Future care for long-term cancer survivors: towards a new model.

PURPOSE: The increase in the prevalence "long-term cancer survivor" (LCS) patients is expected to increase the cost of LCS care. The aim of this study was to obtain information that would allow to optimise the current model of health management in Spain to adapt it to one of efficient LCS patient care. METHODS: This qualitative study was carried out using Delphi methodology. An advisory committee defined the criteria for participation, select the panel of experts, prepare the questionnaire, interpret the results and draft the final report. RESULTS: 232 people took part in the study (48 oncologists). Absolute consensus was reached in three of the proposed sections: oncological epidemiology, training of health professionals and ICT functions. CONCLUSION: The role of primary care in the clinical management of LCS patients needs to be upgraded, coordination with the oncologist and hospital care is essential. The funding model needs to be adapted to determine the funding conditions for new drugs and technologies.

Multidisciplinary consensus on optimising the detection of NTRK gene alterations in tumours.

The recent identification of rearrangements of neurotrophic tyrosine receptor kinase (NTRK) genes and the development of specific fusion protein inhibitors, such as larotrectinib and entrectinib, have revolutionised the diagnostic and clinical management of patients presenting with tumours with these alterations. Tumours that harbour NTRK fusions are found in both adults and children; and they are either rare tumours with common NTRK fusions that may be diagnostic, or more prevalent tumours with rare NTRK fusions. To assess currently available evidence on this matter, three key Spanish medical societies (the Spanish Society of Medical Oncology (SEOM), the Spanish Society of Pathological Anatomy (SEAP), and the Spanish Society of Paediatric Haematology and Oncology (SEHOP) have brought together a group of experts to develop a consensus document that includes guidelines on the diagnostic, clinical, and therapeutic aspects of NTRK-fusion tumours. This document also discusses the challenges related to the routine detection of these genetic alterations in a mostly public Health Care System.

Study of the Spanish Society of Medical Oncology (SEOM) on the access to oncology drugs and predictive biomarkers in Spain.

PURPOSE: The Spanish Society of Medical Oncology (SEOM) has carried out a study to analyse the conditions of access to oncology drugs in clinical practice in Spain. For the first time, the access of predictive biomarkers has also been analyzed. METHODS: A questionnaire was sent to 146 hospitals in Spain to collect information on the process of approval of 11 oncology drugs of an unquestionable clinical benefit and five predictive biomarkers of mandatory determination for specific treatments. RESULTS: Results highlight the still existing differences in the access of oncology drugs, as well as the newly identified differences in the access to predictive biomarkers between Autonomous Communities (AACC) in Spain, as well as between different hospitals within the same Autonomous Community. Conclusions The SEOM considers it necessary to reduce the differences identified, increase homogeneity, and improve conditions of access to oncology drugs and biomarkers, and makes proposals to address these issues.

Correction to: Liquid biopsy in oncology: a consensus statement of the Spanish Society of Pathology and the Spanish Society of Medical Oncology.

The article Liquid biopsy in oncology.

Treatment options beyond immunotherapy in patients with wild-type lung adenocarcinoma: a Delphi consensus.

PURPOSE: Immunotherapy-based approaches are standard first-line treatments for advanced/metastatic lung cancer or for chemoradiotherapy consolidation in locally advanced disease. Uncertainty on how to treat patients at disease progression prompted us to develop a consensus document on post-immunotherapy options in Spain for patients with advanced wild-type lung adenocarcinoma. METHODS: After extensive literature review, a 5-member scientific committee generated 33 statements in 4 domains: general aspects (n = 4); post-durvalumab in locally advanced disease (n = 6); post-first-line immunotherapy ± chemotherapy in advanced/metastatic disease (n = 11); and post-first-line platinum-based chemotherapy in advanced/metastatic disease (n = 12). A panel of 26 lung cancer experts completed 2 Delphi iterations through an online platform rating their degree of agreement/disagreement (first-round scale 1-5 and second-round scale 1-4, 1 = strongly disagree, 4/5 = strongly agree) for each statement. Second-round consensus: ≥ 70% of responses were in categories 1/2 (disagreement) or 3/4 (agreement). RESULTS: Consensus was reached for 2/33 statements in the first Delphi round and in 29/31 statements in the second round. Important variables informing treatment at disease progression with an immunotherapy-based treatment include: disease aggressiveness, previous treatment, accumulated toxicity, progression-free interval, PD-L1 expression, and tumour mutational burden. A platinum-based chemotherapy should follow a first-line immunotherapy treatment without chemotherapy. Treatment with docetaxel + nintedanib may be appropriate post-durvalumab in refractory patients or following progression to first-line chemotherapy + immunotherapy, or second-line chemotherapy after first-line immunotherapy, or first-line chemotherapy in some patients with low/negative PD-L1 expression, or second-line immunotherapy after first-line chemotherapy. CONCLUSIONS: To support decision making following progression to immunotherapy-based treatment in patients with advanced wild-type lung adenocarcinoma, a consensus document has been developed.

