Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
What therapy would you consider for refractory pediatric HR AML with KMT2Ar to try to induce remission for transplant?
For any case of refractory AML regardless of the cytogenetics, we turn to regimens used in the relapse setting. Nowadays common choices are based on fludarabine/cytarabine (FLA), CPX-351, and/or venetoclax. For this patient, I would focus on FLA and venetoclax-based regimens. To take advantage of th...
How would you counsel a young female patient who refuses to use contraception during radiotherapy?
A woman who refuses contraception needs careful psychological and psychiatric assessment and considerable time at the time of consultation to understand why she is refusing, especially since this response is neither rational nor logical. The practitioner needs to take the time to discuss the patient...
For patients with Stage IIIB or IV HD flowing Bv-AVEPC with initial large mediastinal adenopathy, how can we avoid ISRT?
It is true that on the clinical trial AHOD1331, patients who presented with large mediastinal adenopathy received radiation therapy as did patients who were slow early responders (Deauville 4 or 5 after two cycles of therapy). It is noteworthy that 3-year event-free survival was extremely high for a...
What experience have you had with familial clustering of polycythemia vera?
JAK2 V617F is a somatic mutation that can be acquired as early as in utero based on elegant work by Williams et al., PMID 35058638.There is some data available regarding familial MPN predisposition syndromes and this review very nicely summarizes much of the available data (Lim et al., PMID 39316992...
Would you consider combining tovorafenib and trametinib as dual therapy?
A phase 1/2 study of tovorafenib and the MEK inhibitor selumetinib is planned through the Developmental Therapeutics Committee of the Children's Oncology Group for low-grade gliomas that have failed appropriate prior MAPK blocking therapy and other patients with BRAF/RAF1, RAS, and NF driven maligna...
What is the current opinion on G-CSF usage for AML patients during induction and consolidation phases of treatment?
I agree with you that the use of G-CSF for AML patients is still controversial. There are two reasons for using G-CSF for patients with AML. One is to sensitize, or “prime,” the leukemia by driving quiescent blasts into cell cycle and by mobilizing blasts out of their protective niches and into the ...
How do you counsel patients with locally advanced malignancies who have ECOG 3-4?
I agree with @Dr. First Last and @Dr. First Last's comments about the implications of PS and specific situations where medical therapies have the potential to improve PS (heme malignancies small cell) and/or extend quality of life. I have two goals in this conversation. To make sure I understand the...
What is your strategy for breakthrough chemotherapy induced N&V in patients receiving highly emetogenic chemotherapy and already received a NK-1 antagonist, 5-HT3 antagonist, dexamethasone, and olanzapine?
I find the MASCC anti-emetic guidelines to be very well written Davis et al., PMID 34398289.Very few randomized clinical trials in cancer for antiemetics (with positive trials associated with metoclopramide (D2 receptor antagonist) and olanzapine).So - most are based on trial and error + clinician p...
Do you routinely check Pulmonary function testing prior to each cycle of BEP for young patients with testicular cancer with no pulmonary risk factors?
A few comments: I do not check DLCO or PFTs in general in patients under age 50 getting just 3 courses of BEP. We tend to avoid bleo if over age 50. If a patient is getting 12 weeks of bleo, I check DLCO just prior to the start of the 4th course, and if DLCO < 60%, I give VIP for the 4th course. Ad...
How do you treat factor XI deficient patients with surgery or trauma related bleeding?
Given the risk of elevated plasminogen with low FXI, prefer FFP, with fibrinolytic if mucosal bleeding.