Benjamin Lichtiger

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

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Publications (60)285.94 Total impact

  • No preview · Article · Oct 2015 · Human Immunology
  • Fleur Aung · Emil Freireich · Benjamin Lichtiger

    No preview · Article · Jun 2015
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    ABSTRACT: Detection of donor-specific anti-HLA antibodies (DSA) has been associated with graft rejection in all forms of transplantation. The mechanism by which DSA increase the risk of graft failure remains unclear. We hypothesized that complement-binding DSA are associated with engraftment failure in hematopoietic stem-cell transplantation and analyzed 122 haploidentical transplant recipients tested prospectively for DSA. Retrospective analysis to detect C1q-binding DSA was done on 22 allosensitized recipients. The presence of C1q+DSA was labeled as C1q positive, and the absence of C1q+DSA was labeled as C1q negative. Twenty-two of 122 patients (18%) had DSA, 19 of which were females (86%). Seven patients with DSA (32%) rejected the graft. Median DSA level at transplant for patients who failed to engraft was 10,055 MFI versus 2,065 MFI for those who engrafted (p=0.007). Nine patients with DSA were C1q positive in the initial samples with median DSA level 15,279 MFI (range 1,554-28,615), compared with 7 C1q negative patients with median DSA level 2,471 MFI (665-12,254) (p=0.016). Of 9 patients, who were C1q positive in the initial samples, 5 patients remained C1q positive at time of transplant [all with high DSA levels (median 15,279, range 6,487-22,944)] and experienced engraftment failure, while 4 patients became C1q negative pre-transplant and all engrafted the donor cells (p=0.008). In conclusion, patients with high DSA levels (> 5,000 MFI) and complement-binding DSA antibodies (C1q positive) appear to be at much higher risk of primary graft failure. The presence of C1q+ DSA should be assessed in allosensitized patients prior to hematopoietic stem-cell transplantation. Reduction of C1q+DSA levels might prevent engraftment failure in hematopoietic stem cell transplantation. Copyright © 2015 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
    No preview · Article · May 2015 · Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation
  • Ghazala Hashmi · Dipika Patel · Michael Seul · Fleur Aung · Benjamin Lichtiger

