Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
What is your preferred treatment for refractory warm autoimmune hemolytic anemia with autoimmune neutropenia?
For immunomodulation, have you trialed IVIG? If not, this would be worth a trial. For immunosuppression, I prefer to utilize a more T cell-directed agent after failure of steroids/rituximab. Thus, a trial of MMF or cyclophosphamide may be reasonable. I think MMF may take too long to work in a situat...
What is your approach when it comes to reirradiation for DIPG patients who have already received 54Gy upfront?
Early case series reports from MD Anderson suggested that focal re-irradiation (re-RT) for progressive DIPG after full course primary RT was fairly well tolerated, resulted in symptomatic improvement in the majority of patients and was associated with the most durable, albeit temporary, tumor contro...
Do you repeat antiphospholipid antibody testing in a patient that previously met criteria for APLS?
I would repeat APL Ab testing if I am trying to risk stratify a patient in preparation for pregnancy or surgery, for example. In some cases (see a recently posted question about stopping anticoagulation in people with prior APLS history), I would also consider rechecking if I am thinking about disco...
Would you retry rituximab in steroid refractory warm autoimmune hemolytic anemia which responded to rituximab before?
Yes, I would utilize rituximab a second time for treatment of AIHA in light of a response during the first episode. The first response was not that durable in this case, and it would be anticipated the response after the second round of rituximab may not be even as durable as the first. As usual wit...
What are the best radiation therapy options for a young adult with 3 brain metastases from myeloid sarcoma that hasn’t responded well to intrathecal therapy?
The prognosis for young adults with Acute Myeloid Leukemia (AML) experiencing a Central Nervous System (CNS) relapse is generally poor, with most studies reporting a 5-year overall survival rate of ~11%, indicating a very grim prognosis due to the aggressive nature of CNS involvement in AML.The prec...
How do you choose between therapies for newly diagnosed ITP that is refractory to steroids and IVIG?
The important questions here are what are the symptoms and what are the platelet counts? In patients who fail to respond to either corticosteroids or IVIG, the concern is whether this is actually immune thrombocytopenia or another cause of thrombocytopenia. With "normal" flow and bone marrow results...
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,...