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 (hr): 1.13; 95% confidence interval (ci): 1.03 to 1.24], and single patients had a reduced risk of grades 2-4 acute gvhd (hr: 0.87; 95% ci: 0.77 to 0.98). The risk of chronic gvhd was lower in widowed compared with married patients (hr: 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.

中文翻译：

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移植前婚姻状况和造血细胞移植结果

背景 关于造血细胞移植（hct）前婚姻状况对 hct 后结果影响的证据是相互矛盾的。方法 我们确定了国际血液和骨髓移植研究中心登记处 2008 年 1 月至 2015 年 12 月期间接受 HCT 的 40 岁及以上患者。HCT 前的婚姻状况被宣布为以下之一：已婚或与伴侣同居、单身（从未结过婚）、分居或离婚、丧偶。我们进行了多变量分析以确定婚姻状况与 HCT 后结果的关联。结果 我们鉴定了 10,226 例同种异体和 5714 例自体 HCT 病例，中位随访时间分别为 37 个月（范围：1-102 个月）和 40 个月（范围：1-106 个月）。在同种异体 (p = 0.58) 或自体 (p = 0.17) 环境中均未观察到婚姻状况与总生存率之间存在关联。然而，婚姻状况与 2-4 级急性移植物抗宿主病 (gvhd) (p < 0.001) 和慢性 gvhd (p = 0.04) 相关。与已婚患者相比，分居患者发生 2-4 级急性 GVHD 的风险增加[风险比 (hr)：1.13；95% 置信区间 (ci)：1.03 至 1.24]，单身患者发生 2-4 级急性 GVHD 的风险降低（hr：0.87；95% ci：0.77 至 0.98）。与已婚患者相比，丧偶患者患慢性 GVHD 的风险较低（hr：0.82；95% CI：0.67 至 0.99）。结论 hct 后的总生存率不受婚姻状况的影响，但婚姻状况与 2-4 级急性和慢性 gvhd 之间存在明显关联。为了更好地了解婚姻状况和社会支持的影响，未来的研究应考虑使用经过验证的量表来衡量社会支持以及患者和护理人员对护理人员承诺的报告，并评估与健康相关的生活质量以及医疗保健利用率。