The effect of an online acceptance and commitment intervention on the meaning-making process in cancer patients following hematopoietic cell transplantation: study protocol for a randomized controlled trial enhanced with single-case experimental design.

BACKGROUND: Hematopoietic cell transplantation (HCT) is a highly invasive and life-threatening treatment for hematological neoplasms and some types of cancer that can challenge the patient's meaning structures. Restoring meaning (i.e., building more flexible and significant explanations of the disease and treatment burden) can be aided by strengthening psychological flexibility by means of an Acceptance and Commitment Therapy (ACT) intervention. Thus, this trial aims to examine the effect of the ACT intervention on the meaning-making process and the underlying mechanisms of change in patients following HCT compared to a minimally enhanced usual care (mEUC) control group. The trial will be enhanced with a single-case experimental design (SCED), where ACT interventions will be compared between individuals with various pre-intervention intervals. METHODS: In total, 192 patients who qualify for the first autologous or allogeneic HCT will be recruited for a two-armed parallel randomized controlled trial comparing an online self-help 14-day ACT training to education sessions (recommendations following HCT). In both conditions, participants will receive once a day a short survey and intervention proposal (about 5-10 min a day) in the outpatient period. Double-blinded assessment will be conducted at baseline, during the intervention, immediately, 1 month, and 3 months after the intervention. In addition, 6-9 participants will be invited to SCED and randomly assigned to pre-intervention measurement length (1-3 weeks) before completing ACT intervention, followed by 7-day observations at the 2nd and 3rd post-intervention measure. The primary outcome is meaning-related distress. Secondary outcomes include psychological flexibility, meaning-making coping, meanings made, and well-being as well as global and situational meaning. DISCUSSION: This trial represents the first study that integrates the ACT and meaning-making frameworks to reduce meaning-related distress, stimulate the meaning-making process, and enhance the well-being of HCT recipients. Testing of an intervention to address existential concerns unique to patients undergoing HCT will be reinforced by a statistically rigorous idiographic approach to see what works for whom and when. Since access to interventions in the HCT population is limited, the web-based ACT self-help program could potentially fill this gap. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT06266182. Registered on February 20, 2024.

MICB Genetic Variants and Its Protein Soluble Level Are Associated with the Risk of Chronic GvHD and CMV Infection after Allogeneic HSCT.

The aim of the present study was to determine the associations between the MICB genetic variability and the expression and the risk of development of post-transplant complications after allogeneic hematopoietic stem cell transplantation (HSCT). HSCT recipients and their donors were genotyped for two MICB polymorphisms (rs1065075, rs3828903). Moreover, the expression of a soluble form of MICB was determined in the recipients' serum samples after transplantation using the Luminex assay. Our results revealed a favorable role of the MICB rs1065075 G allele. Recipients with donors carrying this genetic variant were less prone to developing chronic graft-versus-host disease (cGvHD) when compared to recipients without any symptoms of this disease (41.41% vs. 65.38%, p = 0.046). Moreover, the MICB rs1065075 G allele was associated with a lower incidence of cytomegalovirus (CMV) reactivation, both as a donor (p = 0.015) and as a recipient allele (p = 0.039). The MICB rs1065075 G variant was also found to be associated with decreased serum soluble MICB (sMICB) levels, whereas serum sMICB levels were significantly higher in recipients diagnosed with CMV infection (p = 0.0386) and cGvHD (p = 0.0008) compared to recipients without those complications. A protective role of the G allele was also observed for the rs3828903 polymorphism, as it was more frequently detected among donors of recipients without cGvHD (89.90% vs. 69.23%; p = 0.013). MICB genetic variants, as well as serum levels of sMICB, may serve as prognostic factors for the risk of developing cGvHD and CMV infection after allogeneic HSCT.

Optimizing Outcomes in Mismatched Unrelated Donor Allogeneic Transplantation: Post-Transplant Cyclophosphamide's Dual Impact on Graft versus Host Disease Incidence and Overall Survival: Retrospective Analysis on Behalf of Polish Adult Leukemia Group.

