Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
Do you use G-CSF for a patient with ALL admitted for febrile neutropenia with prolonged count recovery?
I agree with this response. To highlight one other consideration: G-CSF is not routinely given during COG-based, pediatric-inspired therapy like the C10403 regimen (Stock et al., PMID 30658992). However, when patients treated with this approach in our system develop neutropenic fever, we will usuall...
How do you approach chemotherapy-induced thrombocytopenia in patients who do not respond adequately to romiplostim?
That's definitely a difficult and highly nuanced clinical scenario, especially since it can hamper future delivery of chemotherapy and compromise disease outcomes. My approach to this question also depends on whether we are talking about patients with a hematologic or solid tumor malignancy. I will ...
Based on results of the PINES trial, have you shifted your practice to start treatment for newly diagnosed pediatric ITP with eltrombopag?
I would answer this, "yes and no." As many readers will already know, the PINES trial (Shimano et al., PMID 41123939) was a randomized trial of pediatric patients, between eltrombopag and standard care, in a 2:1 ratio, in newly diagnosed ITP and non-severe bleeding, who required pharmacologic therap...
Is there a role for nitazoxanide for treatment of norovirus gastroenteritis in immunocompromised patients?
There is no good-quality evidence supporting a role for nitazoxanide for treatment of norovirus gastroenteritis in immunocompromised patients. The efficacy of nitazoxanide in viral gastroenteritis is supported by a small manufacturer-sponsored randomized, double-blind trial in non-immunocompromised ...
What is your approach to iron supplementation when ferritin levels remain stagnant despite reported good compliance?
This is a really good question. From my reading of the literature, there seems to be an association between a low ferritin level and restless legs syndrome. Not true iron deficiency as defined by a low transferrin saturation, anemia, or a low MCV. I could not find any definitive evidence for a cause...
What is your approach to systemic treatment of a rapidly progressing, symptomatic, unresectable MPNST arising from a plexiform neurofibroma in a patient with NF1?
MPNST is a different ballgame than plexiform neurofibroma. Unfortunately, it is not chemotherapy-sensitive. We currently do not have a good option for MPNST. Perhaps clinical trial enrollment works best. We also do NGS to look for targets, apart from NF1. MEK inhibitors have been tried in the past w...
What are your top takeaways in Sarcoma from ASCO 2026?
I really enjoyed the panel presentation “Unique Challenges in Sarcoma Care for Adolescents and Young Adults", (Jessop et al., ASCO 2026). I also enjoyed “A Multidisciplinary Case-Based Approach to Non-Rhabdomyosarcoma Soft Tissue Sarcoma in Adolescents and Young Adults: Challenges and Emerging St...
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...
Would you use the pneumococcal conjugate-21 vaccine (Capvaxive) instead of the conjugate-20 (Prevnar-20) for routine vaccinations in immunosuppressed patients?
PCV-21 was recently approved by the FDA and supported by ACIP. At this early stage (August 2024), CDC has not finalized guidance on PCV-21, so we do not know how the vaccine schedule will be changed. An important distinction is that PCV-21 covers different serotypes of pneumococcus, as outlined in t...
When do you refer patients back to their PCP for the predominant management of their medical care following completion of oncologic or BMT treatment?
Transitions of care are always challenging, especially for patients with complex medical histories, including cancer or stem cell transplantation. There are many different models for how and when to transition patients back to primary care or shared care. The ongoing, often complex needs of survivor...