Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
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...
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...
What would be your next line of treatment for disease control in a pediatric patient with metastatic hepatocellular carcinoma in partial response after multiple therapies?
Dear Dr. @Dr. First Last, Does the patient have an underlying hepatopathy (guessing yes, given the presence of varices)? And how old is the patient? Also - what was the AFP at diagnosis and what is it now? And what is the underlying liver function like? Final question - has the tumor been sequenced ...
Would you consider a cycle of EP in a patient with good risk stage IIIB seminoma on BEP but with bleomycin omitted for cycle 3?
There are many aspects to this question. Good risk stage II seminoma has a 90-99% cure rate. I presume he has had all 3 five day courses of the EP component and 6 of 9 weeks of bleomycin. An ECOG study from about 30 (!) years ago compared BEP X 3 versus 3 courses EP for all types and histologies of...
What is the risk of secondary malignancy and/or conversion to MPNST for patients with NF-1 who undergo radiation?
Broadly speaking, this is certainly a possibility and this has been a reason why the community has triaged the application of radiotherapy to more high-risk cases (Williams et al., PMID 19117870). Just playing out the numbers independent of the application of radiotherapy, 100% of NF1 patients will ...
For which pediatric oncology patients do you start bacterial prophylaxis, inpatient or outpatient, and what is your antibiotic of choice?
Bacterial prophylaxis in pediatric oncology patients should be guided by the intensity of treatment, depth and duration of neutropenia, and individualized risk for invasive infection. Current evidence and expert consensus support targeted prophylaxis in children with the highest risk of life-threate...
What chemotherapy regimen would you use for a testicular cancer patient in need of BEPx3 but unable to use platinum based chemotherapy regimen due to cochlear implants?
To be succinct, the correct answer is BEP x 3 if he wants the therapy that would achieve optimal cure rate. If disease is limited to retroperitoneal nodes, especially if < 3 cm is the largest node and normal postorchiectomy, serum hCG and AFP, RPLND would then be the preferred option.