Treatment Outcome for High-Risk Violent and Sexual Offenders

Abstract Abstract 409 Alteration of the IKZF1 gene – encoding the transcription factor IKAROS, a key player in lymphoid development and tumor suppression – has been reported to be associated with a poor outcome in pediatric precursor B-cell ALL, especially in cases positive for the BCR-ABL1 fusion gene. In order to assess the prognostic value of IKZF1 deletions in a representative cohort of pediatric ALL patients treated on the German ALL-BFM 2000 study protocol, we screened 409 patients by applying a multiplex ligation-dependent probe amplification (MLPA) assay covering all eight IKZF1 exons (P335-A3 ALL-IKZF1 probemix; MRC-Holland, Amsterdam, The Netherlands). In ALL-BFM 2000, risk group stratification (standard, SR; intermediate, MR; high, HR) was based on minimal residual disease (MRD) analysis at two different time points (TP) and required two MRD targets with sensitivities of ≤10−4 (Flohr et al. Leukemia 2008). SR patients were MRD-negative on treatment days 33 (TP1) and 78 (TP2). HR patients had residual disease (≥10−3) at TP2. MRD MR patients had positive MRD detection at either one and or both time points but at a level of <10−3 at TP2. Although MRD-based stratification criteria were introduced in ALL-BFM 2000, established high-risk parameters were also retained: patients with prednisone poor-response or ≥5% leukemic blasts in the bone marrow on day 33 or positivity for a t(9;22) or t(4;11) or their molecular equivalents (BCR/ABL1 or MLL/AF4 fusion RNA) were stratified into the high-risk group independent of their MRD results. First results on MRD and outcome were published earlier (Conter et al. Blood 2010). Out of the 409 patients analyzed in our study, 46 (11%) displayed a deletion in at least one of the eight IKZF1 exons. Forty-three out of the 46 cases showed heterozygous deletions, while 3 patients displayed homozygous loss of IKZF1 exons. MLPA results of 11 patients were validated with results derived from copy number/LOH analyses using Affymetrix SNP 6.0 arrays. IKZF1 deletion was significantly more common in precursor B compared to T cell ALL (13% vs. 4%, P = 0.03) and less frequent in TEL/AML1-positive ALL (3% vs. 13%, P = 0.004). Out of 11 BCR/ABL1-positive samples, only two were characterized by an IKZF1 deletion. Forty-four patients with IKZF1-deleted ALL had results of MRD analyses available for both informative time points (day 33 after induction and day 78 after consolidation). Despite a trend towards increasing incidence of IKZF1 deletion in patients with slow response, the distribution of IKZF1-deleted ALL patients over the risk groups was not significantly different from non-deleted ALL (SR: 40.9 vs. 41.9; MR: 45.5 vs. 52.3; HR: 13.6 vs. 5.7%; P = 0.153). Regarding treatment outcome, patients with an IKZF1 deletion had a significantly lower 5-year event-free survival (EFS) compared to non-deleted patients (0.78±0.06 vs. 0.86±0.02; P = 0.015). This result was due to a higher cumulative incidence of relapses in IKZF1-deleted patients (0.16±0.05 vs. 0.10±0.02; P = 0.031). In multivariate Cox regression analyses including known prognostic variables (gender, immunophenotype, WBC count at diagnosis, TEL/AML1 status, risk group criteria of ALL-BFM 2000), IKZF1 deletion conferred a risk of 2.16 (95% confidence interval 1.14 – 4.10; P = 0.018) for an event when compared to non-deleted patients. We conclude that IKZF1 deletion is an independent predictor of treatment outcome for patients enrolled on the ALL-BFM 2000 protocol and represents a candidate marker to be integrated in future algorithms for early risk stratification in pediatric ALL. Disclosures: No relevant conflicts of interest to declare.

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Treatment outcome with juvenile sexual oﬀenders

The Handbook of Clinical Intervention with Young People who Sexually Abuse ◽

10.4324/9780203490341-30 ◽

2004 ◽

pp. 458-468

Keyword(s):

Treatment Outcome ◽

Sexual Offenders ◽

Juvenile Sexual Offenders

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Cognitive-Behavioral Therapy Efficacy for Reducing Recidivism Rates of Moderate- and High-Risk Sexual Offenders: A Scoping Systematic Literature Review

International Journal of Offender Therapy and Comparative Criminology ◽

10.1177/0306624x16644501 ◽

2016 ◽

Vol 62 (1) ◽

pp. 170-186 ◽

Cited By ~ 15

Author(s):

Elias Mpofu ◽

James A. Athanasou ◽

Christine Rafe ◽

Scott H. Belshaw

Keyword(s):

High Risk ◽

Cognitive Behavioral Therapy ◽

Sexual Offenders ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Future Research ◽

