Recent Relapse Research Articles

Discordance between patients and parents regarding the perceived causes of clinical relapse in young inflammatory bowel disease patients.

Relapse in inflammatory bowel disease (IBD) is not predictable, although several factors have been suggested. The aims of the current study were to assess and compare the possible causes of clinical relapse as perceived by patients and parents. Of 107 young (<35 years old) IBD patients, 26 patients who experienced recent (<3 month) relapse and their parents completed a questionnaire at the same time. Baseline characteristics and clinical manifestations were reviewed and the most common causes of relapse as perceived by patients and parents were compared. Median patient age was 22.5 years and the male to female ratio was 17 : 9. Crohn's disease was diagnosed in 23 patients and ulcerative colitis in the other three patients. Mean disease duration was 39.8±30.3 months. Eighteen (69.2%) patients experienced stress before relapse. Fifteen (57.7%) parents thought that their children experienced stress before relapse. Agreement between patients and parents for non-adherence to medication and stress was 100% and 73.1%, respectively. Stress was considered the most likely cause of relapse in both groups. Discordance rate between parents and patients with respect to main causes of relapse was 40.4%. Stress was perceived to be the most common condition noted before clinical relapse in young IBD patients and their parents. However, the discordance rate between patients and parents with respect to the main causes of relapse was 40.4%. This result suggests a considerable difference in terms of disease understanding between young IBD patients and parents.

Eosinophilic dermatitis of hematologic malignancy

Eosinophilic dermatosis of hematologic malignancy is a rare, paraneoplastic phenomenon that presents as a pruritic papular or vesicular eruption that is clinically and histopathologically similar to insect bites. We present a 56-year-old man with multiple relapses of diffuse large B cell lymphoma with a typical presentation of pruritic papules and vesicles on the extremities that correlate with a recent relapse of his lymphoma.

Isocitrate dehydrogenase 1 mutations (IDH1) and p16/CDKN2A copy number change in conventional chondrosarcomas.

To determine whether IDH1 mutations are present in primary and relapsed (local and distal) conventional central chondrosarcomas; and secondly, to assess if loss of p16/CDKN2A is associated with tumour grade progression, 102 tumour samples from 37 patients, including material from presenting and relapse events, were assessed. All wild-type cases for IDH1 R132 substitutions were also tested for IDH2 R172 and R140 alterations. The primary tumour and the most recent relapse sample were tested for p16/CDKN2A by interphase fluorescence in situ hybridisation. An additional 120 central cartilaginous tumours from different patients were also tested for p16/CDKN2A copy number. The study shows that if an IDH1 mutation were detected in a primary central chondrosarcoma, it is always detected at the time of presentation, and the same mutation is detected in local recurrences and metastatic events. We show that p16/CDKN2A copy number variation occurs subsequent to the IDH1 mutation, and confirm that p16/CDKN2A copy number variation occurs in 75 % of high grade central chondrosarcomas, and not in low grade cartilaginous tumours. Finally, p16/CDKN2A copy number variation is seen in both the IDH1 wild-type and mutant cartilaginous central tumours.

Suicidal behavior in a medical professional with comorbid depression and substance use disorder: an educational case report.

Here, we publish a report of a previously practicing nurse practitioner who presented to a community hospital with severely depressed mood and neurovegetative symptoms in the context of recent relapse to alcohol and cocaine abuse. This patient had a long history of depression and polysubstance abuse. Additionally, the patient had a history of multiple previous suicide attempts with a high possibility for lethality. All of his attempts occurred in the setting of depression, escalating substance use, and interpersonal difficulties. Due to his chronic struggles with mental health and substance abuse issues, the patient lost his marriage, many close friends, and, eventually, his license to practice medicine. In this report, we highlight the increased risk of suicidal behavior or completed suicide in patients with co-occurring depressive and substance abuse disorders. We also look to highlight the often unmet need of mental health and substance abuse treatment for healthcare professionals. Studies suggest that healthcare providers experience increasing rates of burnout, mood and anxiety disorders, and substance use disorders, but available treatment resources remain scarce. This is a serious public health issue that will require increased vigilance by the community at large to ensure the safety and wellbeing of both patients and their providers.

