B Lichtiger

University of Texas MD Anderson Cancer Center, Houston, Texas, United States

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Publications (77)471.42 Total impact

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    ABSTRACT: Background Granulocyte transfusions (GTXs) have been used successfully as an adjunctive treatment option for invasive infections in some neutropenic patients with underlying hematologic malignancy (HM).Patients and methodsWe sought to determine the impact of GTX as an adjunct to antifungal therapy in 128 patients with HM and prolonged neutropenia (≥14 days) with a proven or probable invasive aspergillosis (IA) infection by retrospectively reviewing our institutional database.ResultsFifty-three patients received GTX and 75 did not. By univariate analysis, patients with invasive pulmonary aspergillosis who received GTX were less likely to respond to antifungal therapy (P = 0.03), and more likely to die of IA (P = 0.009) when compared with the non-GTX group. Among patients who received GTX, 53% developed a pulmonary reaction. Furthermore, IA-related death was associated with the number of GTX given (P = 0.018) and the early initiation of GTX within 7 days after starting antifungal therapy (P = 0.001). By multivariate competing risk analysis, patients who received GTX were more likely to die of IA than patients who did not receive GTX (P = 0.011).Conclusions Our study suggests that GTX does not improve response to antifungal therapy and is associated with worse outcomes of IA infection in HM patients, particularly those with pulmonary involvement.
    Annals of Oncology 03/2013; · 7.38 Impact Factor
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    ABSTRACT: The transfusion of whole blood derived platelets (WBDPs) or apheresis platelets (APs) is standard support for cancer patients. However, disputes remain about which type of platelets are ideal in terms of efficacy, cost, and the risk of adverse reactions. This cross sectional study included 141 cancer patients who underwent chemotherapy or hematopoietic progenitor cell transplantation and received platelet transfusions at The University of Texas M.D. Anderson Cancer Center between 2002 and 2003 were retrospectively evaluated. A total of 141 patients who did not differ significantly in terms of age or sex had a reaction to transfusions (WBDPs, n=123; APs, n=18), for a frequency of 0.66% in patients who received WBDPs and 0.45% in patients who received APs, but this difference was not statistically significant (p=0.13). More WBDP-related reactions occurred in patients transfused with older platelets (>2 days old) than in patients transfused with fresh platelets, but the difference compared with AP-associated reactions was not statistically significant. However, the rate of reactions to WBDP may increase if WBDPs are stored for a prolonged time (>2 days). Until evidence becomes available that clearly refutes this; the more fresh platelets as possible may be used.
    Mymensingh Medical Journal 01/2013; 22(1):143-7.
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    ABSTRACT: A prospective, randomized double-blind study comparing the effects of irradiated and unirradiated white blood cells was conducted in 108 acute leukemia patients with life-threatening infections, refractory to antibiotics. The study demonstrated no significant improvement in 30-day survival or overall survival. Transfusion of unirradiated white cells did not compromise the patient's opportunity to undergo allogeneic stem cell transplant, nor the success rate or overall survival after allogeneic transplant. The important positive finding in this study was that the unirradiated white cells produced a significantly higher increment in circulating granulocytes and in a higher proportion of patients granulocyte count exceeded one thousand per microliter, approaching normal concentrations. The increase in the number and the improved survival of the unirradiated granulocytes suggest that this procedure might potentially be a method to improve the utility of granulocyte transfusions and merits further investigation. The study demonstrated non-inferiority for unirradiated white cells. There were no harmful effects such as graft-versus-host disease, indicating that such studies would be safe to conduct in the future.Leukemia accepted article preview online, 17 October 2012; doi:10.1038/leu.2012.301.
