Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
In the era of MEK inhibitors and BRAF V600E-targeted therapy, what is the role of traditional vinorelbine/prednisone in the management of Langerhans cell histiocytosis?
A similar question came up during rounds this week, and I recalled seeing this question here.I assume the asker meant vinblastine, and not vinorelbine; the combination of vinblastine and prednisone is considered standard therapy, whereas vinorelbine has not generally been used in LCH.Let's first bet...
Do you recommend preloading with IV magnesium to decrease the risk of cisplatin nephrotoxicity?
Although there have been studies demonstrating that hypomagnesemia has been associated with an increased risk of AKI, there have been no clinical trials indicating preloading with mag prevents AKI. I would recommend to have the magnesium above 2mg/dl prior to cisplatin.
Do you routinely recommend loratadine for pegfilgrastim pain?
Despite its popularity, there is not good evidence that Loratadine improves bone pain from pegfilgrastim. There are small, uncontrolled studies that suggest a benefit, however a randomized trial of Loratadine vs. placebo did not show a difference between groups in bone pain or quality of life.
What are your top takeaways in Classical Hematology from ASH 2024?
In the category of continuing what I already do, ASH 2024 provided an important confirmatory study of how to approach the treatment of patients with high-risk venous thromboembolism (VTE).In the EINSTEIN CHOICE (Rivaroxaban) and the AMPLIFY-EXT (Apixaban) studies, extended reduced-dose anti-coagulat...
Do you recommend adjuvant radiotherapy for an adult patient with localized myxopapillary ependymoma, WHO Grade 2, status-post gross total resection?
I assumed that this is a case of spinal ependymoma. Myxopapillary ependymomas are rare tumors and optimal therapeutic strategy involves a Gross Total Resection (GTR). The more complete the surgery the better the outcome. The role of postoperative radiation after a GTR is somewhat controversial but I...
How do you decide between RPLND vs. chemotherapy in patients with Stage IIA mixed germ cell tumor as primary treatment?
I agree but would add a few comments: If there is a rising hCG or AFP above normal values, we prefer BEP X 3 rather than RPLND. If the patient > age 50, EP X 4. Also, we consider any AFP < 25 to be “ normal” despite many labs listing 0-8 as their normal range. Our group recently published data in J...
How would you approach the prevention of irinotecan-induced diarrhea in a patient who previously experienced a diffuse rash with cefixime?
Prevention of irinotecan-induced diarrhea commonly uses prophylactic oral cephalosporins such as cefixime or cefpodoxime, which suppress intestinal β-glucuronidase–producing bacteria that reactivate SN-38 glucuronide and drive delayed diarrhea [1]. In a patient with a prior diffuse rash to cefixime,...
For what patients/diagnoses do you currently use sodium thiosulfate to reduce the risk of cisplatin associated ototoxicity?
Sodium thiosulfate (STS) is approved in the US (FDA) and Europe (EMA) for the prevention of cisplatin-induced hearing loss (CIHL) in patients 1 month and older treated with cisplatin for any type of cancer. Although intravenous STS has not been subjected to a randomized clinical trial for patients >...
What is your approach to patients/parents seeking alternative or complementary treatment in pediatric oncology patients?
Establishing an open dialogue and collaborative partnership with patients and caregivers regarding complementary and alternative therapies is essential.A critical first step is to clearly distinguish between complementary and alternative medicine. These terms are frequently used interchangeably, yet...
For patients with microcytosis MCV 75-79 and normal Hb, low TIBC, and normal ferritin do you always rule out thalassemia?
Microcytosis is typical in thalassemia. With a normal ferritin and hemoglobin concentration, I would start screening by measuring HPLC, HbA2 levels that are high in beta-thalassemia carriers. (HbA2 can be normal with “mild” thalassemia alleles and for several other reasons.) Microcytosis without iro...