Allogeneic hematopoietic cell transplantation (allo-HSCT) stands as an effective treatment method for various hematologic malignancies. However, graft-versus-host disease (GvHD), an intricate immunological phenomenon where donor immune cells target recipient tissues, remains a significant challenge, particularly in mismatched unrelated donors (MMUD). Post-transplant cyclophosphamide (PTCy) has emerged as a promising immunosuppressive strategy, revolutionizing haploidentical transplantation and demonstrating promise in MMUD settings. Background/Objectives: This study aimed to evaluate the impact of PTCy on MMUD allo-HSCT outcomes, specifically its effects on GvHD incidence and overall survival, compared to anthitymocyte globulin (ATG). Methods: One hundred seventy-four patients were classified into three groups based on the type of transplantation: PTCy-haplo (114/174; 65.5%), PTCy-MMUD (23/174; 13.2%), and ATG-MMUD (37/174; 21.2%). Results: Our findings showed that PTCy-MMUD significantly reduced acute GvHD occurrence compared to PTCy-haplo and ATG-MMUD approaches (p = 0.006). The delayed onset of acute GvHD in the PTCy-MMUD group suggests a more controlled immune reconstitution, contributing to the lower incidence. Importantly, PTCy-MMUD exhibited enhanced five-year overall survival rates, aligning with the notion that reduced GvHD correlates with improved patient outcomes (p = 0.032). Conclusions: We believe that this study contributes valuable insights into PTCy-MMUD's management, underscoring its potential to significantly reduce GvHD incidence and enhance survival outcomes. Although further investigations and clinical trials are warranted, this research underscores the promising role of PTCy-based GvHD prophylaxis in improving MMUD allo-HCT success.

Comparing the Outcomes of Matched and Mismatched Unrelated Allogeneic Hematopoietic Stem Cell Transplantation with Different Anti-Thymocyte Globulin Formulations: A Retrospective, Double-Centre Experience on Behalf of the Polish Adult Leukemia Group.

Despite notable advancements in immunotherapy in the past decades, allogeneic hematopoietic stem cell transplantation (allo-HCT) remains a promising, potentially curative treatment modality. Only a limited number of studies have performed a direct comparison of two prevalent rabbit anti-thymocyte globulin (r-ATG) formulations-specifically, Thymoglobuline (ATG-T, formerly Genzyme) and Grafalon (ATG-G, formerly Fresenius). The primary objective of our retrospective analysis was to compare the outcomes of adult patients undergoing matched or mismatched unrelated donor (MUD/MMUD) allo-HCT, with a graft-versus-host disease (GvHD) prophylaxis based on either ATG-T or ATG-G. A total of 87 patients who had undergone allo-HCT between 2012 and 2022 were included. We observed no significant differences between ATG-T and ATG-G concerning the occurrence of acute graft-versus-host disease (aGvHD), regardless of its severity. Conversely, chronic graft-versus-host disease (cGvHD) occurred less frequently in the ATG-T group compared to the ATG-G group (7.5% vs. 38.3%, p = 0.001). The negative impact of ATG-G on cGvHD was confirmed by multivariate analysis (HR 8.12, 95% CI 2.06-32.0, p = 0.003). Patients treated with ATG-T manifested a higher incidence of cytomegalovirus (CMV) reactivations (70% vs. 31.9%, p < 0.001), with a shorter time between transplant and CMV (<61 days, 77.8% vs. 33.3%, p = 0.008) and a higher median CMV copy number (1000 vs. 0, p = 0.004). Notably, despite a higher occurrence of CMV reactivations in the ATG-T cohort, most patients were asymptomatic compared to ATG-G (85.7% vs. 43.8%, p = 0.005). By multivariate analysis, only aGvHD had an influence on CMV reactivations (HR 0.18, 95% CI 0.04-0.75, p = 0.019). Finally, we observed no significant differences in terms of 5-year overall survival (OS) and 3-year relapse-free survival (RFS) while comparing ATG-T and ATG-G (32.0% vs. 40.3%, p = 0.423; 66.7% vs. 60.4%, p = 0.544, respectively).

Effective treatment of Clostridioides difficile infection improves survival and affects graft-versus-host disease: a multicenter study by the Polish Adult Leukemia Group.

