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PubMed1986

A cluster-analytic classification of smoking relapse episodes.

Using reports of relapse crises collected through a relapse prevention hotline, this paper develops a taxonomy of relapse situations. Cluster analysis resulted in four clusters. Social situations are characterized by social drinking and exposure to smoking. Relaxation situations are marked by relaxation, usually after a meal. Work situations take place during work when the exsmoker is feeling anxious. Upset situations occur when the exsmoker is feeling anxious or depressed while home alone. These situations were significantly discriminated by their scores on the McKennel Smoking Motivation Scales, suggesting a connection between smoking patterns and relapse. Behavioral coping was less likely and relapse more likely in social and upset situations. The frequency of coping accounted for the higher relapse rates in Upset, but not in social situations. Relapse was nearly inevitable among people who failed to cope behaviorally in social situations, suggesting that they are especially tempting.

Affective Symptoms↗

PubMed1991

Importance of substance cues in relapse among heroin users: comparison of two methods of investigation.

Ninety-three heroin users in treatment rated the importance to their last relapse to heroin use of the 13 categories and subcategories of reasons for relapse identified by Marlatt and Gordon (1985). These subject ratings were compared with the consensual categorizations of two independent judges who coded subjects' descriptions of the same relapse episodes. The results showed that, when judges categorized subjects' open-ended responses to questions about their last relapse, temptations or urges in the presence of substance cues were accorded no importance as a reason for relapse, and these categorizations were similar in this respect to previously reported findings. In contrast, when subjects themselves directly quantified the importance of the various relapse categories in precipitating their last relapse, substance-related temptations or urges obtained the highest mean rating of all categories.

Adaptation, Psychological↗

PubMed1992

Predictors of smoking relapse among self-quitters: a report from the Normative Aging Study.

We followed 235 adults for one year after a self-initiated attempt to stop smoking cigarettes. Relapse rates were much larger than expected in the early days and weeks after the quit attempt. Approximately 62% had relapsed by 2 weeks after their quit dates. Those who smoked any cigarettes at all in the post-cessation period (i.e., lapsed) had a 95% probability of resuming their regular pattern of smoking subsequently. Shorter periods of abstinence on prior quit attempts, greater pre-cessation consumption of alcoholic beverages, and lower pre-cessation levels of confidence in quitting were related to relapse. In addition, abstainers who reported decreased confidence after cessation concerning their ability to maintain abstinence were more likely to relapse thereafter. The presence of a greater proportion of smokers in the subjects' environment also increased the likelihood of relapse. Demographic variables such as age, gender, and education level did not predict relapse. Likewise, neither baseline psychosocial stress levels, nor post-cessation increases in stress were related prospectively to relapse. Clinical implications of finding are discussed.

Adult↗

PubMedDate not supplied

The role of attributions in abstinence, lapse, and relapse following substance abuse treatment.

This study examined the role of attributions in the lapse and relapse process following substance abuse treatment. According to Marlatt and Gordon's theoretical framework, attributions made after a lapse (e.g., the Abstinence Violation Effect [AVE]) determine whether it progresses to a relapse. Also examined were the attributions of recovering drug users who were tempted but remained abstinent (never lapsed). Ninety-seven participants were recruited from an inpatient treatment center for substance abuse and completed an interview 6 months after leaving treatment. Findings partially confirmed predictions made by the AVE. Predictions made by the AVE were not supported in that lapsers and relapsers were similar regarding their internal/external attributions following a return to drug use; predictions were supported as relapsers made more stable and global attributions as compared to lapsers. Also as predicted, abstainers made more internal, stable, and global attributions regarding their abstinence (as compared to lapsers following their slip). Abstainers' attributions for their success in remaining abstinent tended to be similar to the attributions made by relapsers for their failure to remain abstinent (i.e., for their relapse). Combined, these findings highlight the complexity of the attributional process in early recovery from substance abuse. Clinical and research implications of the findings are discussed in relation to substance abuse relapse prevention.

Adolescent↗

PubMedDate not supplied

Relapse revisited: a critique of current concepts and clinical practice in the management of alcohol problems.