    Leukemia: official journal of the Leukemia Society of America, Leukemia Research Fund, U.K 10/2012; · 10.16 Impact Factor
  • Aida B Narvios, Musa Mbahi, Caimiao Wei, Benjamin Lichtiger
    Transfusion 05/2010; 50(5):1156. · 3.53 Impact Factor
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    ABSTRACT: Adverse reactions secondary to transfusion of incorrect blood components can be fatal. We have established numerous processes to prevent these reactions in patients with cancer who continuously need blood component support, especially hematopoietic transplant recipients. The development of an active transfusion medicine consultation service at our institution to serve patients undergoing hematopoietic transplantation has led to more organized and simpler management of providing blood components to such patients. Safety tools were employed to attain our goal of providing safe blood components to hematopoietic transplant recipients. These tools were consultation request forms, blood component selection stickers on the patients' charts, and transfusion medicine physician consultation notes posted in the patients' medical records. One hundred randomly selected hematopoietic transplant recipients were reviewed over 16 months. Fifty patients received blood components from ABO-compatible donors, whereas the other 50 patients received components from ABO-incompatible donors. Deviation reports regarding the issuance of blood components in these patients over the study period were reviewed retrospectively. We identified eight reported deviations from the recommended blood components: red blood cells in one case, fresh frozen plasma in one case, single donor platelets in one case, and random donor platelets in five cases. Our transfusion service issued all eight components, but none of them were transfused. In all eight cases, the blood components were intended for transfusion to ABO-mismatched hematopoietic transplant recipients. Nurses identified the incorrect blood components by verifying the recommended blood groups on the patients' chart stickers, returned the components to the transfusion service, and transfused the correct blood components. Use of these safety tools has improved the safety culture regarding transfusion of blood components in hematopoietic transplant recipients at our institution.
    Transfusion Clinique et Biologique 09/2009; 16(4):383-7. · 0.64 Impact Factor
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    ABSTRACT: Superiority of single-donor apheresis platelets (SDAP) over pooled platelet concentrates (PPC) transfusions is largely assumed, but unproven. We hypothesized that prophylactic SDAP and PPC transfusions are clinically equivalent after allogeneic hematopoietic stem cell transplants (HSCT). We studied all transfusions administered to 33 patients with AML/MDS during the first 100 days after busulfan-based, myeloablative HSCT. All donor-recipient pairs were ABO identical. Transfusion threshold was a platelet count < or =15 x 10(9)/l. The corrected increment (CCI) was used for all comparisons. Median time to platelet engraftment was 13 days (n=30). PPC transfusions (n=105) were ABO compatible, while 10% of 41 SDAP were not (P=0.006). Median post-transfusion platelet count was 51K/microl (5-118K) after SDAP and 36K/microl (3-115K) after PPC (P=0.0004). Median CCI was 14.178 (SDAP) versus 7.793 (PPC) (P=0.0001). Median time to another transfusion was 3 days (SDAP) and 2 days (PPC; P=0.3). In the week following any given transfusion, the median number of new transfusions was similar (n=2), as well as the need of further transfusion (16 versus 24%, P=0.2). A total of 17% of SDAP and 30% of PPC transfusions were labeled 'ineffective' (P=0.1). There were two non-lethal hemorrhage episodes (6%). SDAP transfusions produced better platelet counts, but SDAP and PPC were equally effective in preventing hemorrhage.
    Bone Marrow Transplantation 09/2007; 40(5):461-4. · 3.54 Impact Factor
  • Aida B Narvios, Virgil Reddy, Benjamin Lichtiger
    Transfusion and Apheresis Science 11/2006; 35(2):179-80. · 1.23 Impact Factor
  • Salim A Haddad, Benjamin Lichtiger, Harvey G Klein
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    ABSTRACT: Platelet (PLT) concentrates are currently stored in an incubator at 20 to 24 degrees C with continuous gentle agitation. PLTs are routinely shipped for transfusion to thrombocytopenic patients, however. There is a concern that PLT concentrates may be adversely affected during the shipping process. A 40-year-old woman with severe aplastic anemia and immune refractory to unselected PLT transfusions was transferred to a distant medical center for a hematopoietic peripheral blood progenitor cell transplant where she continued to receive HLA-matched PLTs from her dedicated donors. Sixteen such components were collected and air-shipped in insulated boxes to the transplant center. Thirty-seven plateletpheresis components from the same dedicated donors had been transfused to the patient before transfer. Corrected count increments (CCIs) at the two sites were compared, with assessment of the role of HLA-match grades. The mean interruption time of controlled agitation during shipment was approximately 10.5 hours. The mean CCI of all distant transfusions was 14,450 +/- 9700 PLTs per microL x m2 per 10(11) and that of local transfusions was 10730 +/- 4870. The mean donor-paired difference between CCIs at the two sites was 1140 +/- 9940. At the remote location no clinically significant bleeding occurred and one posttransfusion febrile reaction was noted. Despite the study limitations, the effectiveness, in a single patient, of leukoreduced, irradiated apheresis PLTs shipped by lengthy combined surface and airline transport is reported, as measured by posttransfusion CCIs.
