Pediatric Oncology

Hematology   

Questions discussed in this category



There are conflicting reports whether it contributes to renal insufficiency. If you do switch, what is your preferred TKI in this scenario?

How would the risk of VTE associated with crizotinib affect your decision? Should we consider using crizotinib in combination with brentuximab?

In the absence of concerning bleeding or thrombosis, family history of coagulopathy, current anticoagulant use, or malnutrition

What would you recommend within the first year after ATG and thereafter if still maintained on cyclosporine?

Ferritin uptrending >1000, no additional lab abnormalities. HFE wildtype. Too young for age-appropriate cancer screening. Asymptomatic except fatig...

If hydroxyurea modifies the course of sickle cell disease by increasing fetal hemoglobin, is there any benefit to using it in patients with fetal hemo...

What are the differences in approach to B lymphoid/myeloid and T lymphoid/myeloid MPAL?

Do you just use antibiotic prophylaxis if therapy is started prior to meningococcal vaccination?

Patient with high titer acquired FVIII inhibitor with no causative etiology.  Bleeding is well-controlled on emicizumab, but inhibitor has failed...

The patient has no personal history of VTE, but has positive family history of VTE.  Any prophylactic anticoagulation options? How would manage...

For instance, if clonal hematopoiesis of indeterminate potential (CHIP) suspected 

iPET2 and iPET4 showed Deauville 5 response. CT biopsy after 4 cycles was negative. Patient is currently scheduled for 2 additional cycles of ABVD.

I.e., what constitutes well-controlled cancer, IBD, nephrotic syndrome, etc. What other diseases do you put in this category (obesity, autoimmune dise...

If so, what platelet count threshold would you use? Would age impact your decision? Would you do a bone marrow to rule out primary MPD in adults if th...

Do you use a cutoff of 10 cm? Do you measure the size of the largest node or measure the largest conglomerate or measure the total length of the entir...

How does graft function play into your decision making? How do you utilize post allogeneic transplant chimerism in clinical practice? Do you obta...

Should we stop checking factor VIII levels as part of thrombosis workup?

While L-glutamine has minimal side effects and would likely be added after hydrea, how do you decide between the use of voxelotor and crizanlizumab?

How would the approach differ if the patient had a significant bleeding phenotype vs only minor bruising and mucosal bleeding?

This type of etoposide sparing therapy has been previously described in a case series at https://pubmed.ncbi.nlm.nih.gov/32725881/

What is the impact among patients and providers? Has your documentation been adjusted now that patients can readily review?

Does treatment with B-cell depletion and/or negative anti-spike antibody status despite COVID mRNA vaccination influence your decision?

FVL heterozygotes are often treated similarly to the general population. Aside from avoiding other VTE risk factors, are there situations where prophy...

Such as the case in which a patient is unresponsive to steroids, IVIG, TPO-agonist, rituximab, splenectomy, and even fostamitinib.

Given the POLARIX study data presented at ASH 2021, will this replace R-CHOP as the standard of care therapy in your practice? If not, how will y...

Would you offer indefinite anticoagulation if the event is unprovoked and the patient has low bleeding risk? 

Also is there value in using voxelotor for the purpose of reducing hemolysis, and if so what parameters do you use to determine when to initiate voxel...

Is there a particular sequence you would adjust contributing antirejection or antimicrobial medications? Is the use of G-CSF appropriate and at what c...

How does belumosudil now fit in your approach to steroid refractory chronic graft-versus-host disease?

Hydroxyurea is demonstrated to reduce complications and improve long-term outcomes in severe genotypes HbSS and sickle beta0 thalassemia. What clinica...

What if the patient is triple-positive or has continued seropositivity on repeat lab testing? What is the appropriate interval of monitoring and does ...

Provoked or unprovoked VTE: Do you use D-Dimer (or even repeat imaging to reassess residual clot) in any capacity to guide anticoagulation duration? E...

Is an LP only recommended in the setting of particular subtypes of lymphoma or symptoms of CNS disease?

Have you used anticoagulants other than coumadin? Or is that the only appropriate agent given monitoring is based on PT/INR?

While building a trusting patient-physician relationship, what therapies could be discussed that may be aligned with naturopathic medicine? (i.e. L-gl...

There are multiple difficulties that could be seen: steroids can precipitate a sickle cell crisis, vasculitis and sickle cell can produce similar clin...

Does manipulation of blood products (leukoreduction, irradiated) affect your approach? There is growing evidence that routine premedication (at least ...

While this is a known risk factor for venous [Meijers et al NEJM 2000] and potentially arterial [Yang et al, Am J Clin Pathol 2006] thrombosis, it is ...

Are there major differences in standard conditioning and/or GVHD prophylaxis regimens utilized? Does the non-relapse mortality different significantl...