How a problem is understood dictates how it is responded to. In this paper the problem of relapse and alcohol dependence is reconsidered. The existing major relapse paradigm is evaluated against the last two decades of research. It is concluded that the available research strongly questions the notion that relapse is an addiction-specific event. Instead, relapse is probably better understood as a complex, generic, human behaviour, undertaken at times by all of us. Given this, it is possible that mainstream psychological theories, such as decision making and attribution theory, are important in coming to any understanding of the phenomenon of relapse. It is also contended that the investigation of relapse is potentially an error of focus. Such study invites the investigation of those who do not succeed in changing behaviour, as against the study of those who do. For those concerned with the treatment of alcohol dependence, studying the successes may be a more informative process than studying the putative failures. Given the burgeoning of research over the past two decades the impact on treatment practice is reviewed. It is concluded that relapse prevention and management is very much on the alcohol-intervention agenda. However, the research evidence to date is consistent with the general psychotherapy literature in that doing something appears better than no intervention, but that an optimum, effective, intervention has yet to be devised.

Alcoholism↗

PubMed1985

Breast relapse following primary radiation therapy for early breast cancer. II. Detection, pathologic features and prognostic significance.

In order to define better the nature of breast relapse following primary radiation therapy for early-stage invasive breast cancer, we examined the clinical patterns, methods of detection, histopathology and prognosis in 25 patients. Eighty-eight percent of these relapses occurred in the vicinity of the original tumor at an average of 33 months after treatment. Twelve percent occurred in a location distinctly separate from the primary tumor area at an average of 75 months after treatment. In 14 patients breast relapse was detected by physical examination (PE) alone, in 6 patients by mammography alone and in 5 patients by both. In eight of the patients whose relapses were detected by PE alone, mammography was not performed; mammograms were negative in the other six. In 89% of the patients who presented with a new abnormality on physical examination, the recurrence consisted predominantly or exclusively of invasive carcinoma. In contrast, in all six patients who presented with only a new mammographic abnormality, the recurrence consisted predominantly or exclusively of intraductal carcinoma. Eighteen of these patients underwent salvage mastectomy, 3 were inoperable on clinical grounds and 4 refused mastectomy. Only 1 of the 18 patients who underwent mastectomy had a significant complication related to the surgery. Twenty-one of these 25 patients (84%) are alive without further recurrence up to 67 months (mean 24 months) after breast relapse. We conclude that (1) physical examination and mammography are both important for the detection of breast relapses: (2) secondary (salvage) surgery can be performed without significant complications; and (3) a breast relapse does not have the same grave prognosis as a local (chest wall) recurrence after mastectomy.

Adult↗

PubMed1994

Radical radiotherapy as salvage treatment for relapse of Hodgkin's disease initially treated by chemotherapy alone: prognostic significance of the disease-free interval.

PURPOSE: A study was performed to determine the effectiveness of radical radiation therapy (RT) in the treatment of patients with Hodgkin's disease who relapsed following initial treatment with chemotherapy alone. METHODS AND MATERIALS: A retrospective review of patients treated at City of Hope National Medical Center between 1970 and 1987 revealed a total of 10 patients who received radical RT with curative intent as salvage therapy. RESULTS: Complete remission was achieved in eight of the ten patients. Patients had an overall 5-year actual survival of 60% and 10-year actuarial survival of 38%. Relapse-free survival was 30% at 5 years and at 10 years. For the five patients with a disease-free interval (DFI) of at least 12 months prior to radical RT, overall actual survival at 5 years was 100% and relapse-free survival was 60%. Three of the ten patients, all with a DFI > 12 months and in first relapse when undergoing radical RT, were long-term relapse-free survivors. CONCLUSION: Radical RT is an effective salvage regimen for select patients with advanced stage Hodgkin's disease who relapse following initial treatment with chemotherapy alone provided that relapse is limited to sites which can be encompassed by radical RT fields and the DFI is greater than 12 months. Review of other published series supports DFI > 12 months as a favorable prognostic factor. Comparison to other salvage regimens such as autologous bone marrow transplantation is limited. Reviews of other treatment modalities should perform subset analysis on patients with similar presentations to compare the relative effectiveness of various salvage approaches.

