Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
What, if any, cardioprotective measures beyond dexrazoxane may be used to minimize cardiac risk during or after chemo- or radio-therapy?
For cardioprotection, I would recommend: Baseline cardiovascular risk stratification, can use the HFA-ICOS risk calculator (https://www.cancercalc.com/hfa-icos_cardio_oncology_risk_assessment.php), consider alternative chemotherapies if very high risk and alternative therapy equal efficacy. Optimiz...
What infections should we rule out in patients who develop diarrhea on immunotherapy?
Immunotherapy is known to be associated with immune-mediated diarrhea and colitis (IMDC). However, it remains unclear whether cancer patients undergoing immunotherapy are at a heightened risk for Clostridioides difficile colitis infection (CDI). A retrospective study focusing on patients treated wit...
What techniques do you use to address fertility preservation in young female patients being treated with chemoradiation therapy for cancer in the pelvis?
The most important aspect of a fertility preservation strategy is to think of it early on in the discussions with your patient. Many medical centers now have a clinic or center to which patients can be referred and seen within several days. They are experts at explaining the options and outcomes wit...
In pure red cell aplasia, does peripheral blood-positive IgG for parvovirus have significance if persistently positive on retesting, but IgM and PCR are negative?
It is unlikely to be related; IgG will reflect past infection. The IgM is more reliable. I would treat this as autoimmune or idiopathic PRCA.
In what situations do you use G-CSF for patients undergoing allogeneic HSCT to facilitate engraftment?
A word of caution regarding the use of G-CSF in the setting of using ATG for GVHD prophylaxis. We published in 2021 (Orfali et al., PMID 34507002) a multicenter retrospective analysis of the interaction between ATG and post-transplantation G-CSF on allogeneic HCT outcomes for myeloid malignancies an...
What systemic therapy would you offer a patient with metastatic melanoma who is BRAF WT and developed metastases while on adjuvant nivolumab?
Adding an anti-CTLA4 agent after progression on anti-PD1 (even in the adjuvant setting) should be a reasonable choice for patients who are ineligible for clinical trials. In our practice, we recommend using the CheckMate 067 dose (Ipi 3 and Nivo 1) when faced with such a situation. Zimmer et al., PM...
In what situations do you utilize G-CSF in germ cell tumors or Hodgkin lymphoma patients receiving bleomycin?
Having been both a lymphoma doctor and germ cell tumor doctor, I can tell you our experience. The current standard for poor risk germ cell tumors is to routinely include G-CSF with BEP X 4 and VIP X 4 in most high volume centers. A number of experts include growth factors routinely in good risk pati...
How do you approach very treatment-refractory ITP?
Severely refractory ITP doesn't account for a large fraction of ITP patients, but it can be quite a challenge for treaters and patients alike. Combination therapies, varied immunosuppressive agents, and careful checks on adherence are all helpful. Some alternative agents with entirely different mech...
How do you utilize cytokine panels in your clinical practice?
It's become easier to order cytokine panels that get processed locally in my hospital. However, I think we're still far from knowing how to interpret these or make clinical changes as a result. While it's tempting to think, "If TNF is elevated, I will give the patient a TNF inhibitor, which will mak...
How do you approach patients with lymph node positive osteosarcoma of the extremities for neoadjuvant chemotherapy?
The treatment for such patients is still the same as for any osteosarcoma. However, I would approach such patients with a mindset of dealing with metastatic disease. The fact that the lymph nodes are positive for osteosarcoma fortels of a poor prognosis (as it makes this a metastatic disease). In ad...