Clostridioides difficile infection (CDI) is the most common cause of infectious diarrhea after allogeneic hematopoietic cell transplantation (allo-HCT). The impact of CDI and its treatment on allo-HCT outcomes and graft-versus-host disease (GVHD), including gastrointestinal GVHD (GI-GVHD) is not well established. This multicenter study assessed real-life data on the first-line treatment of CDI and its impact on allo-HCT outcomes. Retrospective and prospective data of patients with CDI after allo-HCT were assessed. We noted statistically significant increase in the incidence of acute GVHD and acute GI-GVHD after CDI (P = 0.005 and P = 0.016, respectively). The first-line treatment for CDI included metronidazole in 34 patients, vancomycin in 64, and combination therapy in 10. Treatment failure was more common with metronidazole than vancomycin (38.2% vs. 6.2%; P < 0.001). The need to administer second-line treatment was associated with the occurrence or exacerbation of GVHD (P < 0.05) and GI-GVHD (P < 0.001) and reduced overall survival (P < 0.05). In the multivariate analysis, the risk of death was associated with acute GVHD presence before CDI (hazard ratio [HR], 3.19; P = 0.009) and the need to switch to second-line treatment (HR, 4.83; P < 0.001). The efficacy of the initial CDI treatment affects survival and occurrence of immune-mediated GI-GVHD after allo-HCT. Therefore, agents with higher efficacy than metronidazole (vancomycin or fidaxomicin) should be administered as the first-line treatment.

Significance of HLA-E and its two NKG2 receptors in development of complications after allogeneic transplantation of hematopoietic stem cells.

Transplantation of hematopoietic stem cells (HSCT) is a procedure commonly used in treatment of various haematological disorders which is associated with significantly improved survival rates. However, one of its drawbacks is the possibility of development of post-transplant complications, including acute and chronic graft-versus-host disease (GvHD) or CMV infection. Various studies suggested that NK cells and their receptors may affect the transplant outcome. In the present study, patients and donors were found to significantly differ in the distribution of the NKG2A rs7301582 genetic variants - recipients carried the C allele more often than their donors (0.975 vs 0.865, p<0.0001). Increased soluble HLA-E (sHLA-E) levels detected in recipients' serum 30 days after transplantation seemed to play a prognostic and protective role. It was observed that recipients with higher sHLA-E levels were less prone to chronic GvHD (11.65 vs 6.33 pg/mL, p=0.033) or more severe acute GvHD grades II-IV (11.07 vs 8.04 pg/mL, p=0.081). Our results also showed an unfavourable role of HLA-E donor-recipient genetic incompatibility in CMV infection development after transplantation (OR=5.92, p=0.014). Frequencies of NK cells (both CD56dim and CD56bright) expressing NKG2C were elevated in recipients who developed CMV, especially 30 and 90 days post-transplantation (p<0.03). Percentages of NKG2C+ NK cells lacking NKG2A expression were also increased in these patients. Moreover, recipients carrying a NKG2C deletion characterized with decreased frequency of NKG2C+ NK cells (p<0.05). Our study confirms the importance of NK cells in the development of post-transplant complications and highlights the effect of HLA-E and NKG2C genetic variants, sHLA-E serum concentration, as well as NKG2C surface expression on transplant outcome.

Meaning-reconstruction factors and well-being in cancer survivor-caregiver dyads: Daily associations and mechanisms.

OBJECTIVE: The study aimed to expand the existing research on the meaning-making processes in cancer by examining (a) the relationship between daily meaning making and meanings made versus the emotional and social well-being in survivor-caregiver dyads, (b) whether meanings made moderated or mediated the meaning-making-well-being associations at the within- and between-dyad level, and (c) whether meaning factors varied across or within persons. METHODS: Two hundred dyads completed measures of meaning making, meanings made, positive and negative affect, and loneliness for 28 consecutive posthospitalization days following hematopoietic cell transplantation. Computations were based on the actor-partner interdependence model and its extensions, using multilevel structural equation modeling. RESULTS: Positive emotional effects of meanings made and mixed effects of meaning making were found. Meanings made mediated, but not moderated, the association between meaning making and affect. Meaning factors varied substantially between- but less so within-person. CONCLUSIONS: Further research on the meaning-making process and practical actions will require a greater focus on the level of the analysis, the role in the dyad, and interpersonal aspects. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Benefits of the Post-Transplant Cyclophosphamide in Both Haploidentical and Mismatched Unrelated Donor Setting in Allogeneic Stem Cells Transplantation.