Adolescent↗

PubMed1987

Orthodontic relapse, apical root resorption, and crestal alveolar bone levels.

This investigation examined the relationship of postorthodontic treatment relapse to crestal alveolar bone support and root resorption. Thirty-six persons having completed the retention phase of orthodontics at least 10 years earlier were divided into two groups based on the amount of relapse crowding of the mandibular anterior teeth. Eighteen subjects (relapse group) exhibited 2 mm or more of mandibular anterior relapse crowding and 18 subjects (nonrelapse group) exhibited no mandibular anterior relapse crowding. At time of recall, full-mouth series of periapical and bitewing radiographs were obtained as well as lateral cephalometric films to allow comparison with similar lateral cephalometric films obtained at pretreatment and retention time points. The radiographs were examined to assess three parameters: root resorption, crestal alveolar bone levels, and changes in the position and angulation of the maxillary incisors. The subjects in the relapse group had undergone longer periods of treatment and exhibited a greater prevalence of root resorption; they also displayed significantly greater crestal alveolar bone level distances, indicating greater loss of bone support than that observed in the nonrelapse group. The distances that teeth were translated seemed to affect the extent of root resorption and crestal bone loss with smaller amounts of tooth translation seemingly more prone to demonstrate tissue loss. The findings of this investigation suggest there may be a relationship between orthodontic relapse and the parameters of increased root resorption and decreased crestal alveolar bone levels.

Adult↗

PubMed1992

Loco-regional nodal relapse in melanoma.

Two-hundred and seven patients without evidence of disease following lymph node dissection (LND) were stratified into three groups: Group A, lymph node relapse within the site of prior LND; Group B, lymph node relapse in a different, but regional, lymph node group; Group C, no lymph node relapse. Decreased survival was noted in both Groups A and B versus Group C. Prognostic factors were identified as: (i) axial or subungal/volar (subvolar) location and the number of positive lymph nodes at initial LND for nodal relapse within the same lymph node group; (ii) male gender, axial/subvolar location, and the number of histologically positive lymph nodes at initial LND for nodal relapse in a different, but regional lymph node group; (iii) relapse within the initial LND site for a decreased survival. Six of 10 patients with both axial/subvolar primaries and four or more positive lymph nodes developed a relapse within the dissection site post-LND. These prognostic factors describe a subset of patients who would be candidates for postoperative adjuvant local/regional and systemic therapy trials.

Adolescent↗

PubMed2004

Statistical definition of relapse: case of family drug court.

At any point in time, a patient's return to drug use can be seen either as a temporary event or as a return to persistent use. There is no formal standard for distinguishing persistent drug use from an occasional relapse. This lack of standardization persists although the consequences of either interpretation can be life altering. In a drug court or regulatory situation, for example, misinterpreting relapse as return to drug use could lead to incarceration, loss of child custody, or loss of employment. A clinician who mistakes a client's relapse for persistent drug use may fail to adjust treatment intensity to client's needs. An empirical and standardized method for distinguishing relapse from persistent drug use is needed. This paper provides a tool for clinicians and judges to distinguish relapse from persistent use based on statistical analyses of patterns of client's drug use. To accomplish this, a control chart is created for time-in-between relapses. This paper shows how a statistical limit can be calculated by examining either the client's history or other clients in the same program. If client's time-in-between relapse exceeds the statistical limit, then the client has returned to persistent use. Otherwise, the drug use is temporary. To illustrate the method, it is applied to data from three family drug courts. The approach allows the estimation of control limits based on the client's as well as the court's historical patterns. The approach also allows comparison of courts based on recovery rates.

Child↗

PubMed2005

Predictors of smoking relapse in a sample of Dutch adult smokers; the roles of gender and action plans.