Updated guidelines for predictive biomarker testing in advanced non-small-cell lung cancer: a National Consensus of the Spanish Society of Pathology and the Spanish Society of Medical Oncology.

In 2011 the Spanish Society of Medical Oncology (SEOM) and the Spanish Society of Pathology (SEAP) started a joint project to establish guidelines on biomarker testing in patients with advanced non-small-cell lung cancer (NSCLC) based on current evidence. As this field is constantly evolving, these guidelines have been updated, previously in 2012 and 2015 and now in 2019. Current evidence suggests that the mandatory tests to conduct in all patients with advanced NSCLC are for EGFR and BRAF mutations, ALK and ROS1 rearrangements and PD-L1 expression. The growing need to study other emerging biomarkers has promoted the routine use of massive sequencing (next-generation sequencing, NGS). The coordination of every professional involved and the prioritisation of the most suitable tests and technologies for each case remains a challenge.

Liquid biopsy in oncology: a consensus statement of the Spanish Society of Pathology and the Spanish Society of Medical Oncology.

The proportion of cancer patients with tumours that harbour a potentially targetable genomic alteration is growing considerably. The diagnosis of these genomic alterations can lead to tailored treatment at the onset of disease or on progression and to obtaining additional predictive information on immunotherapy efficacy. However, in up to 25% of cases, the initial tissue biopsy is inadequate for precision oncology and, in many cases, tumour genomic profiling at progression is not possible due to technical limitations of obtaining new tumour tissue specimens. Efficient diagnostic alternatives are therefore required for molecular stratification, which includes liquid biopsy. This technique enables the evaluation of the tumour genomic profile dynamically and captures intra-patient genomic heterogeneity as well. To date, there are several diagnostic techniques available for use in liquid biopsy, each one of them with different precision and performance levels. The objective of this consensus statement of the Spanish Society of Pathology and the Spanish Society of Medical Oncology is to evaluate the viability and effectiveness of the different methodological approaches in liquid biopsy in cancer patients and the potential application of this method to current clinical practice. The experts contributing to this consensus statement agree that, according to current evidence, liquid biopsy is an acceptable alternative to tumour tissue biopsy for the study of biomarkers in various clinical settings. It is therefore important to standardise pre-analytical and analytical procedures, to ensure reproducibility and generate structured and accessible clinical reports. It is essential to appoint multidisciplinary tumour molecular boards to oversee these processes and to enable the most suitable therapeutic decisions for each patient according to the genomic profile.

Prevalencia de agentes etiológicos de meningitis bacteriana en población adulta en el Hospital San Martín de Quillota entre los años 2012-2018 / Prevalence of etiological agents of acute bacterial meningitis in adult population at the Quillota's San Martin Hospital between years 2012-2018

Resumen Introducción: La Meningitis Bacteriana Aguda (MBA) corresponde a la inflamación de las leptomeninges por presencia de bacterias piógenas. La epidemiología es variable y depende multifactorial. A pesar de los avances en medicina la mortalidad de la MBA se ha mantenido estable, evidenciando la necesidad de estudiar esta patología para orientar estrategias de prevención y tratamiento. Objetivos: Determinar la prevalencia de los agentes etiológicos de MBA confirmadas en adultos en el Hospital San Martín de Quillota (HSMQ) entre los años 2012 y 2018. Establecer la tasa de resistencia a antibióticos. Determinar el perfil de los pacientes, y establecer la relación entre perfil, agente etiológico identificado y desenlace. Métodos: c muestra de 38 casos, se estableció la prevalencia de los patógenos involucrados y se realizó un análisis estadístico considerando los factores de riesgo, sus días de estadía y su condición al egreso hospitalario. Resultados: 15 casos en que no se aisló patógeno en LCR (líquido cefalorraquídeo), 13 MBA por neumococo, 4 por Haemophilus spp, 3 por meningococo, 2 por Staphylococcus spp y 1 por Mycobacterium tuberculosis. En el grupo sin agente aislado se observó un mejor pronóstico, valores de PCR (proteína C reactiva) en sangre menores y valores de glucorraquia mayores. Se registraron 6 fallecimientos por MBA. Conclusión: La prevalencia de los agentes etiológicos fue similar a la descrita en la literatura, con neumococo como el microorganismo más frecuente, no se reportaron casos de Listeria monocytogenes. Probablemente en el grupo sin agente aislado se incluyeron casos de meningitis virales.