Allogeneic hematopoietic cell transplantation (alloHSCT) is a standard therapeutic approach for acute leukemias and many other hematologic malignancies. The proper choice of immunosuppressants applicable to different types of transplantations still requires strict and careful consideration, and data in this regard are divergent. For this reason, in this single-centered, retrospective study, we aimed to compare the outcome of 145 patients who received post-transplant cyclophosphamide (PTCy) for MMUD and haplo-HSCT or GvHD prophylaxis for MMUD-HSCT alone. We attempted to verify if PTCy is an optimal strategy in MMUD setting. Ninety-three recipients (93/145; 64.1%) underwent haplo-HSCT while 52 (52/145; 35.9%) underwent MMUD-HSCT. There were 110 patients who received PTCy (93 in haplo and 17 in MMUD group) and 35 patients received conventional GvHD prophylaxis based on antithymocyte globulin (ATG), cyclosporine (CsA), and methotrexate (Mtx) in the MMUD group only. Our study revealed that patients receiving post-transplant cyclophosphamide (PTCy) show decreased acute GvHD rates and CMV reactivation as well as a statistically lower number of CMV copies before and after antiviral treatment compared to the CsA + Mtx + ATG group. Taking into account chronic GvHD, the main predictors are donor age, ≥40 years, and haplo-HSCT administration. Furthermore, the survival rate of patients following MMUD-HSCT and receiving PTCy with tacrolimus and mycophenolate mofetil was more than eight times greater in comparison to patients receiving CsA + Mtx + ATG (OR = 8.31, p = 0.003). These data taken together suggest that the use of PTCy displays more benefits in terms of survival rate compared to ATG regardless of the type of transplantation performed. Nevertheless, more studies with a larger sample size are required to confirm the conflicting results in the literature studies.

The role of psychological flexibility in the meaning-reconstruction process in cancer: The intensive longitudinal study protocol.

OBJECTIVES: Meaning-making is an important element of adapting to disease. However, this process is still poorly understood and the theoretical model has not been comprehensively verified yet, particularly in terms of complexity, dynamics, and intraindividual variability. The aim of this study is a deeper understanding of the meaning-reconstruction process in cancer and empirical verification of the integrative meaning-making model of coping extended by the psychological flexibility model. We postulate that psychological flexibility can foster the meaning-making in cancer by building more flexible and workable meaning-making explanations of disease. DESIGN: A daily-diary study conducted for 14 days in patients following the first autologous or allogeneic hematopoietic cell transplantation (HCT). METHODS: Participants (at least 150) will be requested to complete the daily-diary related to daily situational meaning, meaning-related distress, meaning-making, psychological flexibility, meanings made, and wellbeing for 14 days after hospital discharge following HCT. Also, baseline and follow-up assessment of global meaning, wellbeing, and meanings made will be performed. Statistical analysis of the data will be conducted using the multilevel and dynamic structural equation modeling. CONCLUSIONS: The study will fill in the gaps in health psychology in the understanding of the meaning-reconstruction process in cancer by within- and between-person verification of the integrative meaning-making model and its extension by the psychological flexibility model. The data obtained will be used in further research on the development of meaning-making by means of interventions based on psychological flexibility.

Daily stress and received social support in hematopoietic cell transplant patient-caregiver dyads.

BACKGROUND AND OBJECTIVE: Reception of social support may foster adjustment in dyads facing cancer treatment. Still, understanding of the effects of received support in everyday life of patient-caregiver dyads remains limited. This study investigated whether the positive effect of daily received social support depends on daily stress levels and whether the effect differs by perspective (recipient vs. provider) in dyads undergoing hematopoietic cell transplantation (HCT). DESIGN AND METHODS: The sample comprised 200 patient-caregiver dyads after HCT. The participants completed measures of daily stress levels, received and provided social support as well as affect for 28 consecutive days. RESULTS: Regardless of daily stress levels, the caregivers reported better affect on days when they noticed more received support (recipient perspective), whereas the patients reported worse affect on days when they noticed more received support (recipient perspective) and/or when their caregivers reported higher provided support (provider perspective). CONCLUSION: The effects of daily received support were not related to the levels of daily stress in patient-caregiver dyads after HCT. Also, the effects varied by role (benefits in the caregivers vs. harm in the patients) and perspective (similarities in the patients vs. differences in the caregivers).

Daily analysis of autonomy support and well-being in patient-caregiver dyads facing haematopoietic cell transplantation.