    Transfusion 09/2006; 46(8):1306-10. · 3.53 Impact Factor
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    ABSTRACT: BACKGROUND The response to antifungal therapy alone often is suboptimal in patients with cancer who have therapy-refractory neutropenia, and even donor-derived granulocyte transfusions (GTX) are not always successful. The authors evaluated the safety and efficacy of immune enhancement using recombinant interferon γ1b (rIFN-γ1b) in patients with cancer who received GTX for refractory, systemic, opportunistic infections.METHODS Twenty recipients of high-dose donor GTX (≈5.5 × 1010 neutrophils per transfusion) who had received concurrent rIFN-γ1b between October 2001 and December 2004 were evaluated retrospectively.RESULTSThe median age (± standard deviation [SD]) was 45 ± 17 years. Ten patients (50%) were men, 17 patients (85%) had leukemia, and 3 patients (15%) had myelodysplastic syndrome. The median ± SD Acute Physiology and Chronic Health Evaluation II score was 15 ± 4 (range, 7-22). Most patients (n = 18 patients; 90%) had recurrent or refractory cancer. In 6 patients (30%) who received allogeneic hematopoietic stem cell transplantation, GTX plus rIFN-γ1b was given a median ± SD of 26 ± 100 days (range, 12-372 days) after transplantation. Seventeen patients (85%) had neutropenia during GTX therapy. Five patients (25%) had possible invasive fungal infection, 3 patients (15%) had probable invasive fungal infection, and 11 patients (55%) had proven invasive fungal infection. One patient (5%) had refractory Pseudomonas aeruginosa sepsis. Eight patients (40%) received corticosteroids during GTX plus rIFN-γ1b therapy. Patients received a median ± SD of 8 ± 7 GTX doses (range, 4-28 doses) and 9 ± 7 rIFN-γ1b doses (range, 1-28 doses), for a mean ± SD cumulative dose (CD) of 400 ± 2621 μg. Other concomitant cytokines were granulocyte-colony stimulating factor (12 ± 3 doses; CD, 6720 ± 4721 μg) in 15 patients (75%) and granulocyte-macrophage–colony stimulating factor (12 ± 9 doses; CD, 4750 ± 4410 μg) in 14 patients (70%). Four patients (20%) developed fever, and 2 patients (10%) developed skin rashes. Reversible liver dysfunction (n = 3 patients; 15%) and tachycardia (n = 1 patients; 5%) were considered rIFN-γ1b-associated adverse reactions; whereas, in 1 patient (5%), transient dyspnea was attributed to GTX. Four weeks after therapy started, 9 patients (45%) had complete or partial resolution of infection; and, in another 3 patients (15%), the invasive fungal infection had become stable.CONCLUSIONS The current results indicated that no serious adverse events were associated with rIFN-γ1b immune enhancement in patients with systemic opportunistic infections who received donor GTX therapy. Cancer 2006. © 2006 American Cancer Society.
    Cancer 06/2006; 106(12):2664 - 2671. · 5.20 Impact Factor
  • Aida B Narvios, Mark Rozner, Benjamin Lichtiger
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    ABSTRACT: Preoperative testing in patients scheduled to undergo surgery often includes determining the ABO group and Rh type and screening for atypical alloantibodies in blood samples. AABB recommends obtaining blood samples within 3 days of transfusion. This was extended to 30 days to minimize the number of phlebotomies, avoid delays in providing blood during surgery, and decrease the laboratory workload. This study was conducted to show that extending the expiration date of the preoperative blood sample for blood typing and screening to 30 days will serve our purpose and provide better patient care. Data were collected for all patients undergoing elective surgery with perioperative blood samples submitted to our blood bank over 31 months. Each patient completed a questionnaire to determine whether his or her samples qualified for a 30-day preoperative clot. The questionnaires were validated upon preoperative screening. A transfusion medicine physician made the final determination regarding whether the samples qualified for 30-day typing and screening. These blood samples were used for cross-matching to find compatible blood during surgery. A total of 12,310 preoperative blood samples were received with a request for typing and screening, 4,370 (35.5%) of which qualified for a 30-day expiration date. No significant problems were encountered with these blood samples. Extension of the preoperative clot expiration date from 3 to 30 days has improved service to our patients and their physicians and indirectly reduced the laboratory workload.
    Transfusion 04/2006; 46(3):348-51. · 3.53 Impact Factor
  • International Journal of Infectious Diseases - INT J INFECT DIS. 01/2006; 10.