Introduction: Acute bacterial meningitis (ABM) is denifed as the inflammation of leptomeninges due to the presence of pyogenic bacteriae. Epidemiology is variable and multifactorial. In spite of advance in medicine, ABM's mortality has remained stable, hence the need to study the causative microorganisms in order to guide prevention and treatment strategies. Objectives: To determine the prevalence of the etiological agents of ABM confirmed in adults in a medium complexity hospital located in Quillota, Chile, between 2012 and 2018, to establish the rate of resistance of these to antibiotics. Determine the profile of the patients and establish the relationship between profile, etiological agent identified and outcome. Methods: A sample of 38 cases with ABM was evaluated during, the prevalence of the pathogens involved was established and a statistical analysis was carried out considering the risk factors of patients, their days of in-hospital stay and their condition at hospital discharge. Results: We analyzed 38 cases, 15 without isolated pathogens, 13 of Streptococcus pneumoniae, 4 of Haemophilus spp., 3 of Neisseria meningitidis, 2 of Staphylococcus spp. and we obtained one case of Mycobacterium tuberculosis. In the group without isolated pathogens, a better prognosis was observed, lower blood CRP values and higher glucose on spinal fluid values. 6 deaths per ABM were recorded. Conclusion: The prevalence of etiological agents was similar to that described in the literature, with pneumococcus as the most frequent microorganism, no cases of Listeria monocytogenes were reported. Probably in the group in which no agent was isolated, cases of viral meningitis were included.

Efectividad de hongos micorrizo-arbusculares nativos en suelos con diferentes usos agropecuarios / Native arbuscular mycorrhizal fungi effectiveness in soils with different agricultural uses

RESUMEN Objetivo. Determinar la efectividad de hongos micorrizo-arbusculares (HMA) de suelos con diferentes usos agropecuarios, en el valle medio del río Sinú, Colombia. Materiales y métodos. Bajo condiciones de invernadero se realizó el experimento, donde se utilizó como planta indicadora Leucaena leucocephala, la cual se sembró en materos con suelo de un Andisol (horizonte B) usado como sustrato. Este sustrato, se inoculó separadamente con muestras de siete suelos (horizonte Ap), como fuente de HMA, provenientes del Centro de Investigación Turipaná de Agrosavia. Como controles se incluyeron inoculación con HMA Glomus fasciculatum y uno no-inoculado El efecto de la inoculación micorrizal se evaluó mediante el monitoreo del contenido de P foliar en las plantas de L. leucocephala, en función del tiempo hasta 64 días cuando se determinó la masa seca de su parte aérea y la colonización micorrizal. Resultados. El crecimiento de L. leucocephala y el contenido de P foliar fue significativamente superior cuando el suelo se inoculó con G. fasciculatum, en comparación a aquel observado con los demás tratamientos. De igual forma, la colonización micorrizal fue muy alta en las raíces de L. leucocephala que crecieron en el suelo inoculado con G. fasciculatum e inferior en los otros tratamientos. Conclusiones. Los resultados indican que los HMA nativos de suelos con diferentes usos, provenientes del C.I Turipaná de Agrosavia, exhibieron bajo potencial para desarrollar simbiosis micorrizal, lo que limitó el crecimiento y la concentración de P foliar en la planta hospedera.

ABSTRACT Objective. To determine the effectiveness of mycorrhizal-arbuscular fungi (AMF) of soils with different agricultural uses, in the middle valley of the Sinú river, Colombia. Materials and methods. The experiment was carried out under greenhouse conditions, where Leucaena leucocephala was used as the indicator plant, which was planted in masons with an Andisol soil (horizon B) used as a substrate. This substrate was inoculated separately with samples from seven soils (Ap horizon), as a source of AMF, from the Turipaná Research Center in Agrosavia. As controls we included inoculation with HMA Glomus fasciculatum and one non-inoculated one. The effect of mycorrhizal inoculation was evaluated by monitoring the foliar P content in L. leucocephala plants, as a function of time to 64 days, when the dry mass of its aerial part and mycorrhizal colonization was determined. Results. The growth of L. leucocephala and the foliar P content was significantly higher when the soil was inoculated with G. fasciculatum, in comparison to that observed with the other treatments. Likewise, mycorrhizal colonization was very high in the roots of L. leucocephala that grew in the soil inoculated with G. fasciculatum and lower in the other treatments. Conclusions. The results indicate that the native AMF of soils with different uses, from Turipaná, exhibited low potential to develop mycorrhizal symbiosis, which limited the growth and concentration of leaf P in the host plant.

