Search

Background Evidence about the impact of marital status before hematopoietic cell transplantation (HCT) on outcomes after HCT is conflicting. Methods We identified patients 40 years of age and older within the Center for International Blood and Marrow Transplant Research registry who underwent HCT between January 2008 and December 2015. Marital status before HCT was declared as one of: married or living with a partner, single (never married), separated or divorced, and widowed. We performed a multivariable analysis to determine the association of marital status with outcomes after HCT. Results We identified 10,226 allogeneic and 5714 autologous HCT cases with, respectively, a median follow-up of 37 months (range: 1-102 months) and 40 months (range: 1-106 months). No association between marital status and overall survival was observed in either the allogeneic (p = 0.58) or autologous (p = 0.17) setting. However, marital status was associated with grades 2-4 acute graft-versus-host disease (GVHD), p < 0.001, and chronic GVHD, p = 0.04. The risk of grades 2-4 acute GVHD was increased in separated compared with married patients [hazard ratio (FIR): 1.13; 95% confidence interval (CI): 1.03 to 1.24], and single patients had a reduced risk of grades 2-4 acute GVHD (FIR: 0.87; 95% CI: 0.77 to 0.98). The risk of chronic GVHD was lower in widowed compared with married patients (FIR: 0.82; 95% CI: 0.67 to 0.99). Conclusions Overall survival after HCT is not influenced by marital status, but associations were evident between marital status and grades 2-4 acute and chronic GVHD. To better appreciate the effects of marital status and social support, future research should consider using validated scales to measure social support and patient and caregiver reports of caregiver commitment, and to assess health-related quality of life together with health care utilization.

It remains unknown whether the administration of tyrosine kinase inhibitors (TKIs) targeting BCR-ABL1 after allogeneic hematopoietic cell transplantation (HCT) is associated with improved outcomes for patients with chronic myelogenous leukemia (CML). In this registry study, we analyzed clinical outcomes of 390 adult patients with CML who underwent transplantation between 2007 and 2014 and received maintenance TKI following HCT (n = 89) compared with no TKI maintenance (n = 301), as reported to the Center for International Blood and Marrow Transplant Research. All patients received TKI therapy before HCT. The majority of patients had a disease status of first chronic phase at HCT (n = 240; 62%). The study was conducted as a landmark analysis, excluding patients who died, relapsed, had chronic graft-versus-host disease, or were censored before day +100 following HCT. Of the 89 patients who received TKI maintenance, 77 (87%) received a single TKI and the other 12 (13%) received multiple sequential TKIs. The most common TKIs used for maintenance were dasatinib (n = 50), imatinib (n = 27), and nilotinib (n = 27). As measured from day +100, the adjusted estimates for 5-year relapse (maintenance, 35% versus no maintenance, 26%; P = .11), leukemia-free survival (maintenance, 42% versus no maintenance, 44%; P = .65), or overall survival (maintenance, 61% versus no maintenance, 57%; P = .61) did not differ significantly between patients receiving TKI maintenance or no maintenance. These results remained unchanged in multivariate analysis and were not modified by disease status before transplantation. In conclusion, our data from this day +100 landmark analysis do not demonstrate a significant impact of maintenance TKI therapy on clinical outcomes. The optimal approach to TKI administration in the post-transplantation setting in patients with CML remains undetermined.

The Structural Eurocodes (EN 199x) are a suite of European standards for the design of buildings and civil engineering works, published in 2006 by the European Committee for Standardization (CEN) and with implementation starting in 2010. EN 1990 sets the basis of structural design, with the other Eurocodes dealing with different materials and specific aspects of the design; Eurocode 7 (EN 1997) deals with geotechnical aspects. In 2010, CEN began a process of evolving the Eurocodes in order to incorporate improvements that reflect the state-of-the-art in engineering design and the needs of the civil engineering market; to improve the ease-of-use of the standards; and to harmonize practice between countries. The existing EN 1990 is founded on limit state concepts, and reliability of design is provided mainly by a semi-probabilistic method based on partial factors. Applying the same method to geotechnical design has proved to be difficult, and the revised EN 1990 will present improvements concerning geotechnical design. Reflecting these changes, the title of EN 1990 was changed to “Basis of structural and geotechnical design”. Although initially developed for structures involving soils, Eurocode 7 is also applicable to rock engineering design. A major target of the current revision is that the code should treat soil and rock on an equal basis. The evolution of the Eurocode 7 has been accompanied by a group of rock engineering experts working under CEN, who started their activity in 2011. The paper is authored by the current members of this group and presents the situation of the revision of Eurocode 7 in October 2019, namely: the main objectives of the revision; the new structure adopted for the code, with three parts, and the implementation schedule of the revised Eurocodes; the main changes implemented so far in geotechnical design and rock engineering; the main rock engineering aspects still needing to be addressed., QC 20230328