Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
Can an AYA patient with newly diagnosed AML safely sperm bank after starting cytoreduction with hydroxyurea or cytarabine?
Thanks for the question. Unfortunately, there is not a lot of data available to answer this question with certainty. Because of that, I err on the side of saying that this should not be done. The concern lies with the possible impact on the sperm DNA, and the subsequent effect that might have on a p...
How do you approach DOAC dose reduction for secondary prophylaxis of VTE in cancer-associated thrombosis?
Data from the API-CAT trial (Mahé et al., PMID 40162636) show that de-escalation of apixaban after 6 months was non-inferior compared to the standard dose with respect to recurrent VTE. Although there was no difference in major bleeding, the lower dose of apixaban was superior from the clinically re...
Are you altering your use of immune checkpoint inhibitors given the risk of immune-related pneumonitis and the COVID-19 outbreak?
Nivolumab can be used every 4 weeks rather than every 2 weeks. We have to be flexible and change our approach according to circumstances.
What is the recommended fungal workup in an immunocompromised patient after 5 days of persistent fever?
For any patient with fevers, I focus significantly on any symptoms that a patient might have, like headache, diarrhea, and sinus symptoms, and work up a differential diagnosis based on possible pathogens in this area. If I am not finding anything, I would obtain a CT chest/abd/pelvis, as both invasi...
What is your surveillance regimen for children with nephroblastomatosis?
First, it is important to clarify that there are multiple forms of nephroblastomatosis and multiple clinical contexts in which surveillance for nephroblastomatosis may occur, and the medical literature has not always clearly defined discrete forms.Nephroblastomatosis was originally defined as multip...
Is there any utility for proton beam radiation to replace whole abdominal radiation for patients with Wilms tumor?
It is important to clarify that “whole abdominal radiation” (aka whole abdominal irradiation, or WAI) is a field of radiation therapy (RT) used to treat some Wilms tumor patients. Proton beam RT is a modality of RT delivery, with the main alternative being photon RT. But both photon (more commonly u...
Is dexrazoxane recommended for cardioprotection in AYA patients with Hodgkin lymphoma who are receiving anthracyclines as part of their upfront therapy?
This is a good question that reflects the growing body of evidence in favor of dexrazoxane cardioprotection being safe and beneficial (Chow et al., PMID 26014292; Getz et al., PMID 32343641). For AYAs with Hodgkin lymphoma, doxorubicin remains a key component of therapy even for lower stage disease ...
What is the best way to prepare children with von Willebrand disease for tonsillectomy to reduce the risk of post-operative hemorrhage?
I am an adult provider, but the treatment is similar regardless of age. The exact treatment plan will vary depending on the type and severity of VWD (i.e., mild type 1 VWD vs type 2B VWD); however, for tonsillectomies, I provide VWF concentrate 40-80 IU/kg 5-30 min preoperatively, followed by postop...
How do you approach patients who are inappropriately worried/fixated on a test result that is flagged as abnormal but not clinically significant?
This happens all the time now. I tell them that those results were flagged as outside the reference range (I don't use the term abnormal) but that they are not clinically significant. It does not always work if there is a patient who is super anxious or hyper-focused. Typically, if they need a lot m...
Would you recommend anticoagulation prophylaxis for a pediatric patient admitted with COVID-19?
COVID-19 disease in children seems to be less severe than adults based on the current literature and our personal experience at Children's Hospitals. Among adults, the coagulopathy is beginning to be described with elevated inflammatory markers and other markers of coagulation activation, including ...