Benjamin Lichtiger

Clinical toxicity and laboratory effects of granulocyte-colony-stimulating factor (filgrastim) mobilization and blood stem cell apheresis from normal donors, and analysis of charges for the procedures.

BACKGROUND: Apheresis of granulocyte‐colony‐stimulating factor (filgrastim)‐mobilized blood stem cells from normal donors is now being used in place of a marrow harvest in transplantation. How the adverse effects of and charges for this procedure compare with those of the standard marrow harvest is not known.

Treatment of neutropenia-related fungal infections with granulocyte colony-stimulating factor-elicited white blood cell transfusions: a pilot study.

Neutropenia-related fungal infections can be life-threatening despite antifungal therapy. We evaluated the role of recombinant granulocyte colony-stimulating factor (rG-CSF)-elicited white blood cell (WBC) transfusions in patients with neutropenia-related fungal infections. Adult patients with hematologic malignancies, absolute neutrophil counts (ANC) <500/μl and fungal infections refractory to amphotericin b, received daily transfusions of rg-csf-elicited and irradiated wbc transfusions from related donors. donors received 5 μg/kg/day of rg-csf subcutaneously. donors achieved a mean anc of 29.4 × 103 per microliter. The mean yield of neutrophils per transfusion was 41 × 109 (range, 10–116). Fifteen patients received a median of eight transfusions (range, 3–16). Fourteen patients had received rG-CSF for a median of 12 days. The median ANC baseline was 20/μl. Eleven patients had favorable responses and eight of them remained free of infection 3 weeks after therapy. Favorable responses occurred among patients with better Zubrod performance status (median, 3 vs 4) and shorter duration of both profound neutropenia (median, 15 vs 25 days) and active infection (median, 8 vs 17 days). The mean 1- and 24-h post-transfusion ANCs were 594/μl (range, 98–1472/μl) and 396/μl (range, 50–1475/μl), respectively. Adverse reactions were observed in nine of 35 donors and in the recipients of six of 130 transfusions. rG-CSF-elicited WBC transfusions may be a safe and promising approach for treating neutropenia-related fungal infections.

Spindle-cell variant of squamous carcinoma. A light and electron microscopic study of 13 cases.

Thirteen spindle‐cell tumors of the upper respiratory tract, oral cavity, and skin of face have been studied with light and electron microscopy. Five were primary neoplasms, and 8 had recurred following radiation therapy. The primary lesions were superficially located, and, in light microscopic sections, sites of apparent continuity between tumor and overlying epithelium were observed. The electron micrographs demonstrated the presence in many tumor cells of aggregates of keratohyaline and slender bundles of tonofilaments, and occasional premelanosomes were seen. Desmosomes were present, but were few in number and poorly developed. No evidence could be found to support the concept of malignant connective tissue component. Findings justify designation of this group of tumors as spindle‐cell variants of squamous carcinomas.

Impact of high-dose granulocyte transfusions in patients with cancer with candidemia: retrospective case-control analysis of 491 episodes of Candida species bloodstream infections.

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 × 1010 cells) GTX in patients with candidemia.

Targeting neuropilin-1 in human leukemia and lymphoma

Targeted drug delivery offers an opportunity for the development of safer and more effective therapies for the treatment of cancer. In this study, we sought to identify short, cell-internalizing peptide ligands that could serve as directive agents for specific drug delivery in hematologic malignancies. By screening of human leukemia cells with a combinatorial phage display peptide library, we isolated a peptide motif, sequence Phe-Phe/Tyr-Any-Leu-Arg-Ser (F(F)/(Y)XLRS), which bound to different leukemia cell lines and to patient-derived bone marrow samples. The motif was internalized through a receptor-mediated pathway, and we next identified the corresponding receptor as the transmembrane glycoprotein neuropilin-1 (NRP-1). Moreover, we observed a potent anti-leukemia cell effect when the targeting motif was synthesized in tandem to the pro-apoptotic sequence (D)(KLAKLAK)₂. Finally, our results confirmed increased expression of NRP-1 in representative human leukemia and lymphoma cell lines and in a panel of bone marrow specimens obtained from patients with acute lymphoblastic leukemia or acute myelogenous leukemia compared with normal bone marrow. These results indicate that NRP-1 could potentially be used as a target for ligand-directed therapy in human leukemias and lymphomas and that the prototype CGFYWLRSC-GG-(D)(KLAKLAK)₂ is a promising drug candidate in this setting.

Costs of Blood Transfusion: A Process-Flow Analysis

PURPOSE To determine the cost of transfusing 2 units (U) of packed RBCs at a comprehensive cancer center. METHODS We performed a process-flow analysis to identify all costs of transfusing 2 U of allogeneic packed RBCs on an outpatient basis to patients with either (1) solid tumor who did not undergo bone marrow transplantation (BMT), (2) solid tumor who underwent BMT, (3) hematologic malignancy who did not undergo BMT, (4) hematologic malignancy who underwent allogeneic BMT, or (5) hematologic malignancy who underwent autologous BMT. We conducted structured interviews to determine the personnel time used and physical resources necessary at all steps of the transfusion process. RESULTS The mean cost of a 2-U transfusion of allogeneic packed RBCs was

Fibrin glue for partial nephrectomy

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Evaluation and comparison of three mobilization methods for the collection of granulocytes

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Two-surgeon technique of parenchymal transection contributes to reduced transfusion rate in patients undergoing major hepatectomy: Analysis of 1,557 consecutive liver resections

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Detecting bacteria in platelet concentrates by use of reagent strips

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