BACKGROUND: The object of this study was to investigate the influence of gender and the additional protective quality of action plans on the occurrence of relapse in smokers after a pharmacy-based minimal intervention strategy. METHODS: Respondents received a written baseline questionnaire, based on the I-Change Model, and were contacted 3 months after baseline by telephone. RESULTS: A total of 223 respondents were included in relapse analyses. Relapse was predicted by intention, the use of pharmacotherapy and action plans. Predictors differed for men and women. CONCLUSIONS: Action plans provide a protective value against smoking relapse. Men and women did not differ in relapse rates, but predictors differed. Developers of relapse prevention activities should consider developing programmes based on gender. These programmes could also benefit from making use of action plans as a method for preventing relapse.

Antidepressive Agents, Second-Generation↗

PubMed2006

Clinical outcome following autologous and allogeneic blood and marrow transplantation for relapsed diffuse large-cell non-Hodgkin's lymphoma.

High-dose chemotherapy followed by blood or marrow transplantation (BMT) is generally considered the best salvage option for patients with relapsed diffuse large-B-cell non-Hodgkin's lymphoma (DLCL). The relative roles for allogeneic and autologous BMT remain controversial. We reviewed the clinical outcome of 183 patients with relapsed DLCL who underwent BMT at Johns Hopkins University in 1985-2001. A total of 45 patients received T-cell-depleted HLA-matched allogeneic bone marrow (allo-BMT), and 138 patients received autologous marrow or peripheral blood stem cells (auto-BMT). The allo-BMT recipients had a higher proportion of patients with chemoresistant disease (P = .004) and had received more chemotherapy before BMT (P = .02). The auto-BMT recipients were older (P < .001) and were of more advanced-stage disease (P = .01). The 3-year overall survival (OS) was 23.7% (median survival, 129 days) after allo-BMT and 33.1% (median survival, 263 days), after auto-BMT (log-rank, P = .17). The 3-year OS for patients with sensitive disease was 51.9% after allo-BMT and 46.2% after auto-BMT (log-rank, P = .38). For patients with resistant disease, the 3-year OS was 12.1% after allo-BMT and 19.1% after auto-BMT (log rank, P = .08). In multivariate analysis, significant predictors of death were disease sensitivity (hazard rate [HR], 0.3; 95% confidence interval [CI] 0.2-04; P < .001), age >40 years (HR, 2.42; 95% CI, 1.7-3.4; P < .001), and stage at diagnosis (HR, 1.2; 95% CI, 1.0-1.4; P = .04). The 3-year event-free survival (EFS) for patients with sensitive disease was 52.7% after allo-BMT and 42.0% after auto-BMT (log-rank, P = .29). For patients with resistant disease, the 3-year EFS was 6.2% after allo-BMT and 19.4% after auto-BMT (log-rank, P = .1). The 3-year probability of relapse for chemosensitive patients was 30% after allo-BMT and 46.1% after auto-BMT (log-rank, P = .25). The 3-year relapse rate in patients with resistant disease was 75.0% after allo-BMT and 69.9% after auto-BMT (log-rank, P = .58). In multivariate analysis, only disease sensitivity status (HR, 0.4; 95% CI, 0.2-2.1; P < .001) and age >40 years (HR, 1.7; 95% CI, 1.1-2.9; P = .03) appear to have a significant impact on relapse. Transplant-related mortality (TRM) was the cause of death for 51.1% of allo-BMT recipients and 23.9% of auto-BMT recipients (P < .001). Mortality from lymphoma was 26.6% in allo-BMT recipients and 43.5% in auto-BMT recipients (P = .02). Auto-BMT and allo-BMT produced similar survival for patients with relapsed DLCL. For patients with sensitive disease, allo-BMT seemed to provide longer survival with less relapse; however, this was achieved at the cost of greater TRM.

Adolescent↗

PubMed2004

Secondary near-tetraploidy with double der(15)t(15;17) in acute promyelocytic leukemia in relapse.