Genome-Wide Paternal Uniparental Disomy as a Cause of Beckwith-Wiedemann Syndrome Associated with Recurrent Virilizing Adrenocortical Tumors

Beckwith-Wiedemann syndrome (BWS) is an overgrowth syndrome characterized by fetal macrosomia, macroglossia, and abdominal wall defects. BWS patients are at risk to develop Wilms tumor, neuroblastoma, hepatoblastoma, and adrenal tumors. A young woman with BWS features, but with inconclusive genetic evidence for the disease, came to clinical observation for signs of virilization at the age of 16 years. An adrenocortical tumor was diagnosed and surgically resected. The tumor underwent 2 local relapses that were also surgically treated. The patient was also operated to remove a breast fibroadenoma. SNP arrays were used to analyze chromosome abnormalities in normal and tumor samples from the patient and her parents. The patient presented genome-wide mosaic paternal uniparental disomy (patUPD) both in the adrenocortical and the breast tumors, with different degrees of loss of heterozygosity (LOH). The more recent relapses of the adrenocortical tumor showed a loss of part of chromosome 17p that was absent in the first tumor. Analysis of a skin biopsy sample also showed mosaic patUPD with partial LOH, while no LOH was detected in leukocyte DNA. This case shows that virilizing adrenocortical tumors may be a clinical feature of patients with BWS. The SNP array technology is useful to diagnose genome-wide patUPD mosaicism in BWS patients with an inconclusive molecular diagnosis and underlines the tumorigenic potential of the absence of the maternal genome combined with an excess of the paternal genome.

B-101 Prospects and Strategies for an HIV Cure

Two highly-publicized cures of HIV infection, 1 in an adult who received an allogeneic hematopoietic stem cell transplant for leukemia from a CCR5 delta 32 homozygous donor, and 1 in an infant started on ART within 2 days of birth, have inspired worldwide efforts to cure HIV infection. The recent relapse of HIV infection 3–8 months after stopping ART in 2 allogeneic bone marrow transplant recipients who had cleared HIV from blood is a sobering reminder of the difficulty of eliminating all replication-competent HIV from an infected host. In this special lecture, I will first review major obstacles to curing HIV infection including: (1) persistent viremia despite effective HIV, (2) latent replication-competent proviruses in CD4+ T-cells, (3) HIV diversity and immune escape variants, (4) clonal expansion of HIV-infected cells, and (5) highly-variable and incompletely effective host immune responses to HIV. I will then highlight curative approaches that are being explored: (1) immediate ART after birth in HIV-infected infants, (2) ART in adults during acute/early HIV infection to prevent reservoir expansion and induce post-treatment immune control, (3) latency reversing agents to deplete HIV reservoirs (e.g., romidepsin), (4) reversal of exhaustion of HIV-specific through immune response by targeting inhibitory receptors on T-cells (e.g. anti-PD-L1), (5) antibody- , cell-, and vaccine-based immunotherapies to enhance HIV immune responses, and (6) host modification to confer cellular resistance to HIV replication. Progress towards a cure of HIV infection will undoubtedly occur, but the challenge of developing and delivering effective and scalable therapies for most HIV-infected persons worldwide is a very formidable 1.

Massive exacerbation of multiple sclerosis after withdrawal and early restart of treatment with natalizumab

We present a 46-year-old woman with a relapse of multiple sclerosis (MS) that began 3months after withdrawal from long-term treatment with natalizumab. Shortly after restart of a single dose of natalizumab she developed a fulminant MS rebound with stupor and tetraparesis. Cerebral MRI showed massive progression in the number of lesions and tumefactive lesions with ring gadolinium-enhancement. Stereotactic brain biopsy revealed acute demyelination and B-cell dominated inflammation. The patient improved during therapeutic plasma exchange. We speculate that early restart of natalizumab in the case of a relapse may worsen disease evolution possibly by modifying regulatory immune effector processes during an inflammatory rebound phase. A restart of natalizumab in MS patients suffering from a recent relapse or with signs of active inflammation should be considered with caution.

