Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?
Interesting question. Not being an endocrinologist, I don't have the expertise to advise but the reference below makes the statement that even short-term steroids can be an issue. I suspect that if you have to stop abruptly from 60 mg daily for 2 weeks, it would probably be fine in most instances bu...
Is there any outpatient protocol for cisplatin/doxorubicin neoadjuvant chemotherapy for osteosarcoma?
Outpatient administration of cisplatin/doxorubicin (albeit at a slightly reduced cisplatin dosage of 100 mg/m²) protocol is documented in the BC Cancer out in Vancouver, British Columbia. We offer this at Roswell, with the addition of mannitol, but it is a long 8-hour day, and close follow-up is rec...
What is the best way to support a pediatric oncology survivor with fears about 2nd neoplasm or relapse?
Many survivors of childhood cancer are managing ongoing post-traumatic stress, which can include the persistent concern for relapse or a second neoplasm. It is important to note that these are rational concerns - the risks of relapse or second malignancies are real and can give survivors a sense of ...
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 ...
Is there an age cut off below you would not treat a keloid with radiation post surgical excision?
While radiotherapy is considered an extremely useful modality in the treatment of recurrent keloids in the adult population, most would contend that the risks do not justify the application of adjuvant radiotherapy in the pediatric population (PMID: 10703484) for a benign condition when other modali...
What radiation dose and margins would you recommend for treatment of a progressive cerebellar glioma with BCOR/BCOR1 fusion after initial subtotal resection with residual disease adjacent to the posterior brainstem?
BCOR fusion glioma is a rare type of brain tumor, often seen in children and young adults, characterized by gene fusions involving the BCOR (BCL6 corepressor) gene with partners like EP300 or CREBBP, leading to unique molecular and histological features, presenting as high-grade neuroepithelial tumo...
How would you manage a rare presentation of an older adult after gross total resection of an "infant-type hemispheric glioma" of the left frontal lobe, IDH1 negative and negative for MYB fusions?
Infant-type hemispheric gliomas (IHGs) are rare high-grade astrocytic tumors characterized by giant size and abundant vascularity, often with regions of cystic transformation. They are aggressive brain tumors that occur during early infancy, usually between 0 and 12 months of age. They are often ver...
How do you treat factor XI deficient patients with surgery or trauma related bleeding?
Given the risk of elevated plasminogen with low FXI, prefer FFP, with fibrinolytic if mucosal bleeding.
What are the best labs to trend improvement in HLH?
Unfortunately, there is not one specific laboratory test to definitively trend responses to HLH directed therapy. In general, our approach is to obtain baseline inflammatory labs including CBC with differential, ferritin, soluble IL2 receptor (sIL2r), triglycerides, coagulation studies (PT/PTT) incl...
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