studies that used marital status as a support indicator failed to find a link with survival in large samples of patients after alloHCT ( N = 10,226, Tay et al, 2020 ; N = 715, Gerull et al, 2017 ; N = 309; Sato et al, 2018 ). However, two of these studies still found some evidence that social support could matter for survival: Tay et al (2020) found an association for graft-versus-host disease (GvHD), while Gerull et al (2017) found that patients with missing information on marital status had worse survival than those with available information.…”

Hematopoietic Stem Cell Transplantation Impact on Patients’ Perceived Quality of Life: A Longitudinal Study

“…Recognizing the impact of the length of hospital stay on specific facets of quality of life highlights the importance of tailored interventions and support measures during this critical phase of the transplantation process. Addressing these factors comprehensively may enhance the overall well-being and satisfaction of individuals undergoing HSCT [ 38 , 39 , 40 ].…”

“…In consonance with the findings of the current investigation, a study conducted in 2020 involving 15,940 individuals who underwent hematopoietic stem cell transplantation (HSCT) identified a link between participants’ marital status and complications, particularly graft-versus-host disease (GVHD). The occurrence of GVHD was more prevalent in single patients compared to their married and widowed counterparts, ultimately exerting a negative impact on their quality of life [ 40 ].…”