Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
Can anti-cardiolipin or anti-beta-2 glycoprotein antibodies cause prolonged PTT in the absence of a lupus anticoagulant?
Lupus anticoagulants are a heterogeneous group of antibodies that do not have uniform activity in all assays. Furthermore, testing procedures are not well-standardized. Since relevant clotting factor deficiencies have been ruled out and the long PTT does not correct with mixing, and since there is o...
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 ...
How do you approach melanoma patients with a positive sentinel node with extra-nodal extension for definitive surgical management?
This is a multidisciplinary question so I reached out to our surgical oncologist (Dr. @Dr. First Last) at the Ohio State University Comprehensive Cancer Center for his thoughts as well. This is a grey area as the patients with extra-nodal extension (ENE) were not specifically studied in the landmark...
What is your first line of therapy for refractory Hodgkin lymphoma in an AYA patient?
Our first approach in this setting is second line chemotherapy with the intention to achieve a complete metabolic remission (by PET) and then an autologous stem cell transplant. Our approach to the transplant includes total lymphoid irradiation followed by a conditioning regimen of Cyclophosphamide,...
For patients with newly diagnosed brain metastases without a history of seizure activity, do you routinely start anti-seizure medication?
This is a common clinical question that has been repeatedly explored in meta-analyses and clinical guidelines. Consistently, there's no evidence to support primary prophylaxis for seizures in patients with brain tumors including brain metastases. In summary, the data does not support the routine use...
Would you recommend anticoagulation in a pediatric patient with metastases in a dural venous sinus?
For an adult patient would consider if there is evidence of tumor-associated thrombus on initial imaging or follow-up, but not usually from a prophylactic perspective. This may be different in a pediatric patient and also might depend on the primary malignancy or hematologic, or neurologic comorbidi...
What is your approach to optimizing pre-operative hemoglobin in patients with sickle cell disease?
Unfortunately, I am not aware of a more comprehensive document than the ASH guidelines. These are what I use to define my default management strategy, often in coordination with our dedicated hematology consult subspecialist service.
How would you evaluate a patient with an isolated high RBC count but with a normal hemoglobin and hematocrit?
My first question would be, how long has the elevated red cell count been present? I ask this because, in a study of 10,000 individuals, erythrocytosis was initially found in 88 but after a year only 11 still had this finding (Ruggeri et al., PMID 13679323). If therefore, the observation is recent, ...
Would you extend the duration of anticoagulation in patients with a provoked DVT, but evidence of residual clot at 3 months?
This is a really interesting discussion. I do tend to get Dopplers at the end of the anticoagulation treatment period, but only to assess the new baseline and to help decision-making in the future if they develop new symptoms and have another Doppler. I find this to be very helpful to understand if ...
What would be your recommended regimen for an AYA patient with relapsed mediastinal pure seminoma, with relapse 20 months after completion of BEP?
Mediastinal seminoma is rare and has a high cure rate with chemotherapy alone (BEP x3). I would refer a patient like this to a high-volume center. Treatment options are high-dose chemotherapy followed by ASCT vs. resection. This should be a tumor board discussion. Despite limited data and the interv...