The European Society for Blood and Marrow Transplantation (EBMT) roadmap and perspectives to improve nutritional care in patients undergoing hematopoietic stem cell transplantation on behalf of the Cellular Therapy and Immunobiology Working Party (CTIWP) and the Nurses Group (NG) of the EBMT.

Malnutrition is the most common comorbidity during the continuum of hematopoietic stem cell transplant (HSCT) and negatively impacts clinical outcomes, response to therapy, quality of life, and costs. The intensive conditioning regimen administered before transplant causes inflammatory damages to the gastrointestinal system, which themselves contribute to trigger graft versus host disease (GvHD) in the allogeneic setting. GvHD and other post-transplant complications such as infections adversely affect food intake and gut absorption of nutrients. Consequently, patients exhibit signs of malnutrition such as weight loss and muscle wasting, thus triggering a "vicious circle" that favours additional complications. Among HSCT centres, there is marked variability in nutritional care, from screening for malnutrition to nutritional intervention. The present paper, elaborated by the Cellular Therapy and Immunobiology Working Party and the Nurses Group of the European Society for Blood and Marrow Transplantation, aims at defining a roadmap that identifies the main nutritional critical issues in the field of HSCT. This document will be propaedeutic to the development of clinical algorithms to counteract risk factors of malnutrition, based on scientific evidence and shared among HSCT centres, and thus maximize transplant outcomes.

Donor lymphocyte infusions after haploidentical stem cell transplantation with PTCY: A study on behalf of the EBMT cellular therapy & immunobiology working party.

Donor lymphocyte infusion (DLI) is a treatment option to prevent or treat relapse after allogeneic hematopoietic cell transplantation (HCT). We here report data for 173 patients who received one or multiple DLIs after haploidentical-HCT with post-transplant cyclophosphamide (PTCY) at 47 EBMT centers from 2009 to 2018. Indication for DLI was: prophylactic for 59 (34.3%), preemptive for 20(11.6%), and therapeutic for 93(54.1%). For the prophylactic group, the median number of DLIs was 1 (IQR:1-2.5) with a median first dose of 0.1 × 106 CD3+ T cell/kg, for the preemptive 2 (IQR:1-3) with 0.5 × 106 CD3+ T cell/kg, for the therapeutic 1 (IQR:1-3) with 1 × 106CD3+ Tcell/kg, respectively. OS after first DLI was 61% (46-75%) for prophylactic, 40% (19-61%) for preemptive, and 22% (13-31%) for therapeutic. CI of II-IV aGVHD and cGVHD was 17% (7-27%) and 53% (40-67%) for the prophylactic, 20% (2-38%) and 21% (3-39%) for the preemptive, 17% (9-24%) and 24% (15-33%) for the therapeutic group, respectively. Our data show great variability in the indications and modalities of DLI across responding EBMT centers. Survival rates remain relatively low in patients with active disease. While the cumulative incidence of aGVHD appears acceptable, we showed a high incidence of cGVHD in the prophylactic group, compared with preemptive and therapeutic DLI. These data should be investigated further in prospective clinical trials.

The changing relationship between socio-economic background and family formation in four European countries.

Family formation, a process that includes union formation, fertility, and their timing and order, has become increasingly diverse and complex in Europe. We examine how the relationship between socio-economic background and family formation has changed over time in France, Italy, Romania, and Sweden, using first wave Generations and Gender Survey data. Competing Trajectories Analysis, a procedure which combines event-history analysis with sequence analysis, allows us to examine family formation as a process, capturing differences in both the timing of the start of family formation and the pathways that young adults follow. Regarding timing, socio-economic background differences in France and Sweden have remained relatively small, whereas in Italy and Romania higher parental education has become more strongly associated with postponement. Pathways tend to diverge by socio-economic background, particularly in Sweden and France. These results indicate that while family formation patterns have changed, they continue to be stratified by socio-economic background.

Becoming obese in young adulthood: the role of career-family pathways in the transition to adulthood for men and women.

BACKGROUND: During the transition to adulthood many young adults become obese for the first time in their lives, yet relatively little research has examined why people in this life phase become obese. This study examines what career and family life-course pathways during the transition to adulthood are related to developing obesity in young adulthood. METHODS: We use data from the NLSY97, a U.S. nationally representative panel survey conducted by the Bureau of Labor Statistics between 1997 to 2013 (N = 4688), and apply multichannel sequence analysis in order to identify clusters of typical career-family pathways during the transition to adulthood (age 17 to 27), and subsequently investigate whether these pathways are associated with becoming obese at the end of young adulthood (age 28), using logistic regression. We control for obesity at age 17 and family background factors (race, parental education, parental income, and family structure). To take into account the fact that the transition to adulthood has a different meaning for men and for women, we also interact career-family clusters with gender. RESULTS: For women, pathways characterized by college education, early home leaving, and postponement of family formation decrease the probability of becoming obese. For men, pathways characterized by early marriage increase the probability of becoming obese. CONCLUSIONS: The results highlight the importance of gender differences in how career and family pathways are related to becoming obese in young adulthood.

The Influence of Parental Education on Timing and Type of Union Formation: Changes Over the Life Course and Over Time in the Netherlands.

Family background shapes young adults' decisions in their transition to adulthood, and the outcomes of these decisions lay the foundation for their subsequent life course. This study examines the influence of parental education on their children's union formation. We examine the timing of entry into a first union (a married or a cohabiting union), the choice between marriage and cohabitation, and the timing of first marriage. Data from eight nationally representative surveys conducted in the Netherlands are pooled (N = 39,777), with respondents being born between 1930 and 1990, to examine not only the effect of parental education on union formation but also whether this effect changes over birth cohorts, periods, and the life course, and varies by gender. Results from discrete-time hazard analyses show little change in the effect of parental education across cohorts and periods but strong life-course effects. Gender differences in the effect of parental education are relatively small.