Depresión y ansiedad en mujeres histerectomizadas no oncológicas posterior a la cirugía / Depression and anxiety in non-cancer hysterectomized women after surgery

RESUMEN Introducción y objetivo: La histerectomía es la segunda cirugía ginecológica más frecuente, después de la cesárea, afectando a un importante porcentaje de la población femenina, con un gran impacto emocional. El objetivo de esta revisión es describir las consecuencias psiquiátricas y sus factores predisponentes, en las mujeres histerectomizadas no oncológicas posterior a la cirugía. Material y métodos: Se incluyeron investigaciones en inglés, español y portugués, con un máximo de 15 años de antigüedad. Se excluyeron investigaciones realizadas en mujeres histerectomizadas oncológicas y/o con antecedentes psiquiátricos previos a la cirugía. Resultados: Posterior a la histerectomía por causa benigna, aparecen trastornos depresivos y/o ansiosos en las mujeres en frecuencias variadas. En el post-operatorio inmediato de la histerectomía, se reportan prevalencias de hasta un 84% para depresión y hasta un 92% para ansiedad, respectivamente. En cuanto a los factores que predisponen a la incidencia de estos problemas, se encuentran; la paridad relacionado con la cantidad de hijos engendrados y el deseo de tener más hijos, la nuliparidad, la edad, la falta de información y educación previa a la cirugía, la soledad y escaso apoyo familiar, los mitos y creencias sociales en torno al procedimiento, entre otros. Conclusiones: El significado social del útero y el enjuiciamiento que vive la mujer histerectomizada, son factores relevantes en la aparición de trastornos depresivos y/o ansiosos. La importancia de la educación es esencial para el afrontamiento eficaz por parte de la mujer en este procedimiento.

ABSTRACT Introduction and objective: Hysterectomy is the second most frequent gynecological surgery, after caesarean section, affecting an important percentage of the female population, with a great emotional impact. The objective of this review is to describe the psychiatric consequences and their predisposing factors in non-oncological hysterectomized women after surgery. Material and methods: Research was included in English, Spanish and Portuguese, with a maximum of 15 years old. We excluded investigations carried out in oncological hysterectomized women and / or with psychiatric antecedents prior to surgery. Results: After hysterectomy due to benign cause, depressive and / or anxious disorders appear in women at varied frequencies. In the immediate postoperative period of the hysterectomy, prevalences of up to 84% are reported for depression and up to 92% for anxiety, respectively. As for the factors that predispose to the incidence of these problems, they are found; parity related to the number of children conceived and the desire to have more children, nulliparity, age, lack of information and education prior to surgery, loneliness and poor family support, myths and social beliefs about the procedure, among others. Conclusions: The social meaning of the uterus and the judgment of the hysterectomized woman are relevant factors in the appearance of depressive and / or anxious disorders. The importance of education is essential for effective coping by women in this procedure.

Heat shock proteins in Varroa destructor exposed to heat stress and in-hive acaricides.

Varroa destructor is one of the major pests that affect honeybees around the world. Chemical treatments are common to control varroosis, but mites possess biochemical adaptive mechanisms to resist these treatments, enabling them to survive. So far, no information is available regarding whether these pesticides can induce the expression of heat shock protein (Hsp) as a common protective mechanism against tissue damage. The aims of this study were to determine differences in heat shock tolerance between mites collected from brood combs and phoretic ones, and to examine patterns of protein expression of Hsp70 that occur in various populations of V. destructor after exposure to acaricides commonly employed in beekeeping, such as flumethrin, tau-fluvalinate and coumaphos. Curiously, mites obtained from brood cells were alive at 40 °C, unlike phoretic mites that reached 100% mortality, demonstrating differential thermo-tolerance. Heat treatment induced Hsp70 in mites 4 × more than in control mites and no differences in response were observed in phoretic versus cell-brood-obtained mites. Dose-response assays were carried out at increasing acaricide concentrations. Each population showed a different stress response to acaricides despite belonging to the same geographic region. In one of them, coumaphos acted as a hormetic stressor. Pyrethroids also induced Hsp70, but mite population seemed sensitive to this treatment. We concluded that Hsp70 could represent a robust biomarker for measuring exposure of V. destructor to thermal and chemical stress, depending on the acaricide class and interpopulation variability. This is relevant because it is the first time that stress response is analyzed in this biological model, providing new insight in host-parasite-xenobiotic interaction.

