Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
Is there any outpatient protocol for cisplatin/doxorubicin neoadjuvant chemotherapy for osteosarcoma?
Not really. The full dose of cisplatin (120 mg/m²) is difficult (not to mention cruel) to deliver as an outpatient, given the need for fluids, antiemetics, and supportive care.
How do you approach adjuvant therapy for resected Stage I Ewing sarcoma of the kidney?
From a chemotherapy standpoint, all stages of Ewing Sarcomas are approached the same way. There are differences in surgical approach between localized disease versus metastatic disease. We give VAC alternating with IE for six cycles, each. Since this is resected, this regimen should be given in the ...
Has your practice changed to PLEX-free initial therapy for iTTP?
I am not. The reason is that caplacizumab is not on formulary at my institution, and so implementing PLEX rapidly while obtaining caplacizumab (which typically arrives in 24-48 hours) is my current practice. If I had caplacizumab on formulary, I would utilize it as it was utilized in the MAYARI tria...
How do you choose first or second-line systemic therapy for fibrolamellar hepatocellular carcinoma?
Fibrolamellar carcinoma is histologically unique from hepatocellular carcinoma. The disease is correctly called fibrolamellar carcinoma, and not fibrolamellar hepatocellular carcinoma, or hepatocellular carcinoma fibrolamellar variant. Even though the latter may be permissive if the lack of cirrhosi...
How should you manage a COVID-19 infected/suspected patient who is receiving chemotherapy and cannot interrupt or delay their cancer treatment?
This is difficult to answer specifically without further details. There certainly is accumulating evidence that patients with cancer, especially those receiving immunosuppressive chemotherapy, are at greater risk of COVID-19 infection if exposed, and a greater risk of serious and life-threatening co...
Do you use specific scalp dosimetry constraints to prevent chronic alopecia when treating partial brain volumes with VMAT?
I do try to be mindful of scalp dose for partial brain VMAT, mainly to reduce the risk of alopecia. If feasible, I generally try to keep the scalp/skin max dose around 39 Gy to D0.03 cc or lower. That said, I would prioritize target coverage and overall plan quality if there is a tradeoff. In my pra...
How do you approach treatment of a glioblastoma in pregnancy?
Glioblastoma during pregnancy could be treated safely (to mother and fetus) with certain precautions and modifications. Collaboration and consultation with the patient’s obstetrician are essential. External shielding over the patient’s abdomen during treatment will decrease the external scatter radi...
Do you offer IV iron first line to women with iron deficiency anemia from heavy menstrual bleeding?
I offer first-line IV iron because oral iron cannot keep up with the losses from heavy menstrual bleeding, and the majority can't tolerate it. I routinely give a gram of LMW iron dextran in one hour, Feraheme (not ferumoxytol generic) 1,020 mg in 30 minutes, or ferric derisomaltose 1 gram in 30 minu...
How do you approach cardiac surveillance in an asymptomatic adult who received anthracycline-based chemotherapy for a childhood cancer and presents to you without an active survivorship program?
I'm a pediatric oncologist who runs our childhood cancer survivorship program, so I generally don't take care of adults. We are a free-standing children's hospital, so we have no affiliation with an adult program. So, when I transition our pediatric oncology patients out of our program, I transition...
How do you counsel patients and caregivers regarding management of cancer-associated cachexia?
ASCO guidelines re: anorexia/cachexia were just published in May 2020. Basically, they note the magnitude of the clinical problem and the limited therapeutic options proven to be helpful. They state that dietician consultation is reasonable to employ. They also note that it is reasonable for a clini...