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Does marital status affect the outcomes after allogeneic hematopoietic cell transplantation?

Bone Marrow Transplantation volume 53, pages 774–779 (2018)Cite this article

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Marital status has been reported to be associated with survival in patients with several types of cancer, including acute myeloid leukemia, and those receiving solid organ transplantation [1,2,3,4,5]. However, there have been no reports detailing the impact of marital status on outcomes after allogeneic hematopoietic cell transplantation (HCT). In this study, we retrospectively analyzed whether marital status at the time of HCT affected the outcomes of allogeneic HCT in 309 adult patients with hematological diseases at our institute.

To clarify the impact of marital status on transplant outcomes, we analyzed data from the first allogeneic HCT for 309 patients aged older than 20 years at our institute between January 2000 to January 2017. During the study period, monogamy is the rule of marriage in Japan. The probability of overall survival (OS) was estimated according to the Kaplan–Meier method, and the groups were compared using the log-rank test. The risks of relapse, transplant-related mortality (TRM), acute graft-versus-host disease (aGVHD), and chronic graft-versus-host disease (cGVHD) were estimated based on a cumulative incidence method to accommodate competing risks, and the groups were compared using Gray’s test. A multivariate analysis was performed with a Cox proportional hazard model for overall mortality or a Fine and Gray proportional hazards model for others using these factors: marital status (yes vs. no), age (<45 vs. ≥45 years), sex (male vs. female), recipient cytomegalovirus serostatus (positive vs. negative), disease status at HCT (standard risk vs. high risk), donor source [bone marrow transplantation/peripheral blood stem cell transplantation from an HLA matched-related donor (MRBMT/PBSCT) vs. bone marrow transplantation/peripheral blood stem cell transplantation from an HLA mismatched-related donor (MMRBMT/PBSCT) vs. BMT from an unrelated donor (UBMT) vs. cord blood transplantation from an unrelated donor (UCBT)], conditioning regimen [myeloablative conditioning (MAC) vs. reduced-intensity conditioning (RIC)], ABO compatibility between donor and recipient (match vs. mismatch), and year of HCT (2000–2006 vs. 2007–2017). The disease status at HCT was classified as standard or high risk based on the risk scoring scheme of the American Society for Blood and Marrow Transplantation Request for Information 2006 risk scoring schema, as previously described [6]. Acute leukemia in the first or second complete remission, myelodysplastic syndrome (MDS), myeloproliferative neoplasms (MPNs), chronic myelomonocytic leukemia (CMML) without excessive numbers of blasts, chronic myelogenous leukemia (CML) in the first chronic phase, Hodgkin’s or non-Hodgkin’s lymphoma in complete or partial chemotherapy-sensitive remission, and severe aplastic anemia were classified as standard risk; all other situations were classified as high risk. The MAC regimen was defined according to the criteria of the Center for International Blood and Marrow Transplant Research (CIBMTR), and others were classified as RIC [7]. All statistical analyses were performed with EZR (Saitama Medical Center, Jichi Medical University, Saitama, Japan) [8], a graphical user interface for R 3.0.2 (R Foundation for Statistical Computing, Vienna, Austria). P values of <0.05 were considered to be significant. This retrospective study was approved by the institutional review board of the Institute of Medical Science, the University of Tokyo.

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Acknowledgements

The authors thank all of the physicians and staff at the hospital for their help in this study.

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  1. These authors contributed equally: Tomoko Sato, Takaaki Konuma.

Authors and Affiliations

  1. Department of Nursing, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan

    Tomoko Sato, Fumiko Kasuya, Minayo Hisahara & Koji Kobayashi

  2. Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan

    Takaaki Konuma, Maki Oiwa-Monna, Susumu Tanoue, Masamichi Isobe, Koji Jimbo, Seiko Kato, Satoshi Takahashi & Arinobu Tojo

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  1. Tomoko Sato
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Correspondence to Takaaki Konuma.

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Sato, T., Konuma, T., Oiwa-Monna, M. et al. Does marital status affect the outcomes after allogeneic hematopoietic cell transplantation?. Bone Marrow Transplant 53, 774–779 (2018). https://doi.org/10.1038/s41409-018-0217-2

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