Would this change with someone who has a history of thrombosis (e.g. DVT/PE, MI, CVA)? Would this change with someone who is more fit vs more frail?

Such as patients who are frail, elderly, renally impaired? Would you consider sirolimus over cyclosporine or tacrolimus for safer nephrotoxicity prof...

How often do you monitor ADAMTS-13 levels off therapy?

For example, do we prefer one regimen over the other in patients with a bleeding history or who have relapsed after a lengthy remission?

If given both options, which donor would one prefer: haploidentical related donor or 7/8 mismatched unrelated donor using post transplant cyclophospha...

While benefits outweigh known harms and limited data, do you worry about vaccination in patients with a history of or active autoimmune cytopenias (e....

Do you always treat with the full 21-day treatment course, or can defibrotide be stopped if certain criteria are met sooner?

Do you prefer a cHL chemotherapy backbone or PMBL chemotherapy backbone?

While thrombophilia testing is not routinely recommended prior to starting OCPs, how about after the development of a VTE?

Especially in a triple-positive patient with an acute ischemic stroke who may have urgency for anticoagulation with high bleeding risk and severe thro...

The patient who has not responded to steroids, rituximab/bendamustine, and splenectomy?

Would you give a trial of IST first or immediately refer for SCT if the patient has matched siblings?

Has your medical practice taken any steps either in community outreach or within the clinic to show support for this medically vulnerable population, ...

During the Stimate recall, how are we performing DDAVP challenges for newly diagnosed hemophilia A or von Willebrand disease?

Are most places administering oral iron as once daily or every other day dosing due to upregulation of hepicidin receptors following oral iron adminis...

There is no uniform guideline in the literature. AAP recommends until 5 years old or 1-year post-splenectomy. Some for 5 years post-splectomy.

Specifically, are there strategies you use to 1) empower patients to participate in decision-making and 2) reassure patients who may be skeptical?

Given the high cost of eculizumab, are there patient characteristics that inform which patients, if any, should be on indefinite therapy versus a time...

For example, a patient with hypogonadism unless it matters which organ is involved. Are other markers of iron storage useful in guiding therapy?

For example, in a patient who is steroid-refractory, requiring regular transfusion, and has not had response to rituximab after several weeks.

If autoimmune neutropenia already suspected, is this test informative or unnecessary?

What is the lowest level you have seen with uncomplicated or complicated crises?

There are various formulations of intravenous iron; each with varying costs, test dose requirement, elemental dose, and number or time of infusions ne...

Is there a preferred strategy of transfusional support versus reduced-dose anticoagulation during the duration of thrombocytopenia?

Is it at neutrophil recovery, at documentation of CR on bone marrow biopsy, or is there a different point in time?

Assuming CBC w/ different and complete metabolic panel are within normal limits, what (if any) further evaluation or management is needed?

At what age would you treat an early stage hodgkins lymphoma patient with ABVD + RT (adult treatment) vs OEPA x 2 or AV-PC x 3 (pediatric paradigm)?&n...

Guidelines indicate RCHOPx3 +RT as category I and RCHOP x 6 below that; long term f/u for SWOG 8736 showed similar PFS and OS. Do you have and approac...

We often see young women with favorable, early stage disease in the mediastinum who have had a complete response to chemotherapy. With current smaller...

After ABVE-PC X4 and Ifos/vinorelbine x 2 per AHOD 0831 (and is unable to have these sites biopsied), what dose would you treat to and what volume wou...

It seems that with the arms up, you get better lung blocking but with arms akimbo, you might have a lower dose to the humeral head. 


Papers discussed in this category


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Practical radiation oncology, 2015

Cancer, 2004-08-15

Br. J. Haematol., 2003-11-01

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Cancer, 1994-01-01

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Arch. Dis. Child.,

Pediatric blood & cancer, 2018-05

Br. J. Haematol.,

Fertil. Steril., 2013 Sep 05

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Blood,

J. Clin. Oncol., 2019 Sep 10

Acta Paediatr., 2020 Mar 23

American journal of hematology, 2018-08

Blood, 2019-04-04

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Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-03-20

J. Clin. Oncol.,

QJM, 2013 Feb 27

The New England journal of medicine, 2007-01-25

Haematologica, 2020

Nature, 2019-03

Blood, 2018 May 02

Leuk Lymphoma, 2019 Dec 26

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Blood, 2018 Jul 12

Ann. Intern. Med., 2019 Oct 15

Blood Transfus, 2018 Oct 24

J Thromb Haemost, 2018 May 08

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American journal of clinical oncology, 1992-10