Proposal for the creation of a national strategy for precision medicine in cancer: a position statement of SEOM, SEAP, and SEFH.

Precision medicine is an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person. Precision medicine is transforming clinical and biomedical research, as well as health care itself from a conceptual, as well as a methodological viewpoint, providing extraordinary opportunities to improve public health and lower the costs of the healthcare system. However, the implementation of precision medicine poses ethical-legal, regulatory, organizational, and knowledge-related challenges. Without a national strategy, precision medicine, which will be implemented one way or another, could take place without the appropriate planning that can guarantee technical quality, equal access of all citizens to the best practices, violating the rights of patients and professionals, and jeopardizing the solvency of the healthcare system. With this paper from the Spanish Societies of Medical Oncology, Pathology, and Hospital Pharmacy, we highlight the need to institute a consensual national strategy for the development of precision medicine in our country, review the national and international context, comment on the opportunities and challenges for implementing precision medicine, and outline the objectives of a national strategy on precision medicine in cancer.

Lactobacillus kunkeei strains decreased the infection by honey bee pathogens Paenibacillus larvae and Nosema ceranae.

Due to their social behaviour, honey bees can be infected by a wide range of pathogens including the microsporidia Nosema ceranae and the bacteria Paenibacillus larvae. The use of probiotics as food additives for the control or prevention of infectious diseases is a widely used approach to improve human and animal health. In this work, we generated a mixture of four Lactobacillus kunkeei strains isolated from the gut microbial community of bees, and evaluated its potential beneficial effect on larvae and adult bees. Its administration in controlled laboratory models was safe for larvae and bees; it did not affect the expression of immune-related genes and it was able to decrease the mortality associated to P. larvae infection in larvae and the counts of N. ceranae spores from adult honey bees. These promising results suggest that this beneficial microorganism's mixture may be an attractive strategy to improve bee health. Field studies are being carried out to evaluate its effect in naturally infected colonies.

Efficacy of tyrosine kinase inhibitors in EGFR-mutant lung cancer women in a real-world setting: the WORLD07 database.

BACKGROUND: The WORLD07 project is a female specific database to assess the characteristics of women with lung cancer. METHODS: WORLD07 database sets up in 2007, and prospectively stores clinical characteristics, treatment, outcome, and follow-up of lung cancer women. All women with epidermal growth factor receptor (EGFR) mutation non-small cell lung cancer (NSCLC) were selected for this analysis. RESULTS: From October 2007 to December 2012, a total of 1775 NSCLC women were recruited. EGFR mutation was identified in 34.4% of patients. Upfront EGFR tyrosine kinase inhibitor (TKI) reported a response rate of 60%, a median progression-free survival of 11.7 months, and median overall survival of 23.0 months. EGFR TKI, EGFR-mutation type, and smoking status did not impact in the outcome of treated women. CONCLUSION: Prevalence of EGFR mutation in women with NSCLC is higher than overall population with NSCLC. Efficacy of EGFR TKI in this real-world setting is similar to that previously reported.

A consensus statement on the gender perspective in lung cancer.

Lung cancer is the most common cancer globally and has the highest mortality. Although this disease is not associated with a particular gender, its incidence is rising among women, who are diagnosed at an increasingly younger age compared with men. One of the main reasons for this rise is women taking up smoking. However, many non-smoking women also develop this disease. Other risk factors implicated in the differential development of lung cancer in women are genetic predisposition, tumour histology and molecular profile. Proportionally more women than men with lung cancer have a mutation in the EGFR gene. This consensus statement reviews the available evidence about the epidemiological, biological, diagnostic, therapeutic, social and psychological aspects of lung cancer in women.

Medical oncology future plan of the Spanish Society of Medical Oncology: challenges and future needs of the Spanish oncologists.

