Experience of Peripheral Blood CD34+ Stem Cells Collection in Autoimmune Patients.

BACKGROUND: Autologous Hematopoietic Stem Cell Transplantation with or without CD34+ selection is being used successfully to treat patients with severe and refractory autoimmune disease. This study describes our experience of CD34+ stem cell mobilization, harvesting and selection in autoimmune patients based on conditions in Vietnam - the developing country. METHODS: Eight autoimmune patients (four patients with Myasthenia Gravis and four patients with Systemic Lupus Erythematosus) underwent PBSC mobilization with granulocyte colony-stimulating factor (G-CSF) and cyclophosphamide. The apheresis was performed on a Terumo BCT Spectra Optia machine. CD34+ hematopoetic stem cells were collected from the leukapheresis by CliniMACS Plus device using CD34 Enrichment KIT. CD34+ cells, T and B lymphocytes were counted on a FACS BD Canto II device. RESULTS: Eight patients (4 MG and 4 SLE) including 5 females and 3 males were involved in this study. The mean age of the patients was 33.13 ± 16.64 years (ranging from 13 to 58 years). The average number of days for mobilization was 7.9 ± 1.6 days, whereas the average number of days for harvesting was 1.5 ± 0.5 days. There was no difference in the number of days for mobilization and harvesting between the MG and SLE groups. The number of CD34+ cells in peripheral blood (PB) on the day of harvesting was 108.37 ± 59.64 x 106 cells/L. There was a significant difference in white blood cell (WBC), neutrophil, monocyte, and platelet cell counts between before and after mobilization. On the day of stem cell harvesting, variables such as WBC, neutrophil, lymphocyte, monocyte, platelet, CD34+ cell counts, and hemoglobin were not different between the MG and SLE groups. The CD34+ recovery percentage following the CD34+ selection procedure was 68.8%, whereas almost 99.9% of the T and B lymphocytes, and NK cells in the PBSC products were eliminated. CONCLUSIONS: Very first attempts in mobilizing, harvesting, and selecting CD34+ stem cells were successful, paving the way for autoimmune patients to have autologous hematopoietic stem cell transplantation in Vietnam.

The Value of CT and MRI for Determining Thymoma in Patients With Myasthenia Gravis.

The aim of the study was to evaluate the usefulness of computed tomography (CT) and magnetic resonance imaging (MRI) for differentiating thymoma from nonthymoma abnormalities in patients with myasthenia gravis (MG). A cross-sectional study of 53 patients with MG, who had undergone surgical thymectomy, was conducted at 103 Hospital (Hanoi, Vietnam) and Cho Ray Hospital (Ho Chi Minh City, Vietnam) during August 2014 and January 2017. The CT and MRI images of patients with MG were qualitatively and quantitatively (radiodensity and chemical shift ratio [CSR]) analyzed to determine and compare their ability to distinguish thymoma from nonthymoma abnormalities. Logistic regression was used to identify the association between imaging parameters (eg, CSR) and the thymoma status. The receiver operating curve (ROC) analysis was used to determine the differentiating ability of CSR and radiodensity. As results, of the 53 patients with MG, 33 were with thymoma and 20 were with nonthymoma abnormalities. At qualitative assessment, MRI had significantly higher accuracy than did CT in differentiating thymoma from nonthymoma abnormalities (94.3% vs 83%). At quantitative assessment, both the radiodensity and CSR were significantly higher for thymoma compared with nonthymoma groups (P < .001). The ROC analysis showed that CSR had significantly higher sensitivity (Se) and specificity (Sp) than radiodensity in discriminating between the 2 groups (CSR: Se 100%, Sp 95% vs radiodensity: Se 90.9%, Sp 70%). When combining both qualitative and quantitative parameters, MRI had even higher accuracy than did CT in thymoma diagnosis (P = .031). In conclusion, chemical shift MRI was more accurate than CT for differentiating thymoma from nonthymoma in patients with MG.

The Role of Shear Wave Elastography in the Discrimination Between Malignant and Benign Thyroid Nodules.

BACKGROUND: Grayscale ultrasound (US) is the most common imaging modality for the assessment of thyroid nodules. OBJECTIVE: This research aimed to assess the value of using the elasticity index (EI), obtained using shear wave elastography (SWE), to discriminate between malignant and benign thyroid nodules. MATERIALS AND METHODS: A total of 86 patients (94 distinct thyroid nodules) were operated on at Vietnam National Cancer Hospital from June 2018 to June 2019. Comparisons of the grayscale ultrasound (US) findings and the EI values between the benign and malignant groups were performed using the Chi-square test and Student's t-test, respectively. The discrimination abilities of EI were determined through receiver operating characteristic (ROC) curve analysis, with the computation of optimal cut-off points. RESULTS: The EI values of the benign and malignant groups were 37.6 ± 26.1 kPa and 105.4 ± 48.8 kPa, respectively. The area under the ROC curve (AUROC) value for discrimination between groups based on EI values was 0.889 when using an optimal cut-off point of 74.5 kPa, which resulted in a sensitivity of 74.3% and a specificity of 90%. Logistic multivariate regression analysis found that EI and microcalcification were significant factors for the discrimination between groups, with an odds ratio (OR): 1.487 [95% confidence interval (95% CI): 1.124-1.968, p = 0.005] and OR: 12.119 (95% CI: 2.031-72.323, p = 0.006), respectively. Combining grayscale US imaging with SWE can increase the specificity of the diagnosis but does not increase the accuracy. CONCLUSION: SWE can be helpful for predicting the malignancy of thyroid nodules, although the accuracy of this method is only moderate.