Conditioning intensity and peritransplant flow cytometric MRD dynamics in adult AML

In acute myeloid leukemia (AML), measurable residual disease (MRD) before or after allogeneic hematopoietic cell transplantation (HCT) is an established independent indicator of poor outcome. To address how peri-HCT MRD dynamics could refine risk assessment across different conditioning intensities, we analyzed 810 adults transplanted in first or second remission after myeloablative conditioning (MAC; n = 515) or non-MAC (n = 295) who underwent multiparameter flow cytometry–based MRD testing before as well as 20 to 40 days after allografting. Patients without pre- and post-HCT MRD (MRDneg/MRDneg) had the lowest risks of relapse and highest relapse-free survival (RFS) and overall survival (OS). Relative to those patients, outcomes for MRDpos/MRDpos and MRDneg/MRDpos patients were poor regardless of conditioning intensity. Outcomes for MRDpos/MRDneg patients were intermediate. Among 161 patients with MRD before HCT, MRD was cleared more commonly with a MAC (85 of 104; 81.7%) than non-MAC (33 of 57; 57.9%) regimen (P = .002). Although non-MAC regimens were less likely to clear MRD, if they did, the impact on outcome was greater. Thus, there was a significant interaction between conditioning intensity and “MRD conversion” for relapse (P = .020), RFS (P = .002), and OS (P = .001). Similar findings were obtained in the subset of 590 patients receiving HLA-matched allografts. C-statistic values were higher (indicating higher predictive accuracy) for peri-HCT MRD dynamics compared with the isolated use of pre-HCT MRD status or post-HCT MRD status for prediction of relapse, RFS, and OS. Across conditioning intensities, peri-HCT MRD dynamics improve risk assessment over isolated pre- or post-HCT MRD assessments in patients with AML

Family Structure and the Nature of Couple Relationships: Relationship Distress, Separation, Divorce, and Repartnering

The goal of this chapter is to review the current state of theoretical and empirical knowledge on the quality of the couple relationship and the family structure as determinants of parenting behavior. Ample evidence has accumulated over the past few decades that the functioning of the interparental relationship is pivotal for positive and supportive parenting. Supporting the spillover theory, relationship distress among parenting couples may increase child maladjustment, both directly and indirectly, by disrupted child-rearing and less optimal coparenting. In separated or divorced families, coparenting is a key concept to explain why some couples succeed in compartmentalizing their parenting from their spousal role. As such, cooperative coparenting has been firmly established as a central protective factor buffering the impact of parental separation on children. Based on the reviewed data among stepfamilies, it can be tentatively concluded that a cohabiting stepparent may become a significant new caregiver for the child, but only on condition of good stepparent–child relationship quality, which has emerged as crucially important for children’s adjustment in the new family environment. This chapter posits that the interparental relationship can be regarded as the key relation which is responsible for family functioning across different family types (nuclear, divorced, and stepfamilies). As a practical implication, it might, therefore, be wise to strengthen this core relationship as a potential leverage point to positively affect parents’ individual parenting and their joint coparental alliance