PURPOSE: The SEOM Future Plan is aimed at identifying the main challenges, trends and needs of the medical oncology speciality over the next years, including potential oncologist workforce shortages, and proposing recommendations to overcome them. METHODS: The estimations of the required medical oncologists workforce are based on an updated Medical Oncologist Register in Spain, Medical Oncology Departments activity data, dedication times and projected cancer incidence. Challenges, needs and future recommendations were drawn from an opinion survey and an advisory board. RESULTS: A shortage of 211 FTE medical oncologist specialists has been established. To maintain an optimal ratio of 158 new cases/FTE, medical oncology workforce should reach 1881 FTE by 2035. CONCLUSIONS: Main recommendations to face the growing demand and complexity of oncology services include a yearly growth of 2.5% of medical oncologist's workforce until 2035, and development and application of more accurate quality indicators for cancer care and health outcomes measure.

Long-term survival in advanced non-squamous NSCLC patients treated with first-line bevacizumab-based therapy.

BACKGROUND/AIM: First-line bevacizumab-based therapies have been shown to improve clinical outcomes in patients with non-squamous non-small-cell lung cancer (NSCLC). We aimed to descriptively analyse patients with non-squamous NSCLC who received a long-term period of maintenance bevacizumab. PATIENTS AND METHODS: This retrospective study included 104 patients who had already reached a progression-free survival (PFS) of at least 9 months. RESULTS: Median overall survival and PFS were 30.7 and 15.1 months, respectively. The overall response rate was 83 %. Weight loss ≤5 %, ECOG PS = 0, or low number of metastatic sites seem to be predictive factors of good evolution. The incidence of bevacizumab-related adverse events appeared to be similar as the previous studies. CONCLUSION: Our findings show that there is a long-term survivor group whom the administration of bevacizumab resulted in a relevant prolongation of response without new safety signals. Due to the population heterogeneity, it was not possible to identify the standardised predictive factors.

Marcadores de recambio óseo en mujeres postmenopáusicas: utilidad clínica / Bone remodelling markers in postmenopausal women: clinical utility

Bone metabolism is a dynamic process, which includes formation and resorption. Osteoblast and osteoclast are responsible of replacing 20 percent of bone each year. Bone Markers are fragments of bone matrix; these peptides are released in the process of formation and resorption, later accumulated in body compartments (bone and blood) and finally excreted in the urine, reflecting bone dynamic. The international Federation of Osteoporosis and the International Federation of Laboratory and Clinical Chemistry recommend the use of these two markers (one representing bone formation and the other bone resorption) to evaluate bone turnover, especially in high-risk groups such as postmenopausal women. The collagen C-terminal telopeptide or carboxi-terminal collagen crosslinking (CTX) is one of the most used, among different bone markers. This is a blood biomarker that can be measured to assess bone turnover; this marker increases when the bone resorption is accelerated. On the other hand, osteocalcin (a non-collagen protein) is a bone formation marker, which has been widely studied and can be measured in venous blood during bone formation. Both markers are important for monitoring anti-resorptive therapy, and they have been validated to predict fracture risk complementing densitometry in osteoporosis diagnosis. Main disadvantages are variability of the laboratory techniques and lack of information about normal reference values in different populations. Therefore it is necessary to establish normal reference values for each population before its incorporation as a clinical tool.

Cribado de parto prematuro con progesterona salival / Screening of premature labor with salivary progesterone

Preterm birth is the most frequent cause of perinatal morbidity and mortality, especially before 34 weeks. Current screening methods include medical history of preterm delivery and ultrasound assessment of cervix length during the second trimester of pregnancy, which give a detection rate of approximately 65 percent with a false positive rate of 10 percent. Vaginal progesterone therapy has proved to reduce the risk of early preterm delivery by 50 percent in patient under risk. This might suggest that preterm pregnancies have lower levels of progesterone compared to term pregnancies. Although, the prediction of prematurity using biomarkers, including plasma progesterone, has been researched for several years, none of them have proved to be associated with preterm delivery. However, measuring salivary progesterone has already been suggested to be a potential biomarker associated with prematurity in pregnancies at high risk of preterm delivery. Saliva is a fluid that reflects only the free fraction of the biologically active steroidal hormone, and thus is more representative measure than the total plasma progesterone, which is the one usually measured in laboratories. For these reasons, the aim of our study is to evaluate whether the assessment of salivary progesterone can be used as a screening test for prediction of preterm delivery less than 34 weeks in pregnant women who attended at our Fetal Medicine Unit at 11-14 and 20-25 weeks of gestation.