OBJECTIVES: Caregivers may restore patient self-determination in disease by supporting their autonomy, and thus enhance their well-being. In this study, we investigated the between- and within-person effects of recipient-reported and provider-reported autonomy support on patient daily biopsychosocial well-being in patient-caregiver dyads following haematopoietic cell transplantation (HCT). DESIGN: A dyadic daily-diary study conducted for 28 days after patients' hospital discharge following HCT. METHODS: Patients and their caregivers (N = 200) participated in a 28-day daily-diary study. They completed measures of daily autonomy support reception (patients) and provision (caregivers), subjective physical health, affect (positive/negative), and relationship satisfaction. RESULTS: The patient's feeling of being supported in their autonomy was associated with their better positive affect and relationship satisfaction, both overall (between-person effect) and daily (within-person effect). Caregiver-reported overall and daily support of patient autonomy did not predict patient daily biopsychosocial well-being. CONCLUSIONS: These findings extended the evidence that autonomy support reported by patients facing HCT may have both accumulative and acute beneficial effects on their psychological and social well-being.

Interaction effect of coping self-efficacy and received support in daily life of hematopoietic cell transplant patient-caregiver dyads.

OBJECTIVES: According to the social cognitive theory, social support and self-efficacy may interact with each other i.e. compete or account jointly for better adaptation. This study examined the nature of the interaction between coping self-efficacy and received social support in daily lives of patient-caregiver dyads after cancer treatment. We tested whether the effect of daily fluctuations in coping self-efficacy and received support on daily affect was synergistic (positive jointed effect), compensatory (positive competing effect), or interference (negative competing effect). DESIGN: A dyadic daily-diary study conducted for 28 days after hospital discharge following hematopoietic cell transplantation. METHODS: Coping self-efficacy, received support, and positive and negative affect were measured in 200 patient-caregiver dyads. The analysis was based on the actor-partner interdependence moderation model using multilevel structural equation modeling. RESULTS: Statistically significant effect of interaction between daily coping self-efficacy and received support on negative affect was found, although only in the caregivers. In that group, higher daily received support compensated for lower daily coping self-efficacy but had a negative effect when coping self-efficacy was significantly higher than typical. Also, direct beneficial effects of higher daily coping self-efficacy and received support on caregiver positive affect were found. In the patients, higher daily coping self-efficacy was directly associated with better daily affect. CONCLUSIONS: Diverse effects of daily coping self-efficacy and received social support were found-the interference effect in the caregivers and the main effect of coping self-efficacy in the patients. Higher daily coping self-efficacy and optimal received social support may provide resilience against affect disturbance after cancer treatment.

Tandem autologous hematopoietic cell transplantation with sequential use of total marrow irradiation and high-dose melphalan in multiple myeloma.

The goal of this phase II trial was to evaluate safety and efficacy of a tandem autologous hematopoietic cell transplantation (auto-HCT) using sequentially total marrow irradiation (TMI) at the dose of 12 Gy (4 Gy on days -3, -2, and -1) and melphalan 200 mg/m2 for patients with multiple myeloma (MM). TMI was performed using helical tomotherapy. Additional "boosts" (total 24 Gy) were applied for patients with active lesions as revealed by PET-FDG. Fifty patients with median age 58 years (41-64 years) were included and received tandem auto-HCT. TMI resulted in absolute neutropenia in all patients. Grade 3 infections were reported in 30% patients. Other toxicities were rare. Proportion of patients who achieved at least very good partial response increased from 46% before the first auto-HCT to 82% after tandem transplantation. Complete remission rates changed from 10% to 42%, respectively. The probabilities of overall and progression-free survival at 5 years were 74% and 55%, respectively. No patient died without progression. We conclude that conditioning with TMI ± PET-guided "boosts" represents personalized treatment approach in MM and is characterized by very good toxicity profile. Tandem auto-HCT using TMI in sequence with high-dose melphalan appears safe with encouraging early efficacy.

Total body irradiation + fludarabine compared to busulfan + fludarabine as "reduced-toxicity conditioning" for patients with acute myeloid leukemia treated with allogeneic hematopoietic cell transplantation in first complete remission: a study by the Acute Leukemia Working Party of the EBMT.