Sexual Offense ◽

Recidivism Rate ◽

Recidivism Rates ◽

Sample Median

This literature scoping review compared recidivism rates of moderate- and high-risk sexual offenders who received cognitive-behavioral therapy (CBT) oriented treatments. Ten empirical studies from 2001 to 2014 were selected for review that met the following criteria: (a) Treatment program included a CBT-based intervention with a comparative intervention; (b) participants included adult, male, moderate- and high-risk sexual offenders only; and (c) follow-up data for up to 12 months. Data were analyzed using a summative metric for recidivism rate comparisons ( N = 3,073 for CBT and N = 3,588, for comparison approaches). Sexual offense recidivism rates varied from 0.6% to 21.8% (with CBT) and from 4.5% to 32.3% (with comparison intervention). The within-sample median rate of violent recidivism with a history of sexual offense was 21.1% (with CBT) versus 32.6% (comparison). Sexual offenders had a general felonies (within-sample) median recidivism rate of 27.05% (with CBT) versus 51.05% (comparison). The evidence supports the conclusion that CBT in its various forms is an efficacious treatment modality to prevent offense recidivism by sexual offenders. Suggestions for future research are considered.

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Achieving PSA < 0.2 ng/ml before Radiation Therapy Is a Strong Predictor of Treatment Success in Patients with High-Risk Locally Advanced Prostate Cancer

Prostate Cancer ◽

10.1155/2019/4050352 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Akira Kazama ◽

Toshihiro Saito ◽

Keisuke Takeda ◽

Kazuhiro Kobayashi ◽

Toshiki Tanikawa ◽

...

Keyword(s):

Prostate Cancer ◽

Overall Survival ◽

Radiation Therapy ◽

Treatment Outcome ◽

High Risk ◽

Gleason Score ◽

Advanced Prostate Cancer ◽

Locally Advanced ◽

Locally Advanced Prostate Cancer ◽

T Stage

Background. To predict long-term treatment outcome of radiation therapy (RT) plus androgen deprivation therapy (ADT) for high-risk locally advanced prostate cancer. Methods. In total, 204 patients with the National Comprehensive Cancer Network (NCCN) high risk locally advanced prostate cancer (PSA > 20 ng/ml, Gleason score ≧ 8, clinical T stage ≧ 3a) were treated with definitive RT with ADT. Median follow up period was 113 months (IQR: 95–128). Median neoadjuvant ADT and total ADT duration were 7 months (IQR: 6–10) and 27 months (IQR: 14–38), respectively. Results. PSA recurrence-free survival (PSA-RFS), cancer specific survival (CSS), and overall survival (OS) rates at 5 years were 84.1%, 98.5%, and 93.6%, respectively, and 67.9%, 91.2%, and 78.1%, respectively, at 10 years. Pre-RT PSA less than 0.2 ng/ml was associated with superior outcomes of PSA-RFS (HR = 0.42, 95% CI: 0.25–0.70, p=0.001), CSS (HR = 0.27, 95% CI: 0.09–0.82, p=0.013), and OS (HR = 0.48, 95% CI: 0.26–0.91, p=0.021). On multivariate analysis, age (≥70 y.o.) and pre-RT PSA (≥0.2 ng/ml) were factors predictive of poorer OS (p=0.032) , but iPSA, T stage, Gleason score, number of NCCN high-risk criteria, a combination with anti-androgen therapy and neoadjuvant ADT duration were not predictive of treatment outcome. Conclusion. In patient with high-risk prostate cancer, RT plus ADT achieved good oncologic outcomes. PSA < 0.2 ng/ml before radiation therapy is a strong independent predictor for long overall survival.

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Restorative justice and sex offending

10.1093/oxfordhb/9780190213633.013.34 ◽

2017 ◽

Author(s):

Anne Marie McAlinden

Keyword(s):

Sexual Abuse ◽

High Risk ◽

Restorative Justice ◽

Sexual Offenders ◽

Sexual Offending ◽

Acquaintance Rape ◽

Sex Crimes ◽

Reintegrative Shaming ◽

Penal Policy ◽

First Time

This essay examines the use of restorative justice in sexual offending. Restorative forms of intervention have been used in cases of violent or sexual offending, from first-time and ‘acquaintance’ rape as well as young sexual abusers to high-risk sexual offenders in the form of circles of support and accountability. Such schemes are often presented as a counter to the failings of retributive forms of justice and are premised on Braithwaite’s notion of ‘reintegrative shaming’ that seeks to reintegrate offenders into the community. The essay sets out and seeks to counter arguments against using restorative justice for sex crimes. For the most part, restorative justice has not reached its potential as a full-fledged sentencing rationale and has not been used in more serious cases. The essay examines barriers to restorative justice in contemporary penal policy and highlights some of its controversial applications, including those related to clergy sexual abuse.

