Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
What are your top takeaways in Hematologic Malignancies from ASH 2025?
The PARADIGM study is a very important one that may result in a paradigm change for the treatment of AML. The study showed that outcomes are equal or better with AZA + VEN among patients with AML suitable for intensive chemotherapy. The efficacy was superior in response rate and EFS (but not overall...
How do you approach the treatment of teen patients with recurrent mediastinal germ cell tumor who have failed standard therapy, radiation, and HD therapy/stem cell rescue?
The query failed to delineate whether this was seminoma or non-seminoma, but probably does not matter in this advanced stage of a heavily treated patient. Also failed to address the anatomical location of active cancer. Whether this is a teen or older patient is irrelevant. For mediastinal seminoma,...
When should surgical tumor resection be considered in patients with a low-grade glioma?
In adults with low-grade gliomas, there is substantial evidence suggesting that aggressive, early surgical resection improves outcomes and survival (Jakola et al., PMID 23099483). Historically, this has been particularly true for tumors that carry an IDH mutation or 1p/19q codeletion. This survival ...
For patients on immune checkpoint inhibitors presenting with chest pain, dyspnea, fatigue, and troponin elevation, would you recommend early initiation of high dose steroids for empiric treatment of ICI myocarditis while pursuing workup with coronary angiogram, echocardiogram, and/or cardiac MRI, or wait until alternative etiologies have been ruled out?
This question raises an important point that the clinical presentation of ICI-associated myocarditis often overlaps with other cardiovascular disorders, including acute coronary syndrome, chronic CAD, congestive heart failure, and other nonischemic cardiomyopathies. Therefore, prompt initiation of w...
Should all patients with a remote history of immunotherapy, chemotherapy and/or radiation therapy have a baseline TTE regardless of ASCVD risk?
The current ASCVD risk assessment calculators we have available do not contain cancer-specific parameters and thus are inadequate for accurate assessment of a cancer survivor's risk of developing CHF and ischemic heart disease. If patients have received mediastinal radiation therapy or high-dose ant...
Given recent studies investigating ICI myocarditis biomarkers such as Temra CD8+ cells, is there now a growing selection of clinical biomarkers, besides BNP and troponin, being measured routinely in ICI myocarditis cases?
Since novel biomarkers are not yet clinically available in most practice settings, these are not yet routinely being checked though they certainly merit further investigation for diagnosis of ICI myocarditis. Currently, recommended biomarkers include indicators of cardiac injury (troponin, BNP or NT...
What infectious prophylaxis would you recommend in an infant with Wiskott-Aldrich syndrome during donor search and pre-transplant?
In infants with Wiskott-Aldrich syndrome, the degree of immune deficiency is variable and should be evaluated with a comprehensive assessment of both T-cell and B-cell immunity. Current testing typically includes lymphocyte subsets (CD3, CD4, CD8, CD19/20, NK cells), quantitative immunoglobulins (Ig...
How do you approach managing depression symptoms in patients who have had repeated high risk of bleeding?
Overall, evidence suggests that while SSRIs do increase the risk of bleeding. The absolute risk of a bleeding event remains low and is usually not serious. A 2017 meta-analysis by Laporte et al., suggested that overall bleeding risk is increased by at least 36% while other meta-analyses suggest that...
How do you address logistic barriers related to blinatumomab when treating relapsed B-ALL?
This is a very challenging issue that speaks to an incredibly important aspect of delivering not only this drug but others like it. Despite the strong evidence that supports the use of blinatumomab in a variety of clinical scenarios for patients with B-cell ALL [e.g., Gökbuget et al., PMID 29358182;...
What are your top takeaways in Hematologic Malignancies from ASCO 2026?
As always, lots of compelling data were presented at ASCO highlighting the advancements we continue to see in the treatment of plasma cell disorders. My top takeaways include:1. Phase 3 randomized trial to evaluate the impact of anselamimab on all-cause mortality in κ light-chain amyloidosis: for de...