Caregiver reports of patient-initiated violence in psychosis.

Aggressive behaviour in psychosis is not uncommon. Community provision for people with psychosis has left informal caregivers to take on a greater role in their care. However, few studies have explored links between patient-initiated violence in mental health caregiving relationships and caregiver functioning. Our study investigated caregiver reports of aggressive acts committed by their relative with psychosis and their links to caregiver appraisals of the caregiving relationship and caregiver outcomes. Caregivers of patients with a recent relapse of psychosis, recruited to a psychological therapy trial, completed the audiotaped Camberwell Family Interview at baseline. This semi-structured interview includes questions on the quality of the relationship between caregiver and patient, and patient history of violence. Seventy-two transcripts of interviews were assessed for reports of patient-initiated violence. One-half of the caregiver sample (52.9%) reported an incident of patient-initiated violence during their interview; 62.2% of these involved violence toward themselves, and 24.3% toward property. Reports of patient violence were associated with caregiver ratings of hostility expressed toward patients, lower self-esteem, and emotion-focused coping. People caring on their own were more likely to report incidents of patient violence. Younger patients, males, and inpatients were more frequently identified as having a history of this kind of violence. Our findings suggested that caregiver reports of patient-initiated violence in psychosis are not uncommon. Mental health staff need to be aware of the risks of such violence for caregivers of people with psychosis, and consider appropriate procedures for minimizing it.

Continuous prediction of secondary progression in the individual course of multiple sclerosis

BackgroundPrediction of the course of multiple sclerosis (MS) was traditionally based on features close to onset. ObjectiveTo evaluate predictors of the individual risk of secondary progression (SP) identified at any time during relapsing-remitting MS. MethodsWe analysed a database comprising an untreated MS incidence cohort (n=306) with five decades of follow-up. Data regarding predictors of all attacks (n=749) and demographics from patients (n=157) with at least one distinct second attack were included as covariates in a Poisson regression analysis with SP as outcome. ResultsThe average hazard function of transition to SPMS was 0.046 events per patient year, showing a maximum at age 33. Three covariates were significant predictors: age, a descriptor of the most recent relapse, and the interaction between the descriptor and time since the relapse. A hazard function termed “prediction score” estimated the risk of SP as number of transition events per patient year (range <0.01 to >0.15). ConclusionsThe insights gained from this study are that the risk of transition to SP varies over time in individual patients, that the risk of SP is linked to previous relapses, that predictors in the later stages of the course are more effective than the traditional onset predictors, and that the number of potential predictors can be reduced to a few (three in this study) essential items. This advanced simplification facilitates adaption of the “prediction score” to other (more recent, benign or treated) materials, and allows for compact web-based applications (http://msprediction.com).

Spotlight on the April 8 Issue

Previous reports state that patients with multiple sclerosis who switch from natalizumab to fingolimod are at risk of clinical worsening. Using MSBase Registry data, the authors showed that disease activity remains well-controlled in this scenario. Recent prior relapse activity and treatment gap were identified as the strongest predictors of disease activity. See p. 1204; Editorial, p. 1196 Cognition-specific training (19 patients) vs training with a computer sports game (20 patients) resulted in similar cognitive effects except for attention, which improved more with the sports game. Computer sports games …

Urban governance in the South: How did Bogotá lose its shine?

There are all too few examples of good urban governance in the ‘South’. One city which improved its performance dramatically after 1992 was Bogotá, the capital of Colombia. It joined the ranks of exemplar cities and its former mayors toured the world advertising this ‘miracle’. Unfortunately, after 2008, the city’s administration became mired in corruption and its image ratings have dived. The current administration has so far failed to revive trust in the city’s governance. Based on interviews with key personalities in the city, this paper examines the causes of Bogotá’s recovery and its recent relapse. Bogotá’s experience is useful to students of urban governance in showing not only how a city in the ‘South’ can improve its performance but also that any improvement is fragile. A decent working relationship between technocrats and politicians is critical in guaranteeing both public support and progress in implementing major public works.