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Impersonal and Predatory Relations With Child Victims of Sexual Assault: Pedophilic Interest and Early Childhood Abuse

International Journal of Offender Therapy and Comparative Criminology ◽

10.1177/0306624x20928018 ◽

2020 ◽

Vol 64 (16) ◽

pp. 1741-1756

Author(s):

Judith Abulafia ◽

Robert Epstein

Keyword(s):

Risk Assessment ◽

Early Childhood ◽

High Risk ◽

Sex Offenders ◽

Childhood Abuse ◽

Sexual Offenders ◽

Sexual Attraction ◽

Child Victims ◽

National Centre ◽

Early Childhood Abuse

Fixated pedophilic sexual attraction is considered to be a major determinant of risk among sex offenders, but there is little empirical evidence regarding its treatment. It was hypothesized that two prominent factors which have emerged in the literature as being present among some sexual offenders, namely, impersonal, narcissistic, and predatory patterns of offending against victims, and experiencing childhood sexual abuse, may be related to specifically to the strength of pedophilic interest. Such a relationship would provide a deeper understanding of the corollaries of pedophilic interest and would suggest targets for treatment. These factors were explored in a sample of 532 sexual offenders who attended the National Centre for Risk Assessment in Israel, and were found to be significantly related to the level of pedophilic interest in the sample. The implications for treatment of high-risk offenders are discussed.

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Adaptive theory: an underutilised approach to sexual offender research

Qualitative Research Journal ◽

10.1108/qrj-12-2018-0021 ◽

2019 ◽

Vol 19 (2) ◽

pp. 171-184

Author(s):

Carollyne Youssef

Keyword(s):

High Risk ◽

Sexual Offenders ◽

Service Providers ◽

Sexual Offending ◽

Small Sample ◽

Future Research ◽

Depth Information ◽

Research Approach ◽

Content Type ◽

Offending Behaviour

Purpose While most studies utilise quantitative methodologies to examine issues relevant to sexual offending behaviour, such as treatment programmes and risk assessments; substantially fewer studies have utilised qualitative methods, and specifically Layder’s Adaptive Theory (AT) as a methodology; and there is a paucity of research examining community maintenance programmes altogether. The purpose of this paper is to report on the use of AT to the understanding of the significance of community maintenance programmes for high-risk sexual offenders. Design/methodology/approach Using AT as a unique framework, this study examined an Australian sample of services providers and high-risk sexual offenders participating in a community maintenance programme. In particular, the current research aimed to develop an understanding of community maintenance programmes for released sexual offenders, in a bid to develop a theoretical framework for these programmes. The research had three subject groups, service providers, programme participants who had not reoffended and programme participants who had sexually reoffended. Findings It appears that this methodology is a useful approach to studies within forensic rehabilitation and offender research. Common, reoccurring themes have been gathered through this approach, which would not have been possible with a quantitative methodology. Research limitations/implications While this research methodology was applied to a small sample size, its use suggested that AT was an informative and useful research approach to utilise in offender research more broadly, yielding rich in-depth information. Practical implications Utilising AT provided an in-depth understanding and exploration of experiences for offender populations as well as staff delivering programmes, which enhances the efficacy of programmes delivered by incorporating “user feedback” and allows programme developers to utilise such feedback to improve programmes. An AT approach to offender rehabilitation has been useful in providing exploratory information in the absence of any conceptual or theoretical frameworks and with a very little extant information. Given maintenance programmes are quite understudied, this approach allowed for common themes to emerge in order to guide future research as well as the development of a paradigm. It is worth considering the utility of this methodology for a variety of forensic research, particularly areas which remain understudied. Social implications Sexual offending behaviour is a significant societal concern. A better understanding of what makes programmes more effective for those who use them and run them, will assist in reducing recidivism, which will benefit the community at large. Originality/value Layder’s AT has not been used with an offender population in the past, and specifically within the sexual offending realm, thus this paper offers a unique and effective approach to offender research.

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Current Indications for Cerebral Protection in Surgery and Endovascular Therapy

Rivista di Neuroradiologia ◽

10.1177/197140090301600109 ◽

2003 ◽

Vol 16 (1) ◽

pp. 81-85

Author(s):

G. Coppi ◽

R. Moratto ◽

E. Nicolosi

Keyword(s):

Treatment Outcome ◽

High Risk ◽

Cerebral Protection ◽

Rapid Expansion ◽

Carotid Angioplasty ◽

Significant Drop ◽

First Choice ◽

Cerebral Embolization ◽

Protection Devices

Carotid angioplasty, until recently carried out in selected patients at a few specialist centres, is currently growing at a rate of 20% a year. The main limitation on its development to date was the risk of cerebral embolization demonstrated experimentally at each stage of the procedure. Rapid advances in materials, especially the introduction of cerebral protective devices, has opened the way to a rapid expansion in the use of this method thanks to a significant drop in complications during the method's learning curve. Current outcomes are increasingly close to those of traditional surgery. Carotid angioplasty is now a first choice treatment in patients at high risk or unsuitable for surgery. Angioplasty is also growing as an adjuvant rather than alternative treatment to surgery especially in patients presenting anatomical problems. Cerebral protection devices enhancing treatment outcome are not so much an option as a necessity in all these patients as confirmed by ongoing studies (CARESS, PACE, Italian SICVE register) assessing the efficacy of carotid angioplasty using cerebral protection devices. The final results of these studies should establish the best method of cerebral protection and confirm the role of carotid angioplasty in the treatment of carotid artery stenotic disease.

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