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    A B Narvios, M de Lima, H Shah, B Lichtiger
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    ABSTRACT: Leukoreduction of blood components has been considered a safe alternative to screening donors for CMV. The objective of this study is to analyze the effectiveness of bedside leukoreduction in preventing CMV transmission. We retrospectively studied 72 transplant recipients and donors who were CMV-seronegative pairs. All patients were transfused with CMV-unscreened cellular blood products leukoreduced at the bedside using leukoreduction filters. Quality control measures performed monthly in our leukoreduced blood components consistently demonstrated that at least 95% of the units sampled meet the leukoreduction criterion established by the American Association of Blood Banks standards. The CMV status of the recipients and donors was determined before transplantation by the latex agglutination assay. Recipients were observed for at least 100 days after transplantation. CMV cultures of urine, buffy coat, bone marrow, and bronchial washings were done weekly when indicated. CMV antigenemia testing was performed twice weekly: 11 transplant recipients seroconverted after transplantation. One patient was positive for CMV antigenemia 4 months after transplantation, but did not have CMV infection. Two of 61 patients who were not seroconverted were CMV antigenemia positive and did not have CMV infection: leukoreduction of cellular blood products is an efficient method of preventing CMV infection.
    Bone Marrow Transplantation 10/2005; 36(6):499-501. · 3.54 Impact Factor
  • American Journal of Hematology 06/2005; 79(1):80. · 4.00 Impact Factor
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    ABSTRACT: The efficacy and feasibility of donor granulocyte transfusion therapy (GTX) have changed considerably over the past four decades. The authors sought to determine the impact of high-dose (approximately 5.5 x 10(10) cells) GTX in patients with candidemia. The authors' case-control retrospective analysis comprised 491 consecutive patients treated at The University of Texas M. D. Anderson Cancer Center (Houston,TX) from 1993 to 2000. The cohort included 29 patients with Candida species bloodstream infection who had received GTX and 462 who had not. Both groups were comparable in age, gender, APACHE II score, recent chemotherapy received, broad-spectrum antibiotics, systemic corticosteroids, radiotherapy, intravascular catheter, and concordant antifungal therapy (P > or = 0.1). The patients who received GTX compared with those who did not had a higher incidence of underlying leukemia (86% vs. 29%, P <0.001), persistent neutropenia (59% vs. 18%, P <0.001), non-Candida albicans candidemia (Candida glabrata, 35%; Candida krusei, 31%: 90% vs. 67%, P=0.01), and breakthrough invasive mycosis (62% vs. 23%, P <0.001). Neutropenia was more prolonged in patients who received GTX (28 vs. 10 days, P <0.001). Also, more of the patients who received GTX had received hematopoietic stem cell transplantations (28% vs. 13%, P = 0.03), exposure (within 4 weeks) to antifungals (79% vs. 38%, P <0.001), and stays in critical care units (62% vs. 40%, P=0.02). The overall attributable mortality rate for 25 evaluable recipients of GTX was 48% (n=12), compared with 45% (n=115) of 254 evaluable patients in the control group (P=0.5). Of the 158 patients with leukemia, 25 (16%) had received GTX. In patients with leukemia, more of those who had received GTX experienced disseminated candidiasis (44% vs. 26%; P <0.07) and persistent neutropenia (68% vs. 43%, P <0.02), had candidemia that was more prolonged (> 72 hours, P <0.02), and had more stays in critical care units (68% vs. 44%, P <0.03). On the bases of a reduced multivariate model, a significantly increased risk of death was found for patients with hematopoietic stem cell transplantation (odds ratio [OR]=2.51; 95% confidence interval [95% CI], 0.99-6.31; P <0.05), for patients with persistent neutropenia (OR=4.57; 95% CI, 1.99-10.47; P <0.0003), and for patients with leukemia who also had prolonged candidemia (OR=3.59; 95% CI, 1.61-7.98; P <0.002), disseminated candidiasis (OR=5.19; 95% CI, 2.17-12.42; P <0.0002), or non-C. albicans candidemia (OR=5.02; 95% CI, 1.07-23.64; P <0.04). In patients with leukemia, death was attributable to candidemia in 50% of the GTX recipients, compared with 59% of the non-GTX patients who had received antifungal therapy alone (P=0.4). Despite the presence of multiple predictors of increased mortality, high-dose GTX therapy in these high-risk patients with cancer was associated with better than expected survival rates.