Diagnostic role of fluorodeoxyglucose positron emission tomography-computed tomography in prostate cancer.

The role of fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)-computed tomography (CT) in prostate cancer remains controversial due to a limited number of previous clinical investigations. The aim of the present retrospective study was to assess the diagnostic value of FDG PET-CT in prostate cancer, with an emphasis on the detection of metastatic disease. Twenty-five relevant cases of patients with newly diagnosed prostate cancer, referred for staging, or with a history of prostate cancer or recent prostate specific antigen (PSA) relapse, referred for the detection of metastatic disease, were included in the present study. None of the patients had known imaging or pathological evidence of metastatic disease prior to FDG PET-CT, however, the PSA levels had been recorded in all patients in the two months prior to FDG PET-CT imaging. Verification of the FDG PET-CT observations was made by biopsy, regional diagnostic CT and/or whole-body bone scintigraphy. The sensitivity of FDG PET-CT in identifying untreated primary lesions was only 33% (3/9). However, FDG PET-CT detected metastatic disease in six of the nine patients who underwent initial staging. Out of 16 patients with previous treatments and recent PSA relapse, FDG PET-CT successfully identified metastatic diseases in 12 and tumor recurrence within the prostatic fossa of two patients. The difference in the PSA levels was identified to be statistically significant between the FDG PET-CT-positive and -negative subgroups of the 16 restaging patients. The results indicated that FDG PET-CT is not useful for the diagnosis of prostate cancer, but may aid with the detection of metastatic disease in appropriately selected patients.

The UK patient experience of relapse in Multiple Sclerosis treated with first disease modifying therapies

BackgroundThe fixed, progressive disability associated with late Multiple Sclerosis (MS) is known to have a major impact on patients and their families, but the impact of relapse earlier in the disease course is less well documented, particularly from the patient׳s perspective. This study aimed to understand the effects of relapse for people with MS (PwMS), focussing on the years immediately after starting disease modifying therapy (DMT) when experience of a relapse may particularly influence a patient׳s opinions of their disease and its therapy. MethodsThis was a multi-centre, retrospective, observational research study, recruiting patients from 7 UK NHS Hospital Trusts. Consenting patients with relapsing-remitting MS (RRMS), who had started a DMT more than 36 months before screening, were sent a study questionnaire. Data on MS relapses and treatments over 3 years were collected simultaneously from medical records. ResultsOne hundred and three patients completed the questionnaires. Relapses were under-reported to health care professionals, with 28% of respondents failing to report their most recent attack and 46% declaring they had failed to report an attack in the past. During their most recent relapse, 67% of those in paid employment reported taking time off sick, 48% reduced working hours temporarily, and 41% worked reduced hours and took time off sick. Sixty-six percent required additional support to undertake routine daily tasks during their most recent relapse. A range of effects of relapse which cannot be measured in financial terms were also reported, including effects on physical abilities, mental health and family roles and relationships. ConclusionThis contemporary UK-based study provides an insight into the experience of relapse early in the treatment of RRMS from the patient perspective. The comparison of documented patient reported relapses reveals some deficiencies in the recording of relapses which is important to address in view of the reported impact of individual relapses, and emphasises relapse reduction as a worthy treatment aim.