The optimal conditioning for patients with acute myeloid leukemia in first complete remission treated with allogeneic hematopoietic cell transplantation (allo-HCT) has not been defined so far. In this retrospective study, we compared two "reduced-toxicity" regimens: intravenous busulfan at a total dose of 9.6 mg/kg (3 days) + fludarabine (Bu3/Flu) and total body irradiation at a dose of 8 Gy + fludarabine (TBI8Gy/Flu). In the entire study cohort (n = 518), the probabilities of overall survival (OS), leukemia-free survival (LFS), relapse and non-relapse mortality (NRM) at 2 years for Bu3/Flu and TBI8Gy/Flu were 62% vs. 72.5% (p = 0.051), 59.5% vs. 65% (p = 0.15), 30% vs. 20% (p = 0.01), and 10% vs. 14% (p = 0.18), respectively. In multivariate model for patients <50 years old, TBI8Gy/Flu was associated with improved LFS (hazard ratio (HR) = 0.5, p = 0.04), OS (HR = 0.31, p = 0.004), and survival free from both graft-versus-host disease and relapse (HR = 0.55, p = 0.03), as well as tendency to reduced risk of relapse (HR = 0.53, p = 0.08). Among patients aged 50 years or older the use of TBI8Gy/Flu was associated with increased incidence of NRM (HR = 3.9, p = 0.0009), with no significant impact on other outcome measures. We conclude that the use of TBI8Gy/Flu as "reduced-toxicity" regimen may be advised in younger patients with AML referred for allo-HCT.

Allogeneic hematopoietic cell transplantation for multiple myeloma: A retrospective analysis of the Polish Myeloma Group.

PURPOSE: In this multicenter retrospective analysis of the Polish Myeloma Group we assessed the real-life application of allogeneic transplantations (alloHCT) in multiple myeloma (MM) outside clinical trials in Poland. METHODS: Anonymized clinical data of patients who underwent alloHCT were retrospectively collected from eight transplant centers and analyzed to identify factors affecting the outcome. RESULTS: Sixty patients (34 males, 26 females) at median age of 45 (22-59) years who received alloHCT between 1993 and 2016 were included. In this group, 16 (27%) patients underwent myeloablative conditioning and 44 (73%) reduced-intensity conditioning alloHCT. Acute graft versus host disease (GvHD) occurred in 27 (45%) patients, while chronic GvHD was diagnosed in 13 (22%) patients. With the median observation time after alloHCT of 10 months, the relapse rate was 38%. Median progression-free survival (PFS) reached 9 months (0-183) while median overall survival (OS) was 23 months (0-183). Main causes of death included disease progression in 16 (43%), infections in 10 (27%), and GvHD in 7 patients (19%). Presence of chronic GvHD was the only factor associated with prolonged PFS (28 vs. 6 months; p = 0.05), however its impact on OS was not statistically significant (73 vs. 8 months; p = 0.09). CONCLUSIONS: In this relatively small and heterogeneous study we observed that alloHCT was associated with high risk of severe complications, but resulted in long-term survival in a proportion of patients. Decisions on optimal indications and timing of the alloHCT in MM need to be taken in the broader context of reported outcomes including data from large studies.

Daily received support and relational functioning in HCT survivors and their caregivers.

OBJECTIVES: Numerous authors have expressed their interest in adjustment and social support in the context of cancer. However, none of the previous studies has directly examined the models describing the links between daily social support and adjustment fluctuation, particularly at the relational level. This study aimed to verify the additive and buffering models of daily received support regarding the relational level of patient-caregiver relationship, that is, the relationship-related stress and relationship satisfaction following hematopoietic cell transplantation (HCT). METHODS: Two hundred patient-caregiver dyads participated in a 28-day diary study that was started on the first day after post-HCT discharge. The participants rated the extent of daily relationship-related stress, relationship satisfaction, and received support every evening during the study. The analyses were based on the actor-partner interdependence moderation model. RESULTS: Daily deviations in received support were directly associated with concurrent and lagged daily deviations in relationship satisfaction, regardless of relationship-related stress level in both patients and caregivers. In addition, in caregivers, the effect of daily deviations in received support on relationship satisfaction depended on deviations in relationship-related stress and was significant on the days with higher relationship-related stress. CONCLUSIONS: The findings supported both the additive (in patients and caregivers) and the buffering hypotheses (in caregivers) of daily received support in patient-caregiver dyads during the first month following HCT. The theoretical and practical implications of the findings are further highlighted.

Protective Buffering and Individual and Relational Adjustment Following Hematopoietic Stem Cell Transplantation: A Dyadic Daily-Diary Study.

