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A letter to the editor is presented in response to the article "Palonosetron to Prevent Nausea and Vomiting in Children Undergoing BMT: Efficacy and Safety," by M. Ripaldi and colleagues published online in the February 22, 2010 issue.

We analyzed the long-term outcome of 4865 patients treated in Studies 82, 87, 88, 91 and 95 for childhood acute lymphoblastic leukemia (ALL) of the Italian Association of Pediatric Hematology and Oncology (AIEOP). Treatment was characterized by progressive intensification of systemic therapy and reduction of cranial radiotherapy. A progressive improvement of results with reduction of isolated central nervous system relapse rate was obtained. Ten-year event-free survival increased from 53% in Study 82 to 72% in Study 95, whereas survival improved from 64 to 82%. Since 1991, all patients were treated according to Berlin-Frankfurt-Muenster (BFM) ALL treatment strategy. In Study 91, reduced treatment intensity (25%) yielded inferior results, but intensification of maintenance with high-dose (HD)-L-asparaginase (randomized) allowed to compensate for this disadvantage; in high-risk patients (HR, 15%), substitution of intensive polychemotherapy blocks for conventional BFM backbone failed to improve results. A marked improvement of results was obtained in HR patients when conventional BFM therapy was intensified with three polychemotherapy blocks and double delayed intensification (Study 95). The introduction of minimal residual disease monitoring and evaluation of common randomized questions by AIEOP and BFM groups in the protocol AIEOP-BFM-ALL 2000 are expected to further ameliorate treatment of children with ALL. [ABSTRACT FROM AUTHOR]

Background. Since survival of patients with melanoma is strongly correlated with the Breslow tumor thickness of the primary lesion, factors that influence stage at diagnosis and delay in diagnosis are considered to be crucial. To test the relationship between tumor thickness and some social and clinical variables (including diagnosis/treatment delay) and the relationship between the diagnosis/treatment delay and some clinical variables, we analyzed data on 530 patients with melanoma from our Institute.Methods. In the analysis, Breslow tumor thickness was categorized into two categories (≤1.49, ≥1.5). Three time intervals were examined to evaluate diagnostic delay: patient delay, time from first symptom to seeking medical advice; medical delay, time from first medical consultation to hospital admission; total delay, time from first symptom to resection. The variables evaluated in the analysis were: age at diagnosis, education, occupational status, first symptom, visibility of tumor, anatomic site, and physician who made the initial diagnosis.Results. A significant risk of having a Breslow tumor thickness ≥1.5 mm was noted in patients who had a low level of education (odds ratio 3.0, 95% confidence interval 1.9–5.0) or who were unemployed (odds ratio 1.7, 95% confidence interval 1.1–2.8). With respect to patient delay, a delay >3 months for anatomic locations visible to patients was associated with significant risk (odds ratio 1.7, 95% confidence interval 1.1–2.6); with respect to medical delay, a delay >3 months was associated with a higher risk in patients examined by a dermatologist (odds ratio 2.0, 95% confidence interval 1.2–3.4).Conclusions. Our results clearly indicate that in Southern Italy poorly educated and unemployed subjects are at risk of being diagnosed at a more advanced stage, and admission to an oncological hospital causes a delay (waiting list) in the time interval related to the doctor (medical delay). [Copyright &y& Elsevier]

To evaluate the role of epiluminescence microscopy (ELM) in the differential diagnosis of cutaneous pigmented lesions, and to improve the early diagnosis of cutaneous malignant melanoma (CMM), 15,719 pigmented lesions from 8782 consecutive patients were evaluated using ELM with a hand-held video microscope imaging system (MS 500B Micro-Scopeman, Moritex). Comparison between risk levels as inferred from ELM screening and histology was performed on 2731 surgically excised lesions. ELM sensitivity, specificity, positive and negative predictive values, as well as agreement with histological results for the different subgroups of lesions, were determined. Overall agreement was 87·3% (ranging from 85·1% to 92·2% for melanocytic and non-melanocytic lesions, respectively); sensitivity and specificity were high (values ranging from 87·3% to 96·3% among different subsets of ELM-analysed lesions) and statistically significant (P < 0·0001). ELM screening identified 165 new cases of CMM with a high proportion of lesions (115; 70%) in an early phase of tumour growth (Breslow thickness ≤ 1·5 mm). Thus, ELM is helpful to the clinician in deciding which pigmented lesions need surgical excision, as well as in diagnosing early CMM lesions. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented that discusses detection of PICALM-MLLT10 in children with T-lineage acute lymphoblastic leukemia.