Early failure of frontline rituximab-containing chemo-immunotherapy in diffuse large B cell lymphoma does not predict futility of autologous hematopoietic cell transplantation.

The poor prognosis for patients with diffuse large B cell lymphoma (DLBCL) who relapse within 1 year of initial diagnosis after first-line rituximab-based chemo-immunotherapy has created controversy about the role of autologous transplantation (HCT) in this setting. We compared autologous HCT outcomes for chemosensitive DLBCL patients between 2000 and 2011 in 2 cohorts based on time to relapse from diagnosis. The early rituximab failure (ERF) cohort consisted of patients with primary refractory disease or those with first relapse within 1 year of initial diagnosis. The ERF cohort was compared with those relapsing >1 year after initial diagnosis (late rituximab failure [LRF] cohort). ERF and LRF cohorts included 300 and 216 patients, respectively. Nonrelapse mortality (NRM), progression/relapse, progression-free survival (PFS), and overall survival (OS) of ERF versus LRF cohorts at 3 years were 9% (95% confidence interval [CI], 6% to 13%) versus 9% (95% CI, 5% to 13%), 47% (95% CI, 41% to 52%) versus 39% (95% CI, 33% to 46%), 44% (95% CI, 38% to 50%) versus 52% (95% CI, 45% to 59%), and 50% (95% CI, 44% to 56%) versus 67% (95% CI, 60% to 74%), respectively. On multivariate analysis, ERF was not associated with higher NRM (relative risk [RR], 1.31; P = .34). The ERF cohort had a higher risk of treatment failure (progression/relapse or death) (RR, 2.08; P < .001) and overall mortality (RR, 3.75; P <.001) within the first 9 months after autologous HCT. Beyond this period, PFS and OS were not significantly different between the ERF and LRF cohorts. Autologous HCT provides durable disease control to a sizeable subset of DLBCL despite ERF (3-year PFS, 44%) and remains the standard-of-care in chemosensitive DLBCL regardless of the timing of disease relapse.

Complex trauma exposure and symptoms in urban traumatized children: a preliminary test of proposed criteria for developmental trauma disorder.

Recently, a new diagnostic construct, developmental trauma disorder (DTD), was proposed to describe the effects of chronic exposure to violence in combination with disruptions in caregiving systems. This study uses archival data to field test the consensus proposed diagnostic criteria for DTD in a sample of urban children (N = 214). Children with complex trauma histories as defined in the proposed DTD Criterion A were much more likely to meet the proposed DTD symptom criteria than children who did not meet the exposure criterion. This field trial of the proposed DTD criteria suggests that the proposed construct of DTD is useful for describing the symptoms induced by ongoing traumatic stressors and disrupted caregiving and that the proposed symptom criteria can differentiate children with histories of exposure to developmental trauma from other trauma-exposed children.

Neural correlates of odor learning in the honeybee antennal lobe.

Extracellular spiking activity and local field potentials (LFP) were recorded via tetrodes at the output of the antennal lobe (AL) in the honeybee brain during olfactory conditioning. Odors induce reliable rate responses that consist of either phasic-tonic responses, or complex responses with odor-specific profiles. In addition, odors evoke consistent responses of LFP oscillations in the 50-Hz band during the phasic ON-response to odor stimulation, and variable LFP responses at other frequency bands during the sustained response. A principal component analysis of the ensemble activity during differential conditioning consistently indicates the largest changes in response to the learned odor (conditioned stimulus; CS+). Relative LFP power increases for CS+ in the 15-40-Hz frequency band during the sustained response, and decreases for frequencies above 45 Hz. To quantify the relationship between these population responses given by the ensemble spiking activity and LFP, we show that for CS+ the learning-related changes in the degree of the phase-locked spiking activity correlate with the power changes in the corresponding frequency bands. Our results indicate associative plasticity in the AL of the bee leading to both enhancement and decrease of neuronal response rates. LFP power changes and the correlated changes in the locking between spikes and LFP at different frequencies observed for the learned odor serve as further evidence for a learning-induced restructuring of temporal ensemble representations.

Interactions of biomedical and environmental risk factors for cognitive development: a preliminary study of sickle cell disease.

Sickle cell disease (SCD) is associated with a number of biopsychosocial risk factors for cognitive development. Understanding how these risk factors may interact is important for developing interventions for cognitive functioning. The authors assessed the cognitive abilities of children with SCD (n = 50) and related their performance to anemia severity, socioeconomic status (SES), and their interaction. Demographically matched peers without SCD (n = 36) served as a comparison group. Four areas of cognitive weakness were identified among children with SCD: general cognitive ability, crystallized ability, short-term memory, and processing speed. Anemia severity predicted general cognitive ability, crystallized ability, and processing speed. Interactions between anemia severity and SES were found for general cognitive ability and short-term memory. Disease effects in SCD appear to vary depending on the child's level of socioenvironmental risk. Biomedical interventions to benefit cognitive functioning may have different effects depending on whether additional socioenvironmental risk factors are present.

Cognitive functioning in children with sickle cell disease: a meta-analysis.

OBJECTIVE: To establish whether sickle cell disease (SCD) affects cognitive functioning in children with no evidence of cerebral infarction. METHODS: We conducted a meta-analysis of studies of cognition in SCD to determine the size of any statistical difference between children with SCD and controls. Methodological factors were evaluated according to the size and frequency of group differences. RESULTS: There were small but reliable decrements in cognitive functioning on IQ measures (4.3-point difference overall). The most methodologically rigorous studies showed a highly similar pattern. Sampling issues associated with the effect size for IQ were identified. Measures of specific abilities appear more sensitive than IQ scores to cognitive decrements in SCD. CONCLUSIONS: SCD is associated with cognitive effects even in the absence of cerebral infarction. The causes of this cognitive decrement may include direct effects of SCD on brain function or indirect effects of chronic illness.