Baseline and interim PET-based outcome prediction in peripheral T-cell lymphoma: A subgroup analysis of the PETAL trial

The prospective randomized Positron Emission Tomography (PET)-Guided Therapy of Aggressive Non-Hodgkin Lymphomas (PETAL) trial was designed to test the ability of interim PET (iPET) to direct therapy. As reported previously, outcome remained unaffected by iPET-based treatment changes. In this subgroup analysis, we studied the prognostic value of baseline total metabolic tumor volume (TMTV) and iPET response in 76 patients with T-cell lymphoma. TMTV was measured using the 41% maximum standardized uptake value (SUV_41max ) and SUV₄ thresholding methods. Interim PET was performed after two treatment cycles and evaluated using the ΔSUV_max approach and the Deauville scale. Because of significant differences in outcome, patients with anaplastic lymphoma kinase (ALK)-positive lymphoma were analyzed separately from patients with ALK-negative lymphoma. In the latter, TMTV was statistically significantly correlated with progression-free survival, with thresholds best dichotomizing the population, of 232 cm³ using SUV_41max and 460 cm³ using SUV₄ . For iPET response, the respective thresholds were 46.9% SUV_max reduction and Deauville score 1-4 vs 5. The proportion of poor prognosis patients was 46% and 29% for TMTV by SUV_41max and SUV₄ , and 29% and 25% for iPET response by ΔSUV_max and Deauville, respectively. At diagnosis, the hazard ratio (95% confidence interval) for poor prognosis vs good prognosis patients according to TMTV was 2.291 (1.135-4.624) for SUV_41max and 3.206 (1.524-6.743) for SUV₄ . At iPET, it was 3.910 (1.891-8.087) for ΔSUV_max and 4.371 (2.079-9.187) for Deauville. On multivariable analysis, only TMTV and iPET response independently predicted survival. Patients with high baseline TMTV and poor iPET response (22% of the population) invariably progressed or died within the first year (hazard ratio, 9.031 [3.651-22.336]). Due to small numbers and events, PET did not predict survival in ALK-positive lymphoma. Baseline TMTV and iPET response are promising tools to select patients with ALK-negative T-cell lymphoma for early allogeneic transplantation or innovative therapies.

Effects of escape to alone versus escape to enriched environments on adaptive and aberrant behavior

Escape-maintained aberrant behavior may be influenced by two outcomes: (a) a break from the activity and (b) subsequent access to preferred activities. To assess this hypothesis, a treatment was developed that analyzed response allocation across two break options: break alone and break with access to preferred social activities. The break with preferred activities decreased aberrant behavior and increased appropriate behavior.

Behavioral problems among twins

Despite the frequency of multiple births, little information is available to assist parents and health professionals in the identification and management of behavior problems in multiple-birth siblings. Three case reports are presented that describe quarreling, aggression, and feeding problems among twins. To develop intervention strategies most appropriate for the problem behavior, it is important to determine whether (1) parents are able to effectively implement the intervention strategy, (2) behavior is isolated to one sibling, and (3) different reasons are responsible for similar behavior in siblings. Structured observations were used to determine whether the undesired behavior occurred to escape nonpreferred activities, gain access to preferred activities, or obtain parental attention. The cases provide a framework to facilitate the identification and management of common behavior problems occurring among multiple-birth siblings.

Use of descriptive and experimental analyses to identify the functional properties of aberrant behavior in school settings

We conducted descriptive and experimental analyses of aberrant behavior in school settings with 2 children with autism, using teachers as assessors. Experimental functional analyses carried out by the investigators were followed by training teachers to conduct a descriptive analysis and a classroom experimental analysis. A comparison of the assessment procedures showed that each procedure identified negative reinforcement as a maintaining variable for aberrant behavior. The teacher implemented an intervention based on the assessment with mixed results. We then replicated the initial results by having the first teacher train a second teacher to carry out the two assessment procedures. The results of these analyses were also in agreement, again identifying negative reinforcement as a variable maintaining aberrant behavior. An intervention based on negative reinforcement was then successfully implemented. These results suggest the applicability and utility of functional analyses carried out in school settings.

A brief functional analysis of aggressive and alternative behavior in an outclinic setting

We conducted a brief functional analysis to identify maintaining variable for aggressive behavior and an alternative replacement response during a 90-min outpatient evaluation of 3 individuals with severe handicaps. During the initial analogue assessment, which focused on identifying maintaining contingencies for aggressive behavior, each participant displayed a substantially greater frequency of aggressive behavior during one condition than during any other. The contingency that produced the highest percentage of aggressive behavior was then presented for the occurrence of a specific alternative behavior (a mand). During this contingency reversal phase, each participant displayed a substantial reduction in aggressive behavior and a substantial increase in alternative behavior, thus providing a direct analysis of the equivalency of the contingency for maintaining either behavior.

Applications of a sequential alternating treatment design

We propose the use of a combined version of the alternating treatments and multiple baseline designs in situations in which a traditional baseline (no treatment) condition either does not provide an adequate contrast condition or is not feasible or practical due to clinical constraints. We refer to this design as a sequential alternating treatments design because two treatments are initially implemented in a random or counterbalanced fashion and are followed by a sequential change in one or both treatments across settings, subjects, or tasks. The effects of the independent variables are assessed first by analyzing the two series of data points representing the different treatments (relative effects) and then by assessing changes in one or both series, as application of the alternative treatment is introduced sequentially. The sequential application of treatment provides an analysis of control in the same manner as the multiple baseline design; the initial alternating treatments phase provides a contrast condition in much the same manner as a baseline condition. Applications of this design to the assessment of peer training and self-injurious behavior are described.

Acute liver dystrophy with thrombosis of hepatic veins: a fatal complication of dacarbazine treatment

In the course of adjuvant single-agent chemotherapy with dacarbazine after extirpation of malignant melanoma, a fatal complication was observed in four of our patients. During the second cycle of therapy liver failure due to massive hepatic necrosis supervened, with widespread thrombosis of liver veins. The clinical and pathologic features of our patients are compared with the findings in eight published cases. The possible pathogenesis is discussed in detail, and Budd-Chiari syndrome caused by an allergic thrombophlebitis with secondary liver cell necrosis seems to be most probable.