    Cancer 12/2004; 101(12):2859-65. · 5.20 Impact Factor
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    ABSTRACT: Identifying microsatellite instability (MSI) by partitioning DNA into multiple small pools containing only single genome amounts of DNA results in trapping both progenitor and low-frequency mutant alleles into pools where they can be identified and counted following PCR. Statistical approaches determining both the frequencies and the significant differences between frequencies of these Poisson-distributed alleles are presented. Results indicate a level of sensitivity and quantification not possible by standard PCR methods. Using material from colon cancer patients with high levels of MSI in their tumors, we also present the molecular and robotic methods for carrying out such studies. Validation experiments indicated mutants detectable at frequencies >0.03 above background. Frequencies obtained in tumor tissue (>0.25) met the expectations of the approach. Significant levels of MSI were detected in the constitutive tissue of the patient carrying a germ-line mutation for mismatch repair, suggesting both mechanistic and clinical applications of the procedure.
    Genomics 08/2004; 84(2):419-30. · 3.01 Impact Factor
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    ABSTRACT: Transarterial therapies used for the treatment of acute nonvariceal gastrointestinal (GI) hemorrhage have traditionally included vasopressin infusion and embolization. However, for patients with diffuse or multifocal hemorrhage and severe refractory thrombocytopenia, these options are suboptimal because platelet counts and coagulation parameters may not be adequate to allow for the formation of a stable clot. Herein two such patients treated with direct intraarterial (IA) infusion of platelets into the vascular territory supplying the hemorrhage are described. In both patients, after IA platelet infusion, blood product requirements were immediately reduced, bleeding from the GI tract resolved by clinical and laboratory criteria, and no significant bowel ischemia was seen.
    Journal of Vascular and Interventional Radiology 05/2004; 15(4):393-7. · 2.00 Impact Factor
  • M Asfour, Aida Narvios, Benjamin Lichtiger
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    ABSTRACT: Transfusion-dependent bone marrow transplant recipients are routinely transfused with ABO group and RhD-compatible blood components. However, because of the scarcity of RhD-negative blood components, particularly platelets, a policy was developed to transfuse RhD-positive blood components to RhD-negative patients during periods of shortage. We reviewed the records of 78 RhD-negative patients with hematologic malignancies who received RhD-negative bone marrow and/or peripheral blood stem cells, from June 1995 to August 2000. The patients transfused with RhD-incompatible blood components were screened periodically for evidence of the development of red blood cell (RBC) alloimmunization. Three of 78 patients (4%) developed anti-D antibodies after receiving RhD-incompatible platelet transfusions. One of the patients developed evidence of anti-RhD antibodies after receiving 42 units of RhD-positive random donor platelets; the second patient developed such evidence after receiving 6 apheresis platelets and 2 infusions of intravenous immunoglobulin G (positive for anti-RhD). The third patient received 206 RhD-positive random donor platelets and 5 apheresis units. All patients were discharged from the hospital. The overall immunization rate was 4%. Six patients received Rh-incompatible packed RBCs and showed no evidence of neither anti-RhD nor any other anti-RBC antibodies. All 78 patients had received RhD-incompatible platelets throughout their engraftment period. Transfusion of RhD-positive blood components to Rh-negative patients with hematologic cancers, who have received RhD-negative bone marrow and/or peripheral blood stem cells, are at low risk of developing RhD antibodies. These findings allow for a flexible strategy of blood component therapy support for this special patient population during periods of shortage.
    MedGenMed: Medscape general medicine 02/2004; 6(3):22.