Tetraploidy or near-tetraploidy is a rare cytogenetic abnormality in acute myelocytic leukemia. We report here a case of acute promyelocytic leukemia that showed near-tetraploidy with double der(15)t(15;17) the leukemia relapsed. At diagnosis, cytogenetic analysis failed to reveal any karyotypic abnormality; however, a promyelocytic leukemia-retinoic acid receptor alpha (PML/RARA) fusion transcript of the bcr3-type was detected with reverse transcriptase-polymerase chain reaction analysis, and a single PML/RARA fusion signal was observed with fluorescence in situ hybridization analysis. At the first relapse, the majority of leukemic cells showed pseudodiploid karyotypes with der(15)t(15;17), as well as additional chromosomal abnormalities, and exhibited a single PML/RARA fusion signal. A small fraction of leukemic cells, however, showed near-tetraploid karyotypes with double der(15)t(15;17), as well as some additional chromosomal abnormalities in common with the pseudodiploid clones, and exhibited double PML/RARA fusion signals. At the second and third relapses, leukemic cells with near-tetraploidy and double PML/RARA fusion signals became predominant. The PML/RARA fusion transcript of the bcr3 type was also observed at each relapse. In addition, Southern blot analysis of the RARA gene at diagnosis and at the second relapse showed a common rearranged band. Notably, giant, bizarre, and hypogranular promyelocytes expressing CD2, CD34, and HLA-DR appeared at the first relapse and became predominant at the second and third relapses. These observations indicate that the APL cells with near-tetraploidy and double der(15)t(15;17) clonally evolved from the pseudodiploid leukemic cells and exhibited the bizarre morphology and aberrant surface immunophenotypes.

Blotting, Southern↗

PubMed2005

Relapse to driving under the influence (DUI): a review.

Driving under the influence (DUI) is a major public health problem. In 2003, there were 17,401 alcohol-related crash fatalities. Although there has been a large decrease in the fatality rates over the past two decades, further progress has stalled in recent years. This plateau in the injury and death rates resulting from impaired driving has been attributed, in part, to the persistent or repeat DUI offender. Broadly defined, repeat offenders are those individuals who, following an initial DUI arrest, relapse to driving under the influence of alcohol and other drugs. In this paper, we first provide a brief overview of several models of DUI relapse. We then review the empirical literature on DUI relapse, the data describing characteristics of first-time and repeat DUI offenders, and, especially, studies that have evaluated the impact of legal sanctions and rehabilitation programs on subsequent DUI behavior. The data reveal that DUI offenders are a heterogeneous group, and that simple models relying on only one or two behavioral domains (e.g., driving characteristics, demographics) to explain DUI relapse are insufficient to account for the DUI behavior of offenders. To advance our understanding of DUI relapse, we argue for development and testing of multifactorial models focusing on the interplay of legal, social and psychological factors that describe and explain relapse among DUI offenders. By recognizing the heterogeneity within the offender population it will be easier for researchers and clinicians to identify subgroups that are at high-risk for relapse and which should be targeted by prevention and intervention programs.

Accidents, Traffic↗

PubMed2005

Immunophenotypic cell lineage and in vitro cellular drug resistance in childhood relapsed acute lymphoblastic leukaemia.

At relapse, T-cell acute lymphoblastic leukaemia (ALL) has a worse patient outcome than B-cell precursor (BCP-) ALL. To investigate this further, we compared in vitro cellular drug resistance profiles of T-cell and BCP-ALL samples obtained at relapse. We investigated 237 paediatric relapsed ALL cases, including 151 samples taken at first relapse, of which 30 were T-cell ALL. In vitro drug resistance was measured using the 4-day methyl-thiazol-tetrazolium (MTT) assay and cellular immunophenotype was determined at central reference laboratories. Similar results were found for first relapsed ALL samples and for the total group: T-cell ALL samples were more resistant to 4-HOO-ifosfamide (1.4-fold, P = 0.019) and cisplatin (3.7-fold, P = 0.005). The samples were more sensitive to thiopurines such as mercaptopurine (2.1-fold, P = 0.007) and thioguanine (1.7-fold, P = 0.003). Resistance/sensitivity to 16 other drugs did not differ significantly. These results do not explain the relatively poor prognosis of T-cell ALL at relapse, but do suggest that the more intensive use of thiopurines in relapsed T-cell ALL may be beneficial.

Antineoplastic Agents↗

PubMed2006

Clinico-histologic parameters of osteosarcoma patients with late relapse.