Abnormal blood–brain barrier permeability in normal appearing white matter in multiple sclerosis investigated by MRI

ObjectivesTo investigate whether blood–brain barrier (BBB) permeability is disrupted in normal appearing white matter in MS patients, when compared to healthy controls and whether it is correlated with MS clinical characteristics.MethodsDynamic contrast-enhanced MRI was used to measure BBB permeability in 27 patients with MS and compared to 24 matched healthy controls.ResultsPermeability measured as Ktrans was significantly higher in periventricular normal appearing white matter (NAWM) and thalamic gray matter in MS patients when compared to healthy controls, with periventricular NAWM showing the most pronounced difference. Recent relapse coincided with significantly higher permeability in periventricular NAWM, thalamic gray matter, and MS lesions. Immunomodulatory treatment and recent relapse were significant predictors of permeability in MS lesions and periventricular NAWM. Our results suggest that after an MS relapse permeability gradually decreases, possibly an effect of immunomodulatory treatment.ConclusionsOur results emphasize the importance of BBB pathology in MS, which we find to be most prominent in the periventricular NAWM, an area prone to development of MS lesions. Both the facts that recent relapse appears to cause widespread BBB disruption and that immunomodulatory treatment seems to attenuate this effect indicate that BBB permeability is intricately linked to the presence of MS relapse activity. This may reveal further insights into the pathophysiology of MS.

Treatment of Frequently Relapsing Nephrotic Syndrome

Source: Gellerman J, Weber L, Pape L, et alfor the Gesellschaft für Pädiatrische Nephrologie. Mycophenolate mofetil versus cyclosporin A in children with frequently relapsing nephrotic syndrome [published online ahead of print June 27, 2013]. J Am Soc Nephrol; doi: 10.1681/ASN.2012121200Investigators from Germany conducted a multicenter, randomized, open-label, crossover trial comparing the efficacy and safety of mycophenolate mofetil (MMF) to cyclosporin A (CsA) in pediatric patients with frequently relapsing steroid-sensitive nephrotic syndrome (FR-SSNS). FR-SSNS was defined as >4 relapses in 12 months. Patients with FR-SSNS who were 3 to 18 years old and had minimal change glomerulopathy on biopsy, an estimated glomerular filtration rate (eGFR) of ≥90 ml/min per 1.73 m2, and were in remission after a recent relapse were eligible for inclusion. Participants were randomized to receive either MMF for 12 months followed by CsA for 12 months (Group A) or CsA for 12 months followed by MMF for 12 months (Group B).Demographic and clinical characteristics were collected at baseline. During the study period of 2 years, participants had monthly physical examinations, assessment of side effects, screening for proteinuria, and therapeutic drug monitoring. Other blood tests (eg, lipid profile) were performed every 3 months and blood pressure (BP) monitoring was performed at 12 and 24 months. The primary study outcome was the number of relapses per patient per year during the treatment period. Secondary endpoints included pharmacokinetic profiles, cumulative dose of corticosteroids, side effects, and changes in eGFR, BP, and lipid profile.A total of 60 patients (80% boys) were enrolled and randomized to the 2 treatment groups. There were no significant differences between groups in participant age, eGFR, duration of disease, or relapses before study entry. Most participants (75%) had received previous courses of immunosuppressive therapy in addition to corticosteroids.Significantly more patients relapsed while on MMF than on CsA during the first year of the trial (1.10 relapses per patient per year vs 0.24, P = .03) but not during the second year. The time without relapse was significantly longer with CsA compared to MMF during the first year (P < .05), but not during the second year. The eGFR decreased from 12 months to 24 months in Group A (corresponding with CsA treatment), and increased from 12 months to 24 months in Group B (corresponding with MMF treatment). There were no statistically significant follow-up differences between groups with regards to blood pressure, lipid levels, or adverse events.The authors conclude that MMF was inferior to CsA in preventing relapses in children with FR-SSNS but may be a less nephrotoxic treatment.Dr Sethna has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Idiopathic nephrotic syndrome, namely minimal change nephrotic syndrome, diffuse mesangial proliferation, and focal segmental glomerulosclerosis, account for 90% of all cases of nephrotic syndrome with an incidence in the United States of 2 to 7 per 100,000.1 The first line therapy is corticosteroids. Approximately 80% of cases are steroid-responsive at presentation, indicating a favorable prognosis for kidney function.1 Children who become steroid-dependent (SDNS) or frequently relapse are more difficult to treat.Although the pathogenesis of SDNS and FR-SSNS are not fully understood, an underlying immunological defect is suspected and serves as the rationale for use of second-line immunosuppressant treatment. Such second-line agents are also utilized to avoid serious side effects of prolonged steroid exposure. The preferred class and sequence of immunomodulatory drugs for the treatment of SDNS and FR-SNSS have varied with time and region. Alkylating agents such as cyclophosphamide, chlorambucil, levamisole, and the calcineurin inhibitor CsA have been used for over 20 years.2 Severe side effects, however, have led to consideration of several new classes of drugs that target various stages of T- and B-cell action. Tacrolimus, a calcineurin inhibitor that inhibits interleukin-2-driven T-cell activation, has shown promising results in various single-centered studies. 3 Tacrolimus has a milder side effect profile than CsA; however, nephrotoxicity remains a limitation.MMF, a T- and B-cell proliferation inhibitor, has been recently introduced for the treatment of SSNS. Although the current study demonstrated inferiority of MMF compared to CsA in preventing relapses, it is efficacious in inducing remission of nephrotic syndrome with the advantage of no risk of nephrotoxicity. More recently, the monoclonal antibody rituximab, an anti-B-cell treatment, has been used as a “rescue medication” for especially difficult patients. Past studies have shown promising results although long-term side effects and remission sustainability are uncertain.4 Treatment of SDNS and FR-SSNS in children can often prove to be challenging. There is continued need for large-scale randomized controlled trials that provide strong evidence to guide therapy.