BACKGROUND: Supportive communication (e.g., protective buffering, PB) may impact individual and relational adjustment in patients following hematopoietic stem cell transplantation (HSCT) and their caregivers. Previous studies revealed that PB (i.e., hiding one's concerns and denying one's worries) has mixed effects, namely it is beneficial, costly or unrelated to dyadic adjustment. This study aimed to verify these findings by addressing some unresolved issues, i.e., examining (1) both individual and relational as well as both positive and negative indicators of adjustment, (2) the effect of within-dyad congruence (i.e., complementarity/similarity) in PB, and (3) within-dyad causal associations between PB and adjustment. METHODS: Two hundred patients (following first autologous or allogeneic HSCT) and their caregivers independently completed measures of daily PB, relationship satisfaction, relationship stress, and positive affect (PA) and negative affect (NA) for 28 consecutive evenings after discharge of patients. FINDINGS: For both patients and caregivers, the results showed a same-day association between daily PB and individual (positive and negative) and relational (positive and negative) adjustment indicators showing the advantage of PB. In terms of the dyad congruence, complementarity (one partner high and the other low) in daily PB was related to higher same-day relationship satisfaction for both patients and caregivers and lower same-day relationship stress in caregivers. The benefits from similarity (both patient and caregiver high or low in PB) had delayed effects, although only in patients. As far as the causal associations were concerned, day-to-day changes in PB preceded changes in daily adjustment. In caregivers, reverse causality was found, i.e., changes in adjustment predicted next-day changes in support. DISCUSSION: Contrary to previous studies, daily PB has a rather beneficial effect in dyads following HSCT. Patients seemed to have benefited the most from the similarity in daily PB fluctuation, while caregivers profited from complementarity. Causal associations between PB and adjustment within-dyad were also different. The findings may add to a better understanding of PB-adjustment relationship in dyads facing HSCT.

Salutary effect of daily coping self-efficacy: impact on day-by-day coping to mood effects within dyads following hematopoietic stem cell transplantation.

Background and Objectives: Little is known how coping self-efficacy (CSE) interacts with coping in dyad everyday life. The present study examined the moderating role of daily CSE in the relationship between coping and the next-day positive (PA) or negative (NA) affect in patient-caregiver dyads, following hematopoietic stem cell transplantation. Design: This intensive longitudinal study was conducted during the first 28 days after post-transplant discharge. Methods: Patients and their caregivers (N = 200) maintained daily diaries on CSE, coping strategies, and affect. Results: Daily CSE moderated daily coping-affect relationship: Positive emotion-focused coping increased PA in patients with higher than usual emotion-related CSE, whereas a buffering effect was found at lower than usual emotion-related CSE. A positive association between negative emotion-focused coping and NA in both patients and caregivers was stronger among those with lower than usual levels of emotion-related CSE. Higher than usual instrumental coping reduced NA in patients whose caregivers had higher than usual problem-related CSE, but increased NA for those whose caregivers had lower than usual instrumental CSE. Conclusion: The findings show that daily CSE contributes to the effectiveness of daily coping within dyad, confirming its significance in effective adaptation and the role in the dyadic coping process.

Dyadic support and affect in patient-caregiver dyads following hematopoietic stem-cell transplantation: A diary study.

OBJECTIVE: Cancer and its treatment are highly stressful events that may significantly affect the daily emotional well-being of patients and their informal caregivers. Patient- and caregiver-reported received and provided support may contribute to both dyad members' fluctuation in daily affect, but few studies have examined these associations from a dyadic perspective so far. The current study examined predictions derived from 3 theories on patterns of relations between subjectively assessed dyadic provided and received support and daily affect within dyad members: (a) invisible support theory, (b) the suggestion that providing support may be better than receiving it, and (c) beneficial supportive equity. METHOD: Actor-partner interdependence models were tested using 28-day diary data from 200 patient-caregiver dyads. Diary assessments started on the first day following patients' discharge from the hospital, that is, about 3 weeks following patients' hematopoietic stem cell transplantation (HSCT). RESULTS: Daily invisible support was not related to more positive indicators of patients' or caregivers' daily affect. For patients' affect, findings generally supported the hypothesis of psychological benefits of support provision over receipt, in both concurrent and lagged analyses. For caregivers, visible received support from patients and supportive equity (i.e., both provided and received support relatively high), both concurrently and lagged, were related with better emotional state. CONCLUSIONS: The findings highlight the costs, benefits, and complexities of daily support transactions in dyads following HSCT, thus indicating the practical implications of the study: the importance of screening for support needs and abilities in both patients and caregivers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).