    No preview · Article · Sep 2014 · Clinical Lymphoma, Myeloma and Leukemia
  • Kristin S. Ricci · Fernando Martinez · Benjamin Lichtiger · Xiang Y. Han
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    ABSTRACT: Background Transfusion of blood products requires a vascular port. Use of an indwelling central venous catheter (CVC) provides this port readily and safely in general; however, potential risks require assessment.Study Design and Methods The objective was to examine septic reactions to blood transfusions performed via CVCs owing to subclinical microbial catheter colonization. All transfusion reactions that occurred from 2007 to 2011 at The University of Texas MD Anderson Cancer Center were analyzed and correlated with microbiology culture results. Data on the reactions, including vascular access via a catheter or peripheral venipuncture, were collected prospectively.ResultsA total of 999 reactions were reported, with an incidence of two per 1000 transfusion events. A total of 738 reactions occurred in 642 patients during transfusion through a CVC. Among them, 606 reactions occurred in patients that had cultures of blood samples drawn within 7 days before or after reaction. Sixty of these (9.9%) had at least one significant microorganism isolated from their catheters and/or peripheral blood. The blood culture results and timing suggested that these patients likely had catheter-related bloodstream infections caused by transfusion through a CVC with subclinical microbial colonization. Fever and chills occurred in 35 of these patients (58%), which resembled febrile nonhemolytic transfusion reactions. Culture results of the transfused blood products, although not performed in all cases, were mostly negative in these CVC-related reactions.Conclusion Blood transfusion through an indwelling CVC may lead to septic reaction owing to subclinical microbial colonization. This risk should be considered before transfusion and during investigation of transfusion reactions.
    No preview · Article · May 2014 · Transfusion
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    ABSTRACT: Allogeneic Granulocyte transfusion has evolved into a viable therapeutic option for immunocompromised severely neutropenic leukemic and hematopoietic stem cell transplant patients with life-threatening bacterial and fungal infections. The collection of larger cell doses of Granulocyte concentrates (GC) has been facilitated by the stimulation of donors with G-CSF and dexamethasone. The synergistic effect of G-CSF and dexamethasone has allowed for the collection of larger cell dosesof GC and its use has increased steadily. This has allowed us to split the high yield GC products and facilitatedthe distribution of the split GC products to a second or third patient who needs GC but lacks donors. The main objective of this article was to present our rationale for splitting GC products and how the split GC units were transfused to multiple patients. We believe that split GC are equally effective as unsplit GC and that multiple patients benefit from splitting GC.
    No preview · Article · Jan 2014 · Leukemia & lymphoma
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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.
    No preview · Article · Mar 2013 · Annals of Oncology
  • A Salam · M M Hosain · A Narvios · K Sazama · B Lichtiger
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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.
    No preview · Article · Feb 2013 · Mymensingh Medical Journal
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    ABSTRACT: Major ABO mismatching is not considered a contraindication to allogeneic haematopoietic stem cell transplantation (HSCT). Modern reduced-intensity conditioning and reduced-toxicity regimens cause much less myeloablation than conventional myeloablative regimens, such as cyclophosphamide with busulfan or total body irradiation, which may affect the incidence of pure red cell aplasia (PRCA). We estimated the incidence and described the natural history of PRCA in patients with major ABO-mismatched donor stem cells. Between 2007 and 2008, 161 (27% of all patients undergoing HSCT) underwent allogeneic HSCT with major ABO-mismatched stem cells and 12 (7·5%) of these patients developed PRCA. Thirty and ninety day T-cell and myeloid cell chimerism and neutrophil and platelet engraftment did not differ between patients who developed PRCA and those who did not. The only risk factor associated with PRCA was the use of a fludarabine/busulfan conditioning regimen. All patients with PRCA needed red cell transfusion for several months after HSCT resulting in significant iron overload. Pure red cell aplasia resolved spontaneously in the majority (seven patients) but only resolved after stopping tacrolimus in three patients. Hence, after major ABO-mismatched HSCT, the incidence of PRCA was 7·5% and it resolved spontaneously or after withdrawal of immunosuppression in the majority of patients.
    No preview · Article · Jan 2013 · British Journal of Haematology
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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.
    Preview · Article · Oct 2012 · Leukemia: official journal of the Leukemia Society of America, Leukemia Research Fund, U.K
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    Preview · Article · Feb 2011 · Biology of Blood and Marrow Transplantation
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    Full-text · Article · Feb 2011 · Vox Sanguinis
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    Fleur M Aung · Pedro Cano · Marcello Fernandez-Vina · Benjamin Lichtiger
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    ABSTRACT: We reviewed HLA antibody testing results using an enzyme-linked immunosorbent assay (ELISA) for all male blood donors at our institution during a 3.5-month period to look for HLA immunization. Confirmatory testing of 33 blood samples positive for HLA class I and/or II antibodies was performed using the fluorescent bead method. A retrospective review of recipients of packed RBCs and platelets processed from these 33 HLA-immunized male donors were conducted to identify transfusion-related acute lung injury and cognate antigens. The agreement rates between the methods for HLA class I and II antibodies were 21% (7/33) and 6% (2/33), respectively. We noted HLA antibodies in the male donors corresponding to cognate antigens in 2 recipients of packed RBCs and in 3 recipients of platelets. Of 8 donors positive for HLA antibodies, 5 did not have a history of blood transfusion. We conclude that ELISA was too sensitive and had a high false-positive rate for the detection of HLA class II antibodies.
    Preview · Article · Jan 2011 · American Journal of Clinical Pathology
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    ABSTRACT: Safety concerns raised in the recent oncology trials with erythropoiesis-stimulating agents (ESAs) have led to regulatory restrictions on their use. We wished to determine the impact of these changes on the use of ESAs and RBC transfusions. In a retrospective observational study of patients treated at a comprehensive cancer center in 2006-2008, data on all ESA doses dispensed, RBCs transfused, and hemoglobin levels on the days of transfusions and ESA initiations were analyzed. Compared with 2006, the total patients treated was 14% higher (28,339 versus 24,806) in 2007 and 22% higher (30,254) in 2008. Patients receiving ESAs decreased by 26% and 61%, and ESA units dispensed decreased by 29% (from 30,206 units to 21,409 units) and 80% (6,102 units) in 2007 and 2008, respectively. However, RBC transfusions increased by only 2% (from 38,218 units to 38,948 units) in 2007 and by 8% (41,438) in 2008. The mean hemoglobin on the day of transfusion was the same for each year (8.4 g/dl); however, an increasing proportion of patients initiated ESAs at lower hemoglobin (< 10 g/dl) levels. After adjusting for demographics and diagnostic variables for 3 years (n = 83,399), a multivariate logistic regression showed a significant decline in ESA use (p < .0001) without an increase in RBC transfusions. Recent ESA safety concerns and regulatory restrictions have significantly decreased ESA use. The lack of a significant impact on transfusions may be related to a lower hemoglobin threshold used to initiate ESAs or treatment of patients less likely to respond.
    Preview · Article · Dec 2010 · The Oncologist
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    Fernando Martínez · Jeffrey Tarrand · Benjamin Lichtiger
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    ABSTRACT: This study examined the clinical outcome of every patient who received a bacterially contaminated unit of platelets at The University of Texas M.D. Anderson Cancer Center, Houston, during 2007. Samples of platelets were aerobically cultured and read for 1 day at 35 degrees C. Positive bottles were subcultured in the appropriate media. The effect of independent variables in the clinical outcome of patients infused with bacterially contaminated platelet units was analyzed. A total of 23,199 platelet units were transfused, 71 of which were bacterially contaminated units; 8 were apheresis platelets and 63 were whole blood platelets. Of the 71 units, 70 were contaminated with gram-positive bacteria and 1 with gram-negative bacteria. Only 1 patient developed fever, and coagulase-negative staphylococci were isolated from the transfused unit. Transfusion of fresh units and antibiotic therapy possibly explain the lack of clinical consequences in our patients.
    Preview · Article · Aug 2010 · American Journal of Clinical Pathology
  • Aida B Narvios · Musa Mbahi · Caimiao Wei · Benjamin Lichtiger