Decision-making throughout the whole process of relapse: a qualitative analysis of problem drinkers’ accounts of recent episodes

Background & Aims: Models of relapse have usually focused on the antecedents to a drinking session. This qualitative study examined themes within the whole process of relapse in alcohol use (including four phases: before, during, ending and following a drinking session).Methods: Fifteen clients from a UK alcohol treatment clinic received a semi-structured interview, and in-depth accounts of their most recent relapse experiences were obtained. Interview transcripts were analysed using thematic analysis.Results: Participants made sense of their relapse as being caused by circumstantial and compelling triggers, over which they perceived having little control. However, less readily identified, the whole process of relapse was underpinned by a sequence of ordinary decisions. Participants selected options in beverage choice, purchasing and drinking behaviour, which minimised anticipated negative outcomes of a relapse. Their continued drinking was reinforced by primary and secondary gains, and beliefs of uncontrollability. Participants were able to stop drinking, without assistance, when they had enough. Negative consequences of relapse were delayed and less serious than drinkers anticipated. Sharing their accounts with supportive others gave them a sense of consolation.Conclusions: Reflecting on the whole process of relapse and building up drinkers’ sense of control may be important components of relapse prevention.

Low vitamin D level is associated with higher relapse rate in natalizumab treated MS patients

BackgroundPrevious research suggested a relationship between low vitamin D and relapse rate. We examined whether vitamin D levels were associated with: 1) MS severity and 2) recent MS relapse activity, in patients treated with natalizumab. MethodsAll patients (n=118) were treated with natalizumab and were tested for vitamin D levels during the winter of 2009–10. Number of relapses during treatment with natalizumab was determined by retrospective chart review. MS severity was estimated with the Roxburgh's MS Severity Score (MSSS) at the time of the initial blood draw and 1year preceding and following initial draws. Vitamin D levels of 50nmol/L or greater were defined as normal. ResultsPatients with deficient vitamin D levels (DVD) totaled 45. Sixteen of the 26 patients with relapse in the year prior to the initial blood draw (4 patients had multiple relapses — all were in DVD) and 12 of 17 patients with relapse in the following year were in the DVD group. There was a significant difference between the normal vitamin D group (NVD) and DVD in MS relapse activity in the year prior (p=0.005) and following blood draw (p=0.006). There was no significant between group differences in MSSS at any time. ConclusionsNatalizumab treated patients with DVD were more likely to experience relapse and may experience more relapses than patients with NVD.