Primary high-grade intramedullary osteosarcoma of the extremities is a clinically aggressive bone tumour. There is an ongoing effort to further improve efficacy of neo-adjuvant chemotherapy and reduce chemotoxicity by trying to identify osteosarcoma patients who are at risk of treatment failure as well as to identify those who can do with less chemotherapy. In only 5% of patients, first distant metastasis or local relapse occurs 5 years or more after initial treatment for osteosarcoma. Patients and physicians can therefore easily erroneously consider a patient with osteosarcoma cured if he or she is disease-free for more than 5 years following diagnosis and treatment. To investigate if these rare late relapsing patients are characterised by specific clinico-pathological features, we examined clinical and histological variables of late relapse (first local recurrence or metastasis 5 years or more after initial diagnosis) out of a total of 2,243 patients, with a special interest in the histological osteosarcoma subtype. In total, 33 patients had a documented relapse 5 years or more after diagnosis. Half of the patients had good response (>or=90% necrosis) to pre-operative chemotherapy and the other half a poor response (<90% necrosis) and late relapses seemed to be more frequently proportionately in those who had a good initial response to chemotherapy. The occurrence of late relapse did not appear to be associated with age or gender. Although not statistically significant, there was a trend for patients with a chondroblastic subtype of osteosarcoma, or a location in the tibia or fibula, to have a higher risk for late relapse.

Adolescent↗

PubMed2005

Pattern of relapse after first line treatment of advanced stage germ-cell tumors.

OBJECTIVES: We performed a retrospective analysis of first relapses after cisplatin-based chemotherapy in patients with advanced germ-cell tumors, in order to better define the appropriate follow-up. METHODS: These patients were treated between 1986 and 1998 in two institutions. They were either followed after first-line chemotherapy at the same center or referred for relapse. RESULTS: Ninety-six patients relapsed (17.5% of the total number of patients treated in the same time period). Thirty-five (36.4%) patients had serum tumor marker levels (AFP, hCG and LDH) normal values. Sites of relapse were: abdominal in 47 (49%) patients, thoracic in 17 (17.7%), thoraco-abdominal in 15 (15.6%), and brain in 8 (8.3). Seven (7.3%) patients had elevated markers only, 1 (1%) had isolated supra-clavicular lymph node, 1 (1%) had bone metastasis only. Eighty-two patients (85%) relapsed during the first 18 months of follow-up. All patients with brain metastases at relapse and those who obtained sCR after chemotherapy relapsed within 8 months of follow-up. Sixteen patients underwent resection of growing teratoma. CONCLUSIONS: These results allow to recommend extensive follow-up during the first two years after response to first line treatment. It includes marker level determination and whole body CT scan and less intensive work-up there after.

Adult↗

PubMed2005

Distinctive clinical course and pattern of relapse in adolescents with medulloblastoma.

PURPOSE: To report the clinical course of adolescents with medulloblastoma, with specific emphasis on prognosis and pattern of relapse. METHODS AND MATERIALS: We retrospectively studied the clinical course and outcomes of children aged 10-20 years with medulloblastoma, treated at centers throughout Canada between 1986 and 2003. To better assess time to relapse, a cohort of patients aged 3-20 years at diagnosis was generated. RESULTS: A total of 72 adolescents were analyzed. Five-year overall survival and event-free survival rates were 78.3%+/-5.4% and 68.0%+/-6.2%, respectively. Late relapses occurred at a median of 3.0 years (range, 0.3-6.8 years). In univariate analysis, conventional risk stratification and the addition of chemotherapy to craniospinal radiation did not have prognostic significance. Female patients had improved overall survival (p=0.007). Time to relapse increased with age in a linear fashion. After relapse, patients faired poorly regardless of treatment modality. Patients who did not receive chemotherapy initially had improved progression-free survival at relapse (p=0.05). CONCLUSIONS: Our study suggests that adolescents with medulloblastoma might have a unique prognosis and pattern of relapse, dissimilar to those in younger children. They might benefit from different risk stratifications and prolonged follow-up. These issues should be addressed in future prospective trials.

Adolescent↗