Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
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...
When would you use dexamethasone-free antiemetic prophylaxis with olanzapine in pediatric patients receiving highly emetogenic chemotherapy?
At our institution, our leukemia/lymphoma, bone marrow transplant, and neuro-oncology providers generally do not feel comfortable with the use of dexamethasone for the prevention of CINV in their patients. In addition, neuroblastoma patients receiving dinutuximab also do not receive dexamethasone. T...
In light of promising results of hydroxychloroquine in COVID-19, should we consider using it prophylactically in cancer patients, especially if immunocompromised?
At this time, as there is no good evidence available, I would not recommend the use of hydroxycholoroquine prophylactically in cancer patients. It is unclear whether it would prevent contagion, probably not, and we still don't know if it will have any effect on the course of COVID-19. We expect ther...
How would you manage a patient with HbSS and severe pulmonary hypertension on home oxygen?
This patient should be referred to a specialist in pulmonary hypertension in sickle cell disease for right heart catheterization and aggressive management of the pulmonary hypertension. As described, the patient is not a good candidate for lung transplant or gene therapy.
How would you approach adjuvant radiation therapy for a young adult woman with recurrent myxopapillary ependymoma?
Extraneural spread of a myxopapillary ependymoma is exceptionally rare. In this case, I would strongly favor adjuvant local radiotherapy to the postoperative sites, assuming they have not previously received prohibitive radiation doses (especially the pre-coccygeal site). The situation is different ...
Can we use a linear accelerator to sterilize PPE?
Per FAQ's posted by ASTRO: "At this time, ASTRO does not recommend the use of clinical linear accelerators to sterilize PPE. While ionizing radiation is used for sterilization of blood and food products, this is achieved using industrial irradiators that use gamma irradiation at doses rates far grea...
Between the MERLIN and CASTLE tests for melanoma, which do you prefer and why?
I prefer DecisionDx-Melanoma, without question. It’s the only test that prospectively met its primary endpoint, with SLN positivity below 5% in the low-risk group. Merlin’s CP-GEP did not meet that threshold in MERLIN_001. DecisionDx also goes beyond the SLNB decision by independently predicting rec...
How do you approach perioperative hemostatic management for a patient with severe factor 11 deficiency <1%, without inhibitor, who has a significant postoperative bleeding history despite FFP prophylaxis who is undergoing major ENT/skull-base surgery?
This is a complex group of patients. There are systematic reviews that one could look up (Al-Housni et al., PMID 42189746). They involve various combinations of FFP transfusion, rFVIIa, and antifibrinolytics. Our practice has been to risk stratify the surgery based on the patient's personal bleeding...
Is there any indication for IVIG in immunocompromised patients with only decreased IgM and/or IgA levels?
Nope. IVIG preparations contain IgG not IgA or IgM. Low serum IgA may or may not be associated with low IgA levels in mucosal surfaces leading to a risk of local infections. Low levels of one or both may be asymptomatic but in the right setting might suggest a need for evaluation of plasma cell dysc...
How do you present the trade off between a small chance of a sustained response for a new drug at the expense of potential worsening quality of life?
Since we now have an increasing number of treatments at our disposal, this becomes an ever more frequent conversation in oncology. This question gets at several Shared Decision Making (SDM) model steps. Usually in this scenario, there are not routine standard of care options and highlighting the pat...