A novel oral nutraceutical formula of omega-3 and omega-6 fatty acids with vitamins (PLP10) in relapsing remitting multiple sclerosis: a randomised, double-blind, placebo-controlled proof-of-concept clinical trial

ObjectiveTo assess whether three novel interventions, formulated based on a systems medicine therapeutic concept, reduced disease activity in patients with relapsing–remitting multiple sclerosis (MS) who were either treated or not...

Prognostic Significance of Minimal Residual Disease in Adult Patients with B-Lineage Acute Lymphoblastic Leukemia by 8-Color Flow Cytometry

Abstract 4789Monitoring of minimal residual disease (MRD) in patients with acute lymphoblastic leukemia (ALL) by immunophenotyping and/or molecular techniques provides a way to precisely evaluate early treatment response and predict relapse. In this study, we have investigated the prognostic significance of MRD in adult patients with B-lineage acute lymphoblastic leukemia (B-ALL) by 8-color flow cytometry. A cohort of 106 patients with B-ALL who had achieved a complete remission (CR) and at least 1 LAIP characteristics were enrolled to perform MRD assessment at the end of induction and 1 cycle of consolidation. LAIPs were identifiable in 96% of the patients by 8-color flow cytometric assay, in which, most cases (90.6%) containing 2 or more LAIPs had a sensitivity as high as identifying 1 leukemic blast among 1×105 BM nucleated cells. MRD negative status could clearly predict a favorable 1 year relapse free survival (RFS) and 2 year overall survival (OS) when a cut-off level of 0.01% was used to define MRD positivity at the point of achieving CR (P=0.000 and 0.000, respectively) and after 1 cycle of consolidation (P=0.000 and 0.000, respectively), respectively. In multivariate analysis including cytogenetic abnormalities, clinical factors and MRD status, late CR (P=0.046), MRD status at the points of obtaining CR (P=0.016) and 1 consolidation (P=0.007) were associated with RFS independently, while only MRD status after 1 course of consolidation was independent prognostic factor for OS (P=0.000). Of note, in exploring the fewer patients with MRD negative status experienced recent relapse, we have identified that most of such patients had a MRD level of 10−4−10−5 comparing to undetectable MRD level. Furthermore, our evidences showed that MRD assessed by flow cytometry and by RQ-PCR assay targeting to BCR-ABL fusion gene yielded concordant results in the vast majority of cases (90%). In conclusion, immunophenotypic evaluation of MRD by 8-color flow cytometry could work as an important tool to assess the treatment response and prognosis precisely in adult B-ALL. Disclosures:No relevant conflicts of interest to declare.

Patients' beliefs about the causes, persistence and control of psychotic experiences predict take-up of effective cognitive behaviour therapy for psychosis

There is evidence that patients with schizophrenia benefit from standard cognitive behaviour therapy (CBT) only if active techniques are used ('full therapy'). By contrast, attending sessions but not proceeding beyond engagement and assessment strategies ('partial therapy'), or simply not attending sessions ('no therapy'), is not associated with better outcomes. The factors leading to full therapy are unknown. We hypothesized that patients' initial ideas about the nature and extent of their problems would predict use of CBT. A match between patients' views of their problems and the principles underlying treatment would lead to better outcomes. Ninety-two patients with a recent relapse of psychosis completed the Illness Perception Questionnaire (IPQ) before receiving CBT. We examined whether their illness perceptions predicted the take-up of therapy. Patients who did not attend sessions believed their problems would not last as long as those who attended them. Those who attended sessions but did not proceed to full therapy had a lower sense of control over their problems and a more biological view of their causes. Patients who took up full therapy were more likely to attribute the cause of their problems to their personality and state of mind. The take-up of therapy was predicted neither by levels of psychiatric symptoms nor by insight. People with psychosis who have psychologically orientated views of their problems, including the potential to gain control over them, may be more likely to engage fully and do well with standard CBT for psychosis, irrespective of the severity of their problems.