Objective: We assessed the association between thyroid autoimmunity and thyroid cancer in a retrospective series of unselected thyroid nodules submitted to fine-needle aspiration cytology (FNAC) to avoid the selection bias of surgical series. Subjects and methods: Ultrasound (US)-guided FNACs were obtained from 590 unselected consecutive patients with single thyroid nodules and positive (ATA þ , n ¼ 197) or negative (ATA 2 , n ¼ 393) serum anti-thyroid antibody (ATA). Cytological results were classified in three classes of increased risk of malignancy: low risk or benign (class II); indeterminate risk (class III); and suspect or malignant (class IV). Results: A higher prevalence of class III (28.9% vs 21.4%, P , 0.05) and class IV (18.8% vs 9.2%, P , 0.001) and lower prevalence of class II (52.3% vs 69.5%, P , 0.001) were found in ATA þ vs ATA 2 nodules respectively. By multivariate logistic regression analysis ATA þ conferred a significant risk (odds ratio (OR): 2.29 (95% confidence interval (CI): 1.39 -3.76)) for class IV cytology independently from age and sex. In 106 patients where thyroidectomy was carried out, thyroid cancer was found in 54/61 (88.5%) patients with class IV nodules (with similar positive predictive value for cancer in ATA þ (96.4%) and ATA -(81.8%) nodules), in 6/31 (19.3%) of class III nodules (all ATA 2 ) and in none of 14 class II nodules. Non-specific cytological atypias from hyperplastic nodules in lymphocytic thyroiditis probably accounted for the different prevalence of cancer in class III ATA þ and ATA 2 nodules. Histologically proven thyroid cancer (mostly papillary) was then observed in a higher proportion (27/197 ¼ 13.7%) of ATA þ , when compared with ATA 2 nodules (33/393 ¼ 8.4%, P ¼ 0.044), but the significance of this finding is limited by the low number of class II nodules operated on. Conclusions: The presence of ATA þ confers an increased risk of suspicious or malignant cytology in unselected thyroid nodules. Since ATA þ is not responsible for increased false-positive class IV FNAC, our study provides indirect evidence supporting a significant association between thyroid carcinoma and thyroid autoimmunity, although further studies with a different design are needed for a definitive histological proof.European Journal of Endocrinology 153 637-642

No abstract

Acute myeloid leukemia (AML) is a malignant disease of hematopoietic precursors at the earliest stage of maturation, resulting in a clonalproliferation of myoblasts replacing normal hematopoiesis. AML represents one of the most common types of leukemia, mostly affecting elderly patients. To date, standard chemotherapy protocols are only effective in patients at low risk of relapse and therapy-related mortality. The average 5-year overall survival (OS) is approximately 28%. Allogeneic hematopoietic stem cell transplantation (HSCT) improves prognosis but is limited by donor availability, a relatively young age of patients, and absence of significant comorbidities. Moreover, it is associated with significant morbidity and mortality. However, increasing understanding of AML immunobiology is leading to the development of innovative therapeutic strategies. Immunotherapy is considered an attractive strategy for controlling and eliminating the disease. It can be a real breakthrough in the treatment of leukemia, especially in patients who are not eligible forintensive chemotherapy. In this review, we focused on the progress of immunotherapy in the field of AML by discussing monoclonal antibodies (mAbs), immune checkpoint inhibitors, chimeric antigen receptor T cells (CAR-T cells), and vaccine therapeutic choices.

No abstract

Background: Children with severe atopic status may present high risk of fatal or near fatal anaphylaxis and a highly impaired quality of life. Omalizumab has been shown to be a promising approach as monotherapy for severe allergy to multiple foods. However, very high serum total IgE levels may limit its use. Objective: To assess the efficacy of selective IgE-immunoadsorption (IgE-IA) on total IgE levels and threshold of reactivity to the culprit foods in children with history of severe anaphylaxis due to multiple foods and allergic comorbidities.  Methods: In this single-center, prospective, open-label efficacy study we evaluated children with severe asthma, allergy to 2+foods and total IgE levels >2,300 kUI/L. To establish the food reactivity threshold, each patient underwent oral food challenges (OFCs) before and after IgE-IA. Results: Five patients (4 males; age, 10.9±5 years, mean±SD), underwent an average of three (range 2–5) sessions of IgE-IA. Each session reduced IgE levels by a mean of 1,958.87 kUI/L. After the IgE-IA cycle, serum total IgE dropped from 3,948±1,652.7 (mean±SD) to 360.8±71.89 kUI/L (-10.94 folds; p=0.01). The threshold of reactivity (No Observed Adverse Effect Level, NOAEL) tested at OFCs for the culprit foods (4baked-milk+2baked-egg+1lentil+2hazelnut+1wheat) increased overall from 21.51 (median, IQR 1.49-82.62) protein milligrams to 1,114.99 (837.2-4,222.8) milligrams (p<.001), ie. up to 51.8 times higher than baseline. 8/10 OFCs were negative after IgE-IA. Conclusions: IgE-IA increased food threshold quickly. It can be considered in well-selected patients with severe food allergies and high IgE-levels especially if otherwise eligible to anti – IgE treatments.