The New England journal of medicine, 2017-02-02

Blood, 2009 Nov 10

Clin Lymphoma Myeloma Leuk, 2017 Mar 07

American journal of hematology, 2011-10

The American journal of medicine, 2017-12

American journal of hematology, 2018-05

Am J Hematol, 2020 Jun 29

Am J Hematol, 2019 Sep

Am J Hematol, 2018 Jun

JAMA,

N Engl J Med,

BMJ, 2008 May 20

Circulation,

The journal of allergy and clinical immunology. In practice, 2017

Journal of thrombosis and haemostasis : JTH, 2018-06-07

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Am J Gastroenterol,

American journal of hematology, 2008-08

Blood, 2017-07-20

Clin J Am Soc Nephrol, 2016 Oct 31

Blood, 2020 Dec 03

Rheumatol Int, 2019 Apr 30

Clin Exp Rheumatol, 2012 Sep 25

Wien Klin Wochenschr,

J Rheumatol, 2006 Jul 01

Semin Arthritis Rheum,

Lancet Haematol, 2019 Nov 05

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Blood, 2013 Sep 19

The Lancet. Haematology, 2015-09

Haematologica, 2017-07

Blood, 2018 Jun 13

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American journal of hematology, 2019-04

Blood Transfus, 2016 Dec 16

Bone Marrow Transplant, 2019 Oct 01

Front Immunol, 2020 Apr 03

Haematologica, 2019 Oct 17

J Thromb Haemost,

Transfus Med Rev,

Ann Intern Med,

Arthritis Rheumatol, 2019 Dec 26

Seminars in hematology, 2013-07

Pediatr Blood Cancer, 2019 Jul 24

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2013-02-20

Lancet (London, England), 2010-12-11

Blood, 2012 Apr 04

Clin Lymphoma Myeloma Leuk, 2019 Sep 30

Bone Marrow Transplant, 2018 Jun 08

Semin Hematol,

Blood, 2016-07-14

Blood, 2016 Sep 26

Transplant Cell Ther, 2021 Sep 02

Blood Adv,

Front Oncol, 2021 Mar 25

Regen Ther, 2020 May 15

Transfusion, 2020 Sep 24

Lancet Haematol,

Lancet (London, England), 2016-02-13

British journal of haematology, 2014-06

International journal of radiation oncology, biology, physics, 2019-06-01

Annals of oncology : official journal of the European Society for Medical Oncology, 2007-04

Blood, 2018-07-05

Blood,

Blood,

J Clin Oncol, 2021 Jun 25

Blood, 2019-06-06

Eur J Haematol, 2021 Feb 17

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, 2009-10

Journal of pediatric hematology/oncology, 2019-08

Lancet, 2012 Apr 04

Blood, 2018 Aug 30

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2014-09-20

Blood, 2016-11-24

British journal of haematology, 2008-06

Leukemia, 2021 May 03

N Engl J Med,

Transfusion, 2017 May 03

Autoimmun Rev, 2017 Sep 09

Practical radiation oncology, 2019-03

Cancer Cell, 2020 Oct 08

J Gen Intern Med, 2021 Feb 02

JAMA Netw Open, 2020 Jun 01

Br J Haematol, 2013 Aug 02

Blood Adv, 2020 Jan 28

Blood, 2019 Apr 25

J Clin Med, 2020 Nov 23

Am J Hematol, 2012 May 28

Blood, 2008-02-15

Blood, 2016-07-28

Blood advances, 2016-12-27

The Lancet. Haematology, 2018-12

N Engl J Med,

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, 2015-04

Pediatr Blood Cancer, 2019 Jul 31

J Clin Oncol, 2021 Dec 9

Blood Cancer Discov, 2021 Dec 01

Lupus, 2021 May 27

Journal of the National Medical Association, 2009-10

Blood,

Ann Oncol,

Lancet,

Am J Hematol, 2019 Aug 07

Exp Hematol Oncol, 2021 Feb 19

Clin Microbiol Infect, 2018 Feb 07

The Lancet. Haematology, 2019-03

J Clin Oncol, 2021 Dec 02

Urology, 1982-09

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, 2009-03

Clin Infect Dis, 2005 Jan 21

Pediatr Transplant, 2014 Sep 08

J Clin Oncol, 2021 Apr 30

Pediatr Infect Dis J, 2014 Nov

Bone Marrow Transplant, 2006 Mar

Blood, 2006-05-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2009-02-01

Blood, 2017-03-09

The Lancet. Oncology, 2015-10

N Engl J Med, 2013 Jul 11

Blood, 2012 Jun 19

Genetic epidemiology, 2016-09

American journal of hematology, 2019-03

Blood, 2021 Jan 07

Blood, 2019-04-11

N Engl J Med, 2022 Dec 11

Blood, 2013-08-01

Circulation, 2003 Jun 17

Haematologica, 2007 Feb

PLoS One, 2015 Dec 30

Int J Lab Hematol, 2021 Oct 05

Pediatr Blood Cancer, 2021 Oct

J Clin Pharmacol, 2021 Jul 16

J Clin Oncol, 2022 Dec 19