Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
Are there any unique considerations for treating pediatric high grade glioma?
Trial availability, disease extent, age, specific molecular alterations, and family history should likely all play a role in choosing the most appropriate treatment paradigm.It’s expected that most future studies in pediatric high grade glioma will be stratified by their nascent biology, given that ...
When do you consider testing with stroke gene panels in young stroke patients?
Broadly, I ask for genetic testing only when I have a specific diagnosis in mind. This testing is not routine in my practice. Examples are: A patient is referred for white matter lesions found on brain MR and a transient neurological episode. The question of CADASIL(NOTCH-3) or related disorders is...
Is there any benefit of using aspirin to mitigate VTE risk in testosterone-induced polycythemia?
Erythrocytosis is a common adverse effect of testosterone therapy, and results from several studies suggest an association between elevated hematocrit (Hct) and risk of VTE (Braekkan et al., PMID 19833630; Ory et al., PMID 35050717). There is currently no data to support the routine use of aspirin o...
What is your approach to an infant (<12 mo) with new onset petechiae and thrombocytopenia, with labs consistent with ITP?
In an older (1-6 year old) child with apparent ITP, less work up might be needed. While many tests are possible, in this case, labs consistent with ITP, I would interpret as including a CBC otherwise normal for age without blasts on a smear (if this is not true, the differential is much wider). If i...
Do you recommend salvage radiation therapy to limited recurrent Ewing's sarcoma bony lesions?
Depending on the age of the patient, size, and location of the tumor, SBRT is often an attractive option for re-irradiation for a limited volume recurrence from Ewing sarcoma that failed to respond to prior conventional treatment. There is data from Mayo Clinic (Brown et al., PMID 25548538) and MSK ...
What adverse events would make you switch off nivo + AVD therapy and to what second line therapy in patients with Hodgkin Lymphoma?
The question of how to handle severe IRAEs when using the N+AVD regimen is an important one. First, of course, is to hold CPI therapy, empirically treat as indicated to avoid ongoing or worsening organ injury, and concurrently ensure that there is no other cause for the observed event(s). But if you...
How do you consider SBRT relative to other emerging therapies for pediatric sarcomas, such as proton therapy or immunotherapy, in terms of efficacy and safety?
Treatment paradigms for pediatric malignancies have evolved through group trials over the past 5 decades, both in the US (e.g., COG) and abroad (SIOP). Sequential improvements have been made over the years to the quality of radiation for both pediatric and young adults, a population at risk for majo...
What is your recommended long term management of extensive dural venous sinus thrombosis in an otherwise healthy young patient?
From a Vascular Neurology perspective, there are two considerations when faced with patients with venous sinus thrombosis. First is the status of the intracranial venous circulation and whether or not there has been adequate reconstitution of venous outflow, either through recanalization or collater...
Do you use direct oral anticoagulants to treat port-a-cath related VTE in patients with an active malignancy?
The initial trials that established DOACs as effective and safe in most patients with cancer-associated thrombosis (Agnelli et al., PMID 32223112, Planquette et al., PMID 34627853) only included patients with lower-extremity DVT or PE but clearly showed equivalence to low-molecular weight heparin (w...
Do you screen for VWD in all women with menorrhagia severe enough to cause iron deficiency anemia?
Yes, testing vWF is needed in this situation of severe menometrorrhagia. Excessive menstrual bleeding, especially when severe enough to cause anemia, is a common presenting symptom of vWD in women. The testing should be done as part of a comprehensive workup for gynecologic etiologies and other coag...