  • Aida B Narvios, Benjamin Lichtiger, Joyce L Neumann
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    ABSTRACT: Minor adverse reactions following transfusion of blood components to cancer patients are not uncommon. Reporting these minor reactions to the transfusion service needs a careful evaluation. The objectives of this study were to closely monitor the transfusion reactions that occurred and had not been reported to the transfusion service and to evaluate the process by which the medical and nursing staff recognized and managed these reactions. We prepared a questionnaire with the nursing staff of a selected inpatient unit that addressed important questions, such as signs and symptoms during the transfusion, premedications given, process for physician notification, recommended action, and blood component implicated. Charts of the patients were reviewed, and the process was monitored for a 6-month period. A total of 58 cases were completed and analyzed. Platelet concentrates were transfused in 43 cases (74.1%), packed red blood cells in 9 cases (15.6%), and fresh frozen plasma in 6 cases (10.3%). Minor adverse reactions that were documented included chills in 11 cases (19.0%), low-grade fever in 11 cases (19.0%), hives and itching in 24 cases (41.4%), nausea and vomiting in 1 case (1.7%), and headaches and nonspecific mild pains in 11 cases (19.0%). Transfusions had been resumed in 27 cases (46.6%) and stopped completely in 13 cases (22.4%). Twenty-seven of 58 (46.6%) were first-time events. We conclude that underreporting of minor transfusion reactions, such as a febrile nonhemolytic transfusion reaction and allergic reactions, exists. To ensure safety to our cancer patients who are transfusion-dependent, we suggest that careful evaluation of any suspected transfusion reaction event should be referred to the transfusion medicine physicians who will evaluate each case and discuss it with the attending physician. This process will prevent detrimental, acute transfusion reactions.
    MedGenMed: Medscape general medicine 02/2004; 6(2):17.
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    ABSTRACT: The purposes of this study are to report experience with transjugular liver biopsy (TJLB) in patients with hematologic malignancy and severe thrombocytopenia and to determine the incidence of hemorrhage-related complications in patients with prebiopsy and pretransfusion platelet counts of 30 x 10(9) /L or lower to propose a threshold platelet count above which TJLB can be safely performed without transfusion. Medical records and laboratory reports of 50 patients with severe thrombocytopenia who had undergone 51 TJLB procedures and prebiopsy platelet transfusions between August 1999 and September 2001 were retrospectively reviewed. Biopsy success and procedural complications were recorded. TJLB was technically successful in 49 of 51 procedures (96%). The mean prebiopsy, pretransfusion platelet count was 17 x 10(9)/L (range, 3-30 x 10(9)/L) and a mean of 11 U (range, 6-32 U) of platelets per patient were transfused. The overall mean postbiopsy platelet count was 38 x 10(9)/L (range, 5-105 x 10(9)/L), but it remained 30 x 10(9)/L or lower in 24 TJLB procedures. No hemorrhage-related complications were encountered, but ventricular fibrillation occurred in one patient during the procedure. A threshold platelet count for safe TJLB resides below 30 x 10(9)/L. A prospective study is necessary to better define a lower threshold above which TJLB can be performed without platelet transfusion.
    Journal of Vascular and Interventional Radiology 04/2003; 14(3):323-7. · 2.00 Impact Factor
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    ABSTRACT: BACKGROUND: Cancer chemotherapeutic regimens have become more potent and myeloablative. As a consequence, morbidity and mortality due to opportunistic infections have become a major challenge. The provision of adequate doses of viable granulocytes has thus become an important approach for circumventing the problem. A schedule for collecting therapeutic numbers of cells with minimal donor toxicity has yet to be established.STUDY DESIGN AND METHODS:An investigation of three mobilization schedules for the collection of granulocytes for transfusion-granulocyte-colony-stimulating factor (G-CSF) 5 micrograms per kg daily; G-CSF 5 micrograms per kg every other day, and prednisone 60 mg given orally (20 mg doses at 17 hours, 12 hours, and 2 hours before the collection).RESULTS:A total of 464 apheresis procedures involving 163 healthy donors were analyzed. Prednisone caused a small increase in the white cell (WBC) counts over the collection days, while G-CSF every other day and daily schedules improved WBC counts to 145 and 160 percent, respectively (p = 0.004). Similarly, administration of G-CSF daily and every other day mobilized higher yields of granulocytes over the collection days, compared to the prednisone schedule (170% and 180% vs. 105%; p = 0.02). CONCLUSION: Compared with prednisone, higher WBC yields were achieved by G-CSF stimulation; G-CSF given every other day is as effective as daily G-CSF administration for the recruitment of granulocytes, which makes the mobilization procedure more cost- effective.
    Transfusion 02/2003; 38(8):722 - 728. · 3.53 Impact Factor

Publication Stats

905 Citations
471.42 Total Impact Points


  • 1975–2013
    • University of Texas MD Anderson Cancer Center
      • • Department of Stem Cell Transplantation & Cellular Therapy
      • • Department of General Surgery
      Houston, Texas, United States
  • 2004
    • University of Mississippi Medical Center
      • Department of Pathology
      Jackson, MS, United States
  • 1973
    • University of Houston
      Houston, Texas, United States