    No preview · Article · May 2010 · Transfusion
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    ABSTRACT: Blood transfusions are an independent risk factor for adverse outcomes after hepatectomy. In-hospital transfusions are still reported in one third of patients in major series. Data on factors affecting blood transfusions in large series of liver resection are limited. The aim of this study was to evaluate factors predictive of blood transfusion in hepatectomies performed at a tertiary referral center. Records of 1,477 patients who underwent 1,557 liver resections between 1998 and 2007 were reviewed. Multivariate analysis of risk factors for red cell transfusion was performed. Median intra-operative blood loss was 250 cc, and 30-day peri-operative red cell transfusion rate was 27%. On multivariate analysis, factors that significantly predicted increased red cell transfusion rates were female sex, pre-operative hematocrit<30%, platelet count<100,000/mm3, simultaneous resection of other organs, major hepatic resection, use of the Pringle maneuver, and tumors>10 cm. Parenchymal transection technique was an independent risk factor for perioperative red cell transfusion; the usage of the 2-surgeon technique (combined saline-linked cautery and ultrasonic dissection) was associated with a lower transfusion rate than other techniques, including ultrasonic dissection alone, finger fracture, and stapling (P<.001). Although most factors that affect the red cell transfusion rate for liver resection are patient- or tumor-related, the parenchymal transection technique is under the surgeon's control. The decrease in transfusion rate associated with the use of the 2-surgeon technique emphasizes the important role of the hepatobiliary surgeon in determining outcomes after liver resection.
    No preview · Article · Oct 2009 · Surgery
  • A Narvios · L Rodriguez-Jackson · V Reddy · B Lichtiger
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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.
    No preview · Article · Sep 2009 · Transfusion Clinique et Biologique
  • Benjamin Lichtiger · Juan Surgeon · Susan Rhorer
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    ABSTRACT: The clinical histories of 30 consecutive Rh0D-negative oncology patients transfused with Rh0D-incompatible platelet concentrates were analyzed. No evidence of sensitization to the Rh0D antigen was found whatsoever, in spite of the large numbers of Rh0D-incompatible platelet transfusions given to these patients. The results of this work seem to indicate that patients with malignant diseases, who are undergoing various forms of antineoplastic therapy, are immunomyelosuppressed, and have severe thrombocytopenia, can safely receive platelets from Rh0D-positive donors without developing evidence of immunization to Rh0D antigens.
    No preview · Article · Mar 2009 · Vox Sanguinis
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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.
    Full-text · Article · Sep 2007 · Bone Marrow Transplantation

Publication Stats

988 Citations
285.94 Total Impact Points


  • 1991-2015
    • University of Texas MD Anderson Cancer Center
      • • Division of Pathology and Laboratory Medicine
      • • Department of Stem Cell Transplantation & Cellular Therapy
      • • Department of Leukemia
      Houston, Texas, United States
  • 2009
    • Texas Medical Center
      Houston, Texas, United States
  • 2004
    • University of Mississippi Medical Center
      • Department of Pathology
      Jackson, MS, United States
  • 2002
    • University of Houston
      Houston, Texas, United States