Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
Would you offer adjuvant radiation therapy in a young adult with NF1 who has a craniopharyngioma s/p STR?
In NF1 patients, radiation therapy for craniopharyngioma has been associated with vascular damage and Moya Moya syndrome. On the other hand, subtotally resected craniopharyngiomas have a high chance of recurrence. It has been shown that, dosimetrically, intensity-modulated proton therapy (IMPT) coul...
How do you approach anti-seizure medication management when it was started by another team for a seizure-naive patient before/after craniotomy for a tumor?
I would refer you to Dr. @Dr. First Last's answer to a similar question (https://www.themednet.org/question/15031) which beautifully summarizes data and guidelines. I usually counsel patients that everyone regardless of their medical history has a certain risk of seizure under physical stressors, th...
How do you approach patients with neonatal intrapericardial germ cell tumor, as compared to other patients with mediastinal germ cell tumors?
I need help too!! I have a patient in their teens with recurrent mediastinal GCT. Failed standard therapy radiation HD therapy/stem cell... but never tried immunotherapy, anti-angiogenesis, or TKI. Does anyone have experience with CPI in combination with Lenvatinib??
How do you manage insomnia in cancer patients that is refractory to traditional sleep aides?
Insomnia and other sleep disturbances are very common in individuals diagnosed with cancer, and it is often helpful for patients to hear this. A good history of other contributors to sleep disturbance can be helpful as well. Often, depression, anxiety, and pain, as well as other stimulant medication...
How do you incorporate blinatumomab into therapy for a pediatric or AYA patient with isolated CNS relapse of B-ALL, if at all?
I try to prioritize CAR-T in this setting. Getting there depends on logistics such as financial clearance/collection though. If late relapse or if there is a delay in getting CAR-T, would treat with AALL1331 Arm D (with XRT in mtn), substituting block 3 of blina for block 3 on Arm C (to get more CNS...
What antibiotic, antifungal and antiviral prophylaxis you give post CAR-T therapy, and what is the duration?
This is a critical issue as more patients are being treated with CAR-T cell therapy. My approach would be as follows: Antiviral PPx: I usually consider acyclovir PPx for at least 1 year Antifungal PPx: Consider fluconazole PPx for initial neutropenia if it is prolonged beyond a week ---> once the c...
For von Willebrand type 2B, do you expect a decline in platelet count over time as vWF increases with age?
Von Willebrand factor levels increase with age in normal people and in those with type 1 VWD. There is no or a much lesser degree of VWF rise in variants type 2 and 3. I would not expect a significant decrease in the platelet count in a patient with type 2B with increasing age, but if it occurred, ...
For a pediatric patient with B-ALL who requires surgery during maintenance, what therapy modifications do you recommend to allow for optimal healing and minimal treatment disruption?
If the patient has a history of stable ANC and platelet count while on mercaptopurine and methotrexate, no change in treatment is necessary. For a patient with unpredictable fluctuations in ANC and platelet count while on mercaptopurine and methotrexate, I recommend stopping oral antimetabolites two...
At what ferritin threshold would a patient with anemia of inflammation or malignancy no longer benefit from iron supplementation for functional iron deficiency?
There is no level. I have given IV iron to people with low TSATs and ferritins in the thousands. 200 isn't even close to too high.
How do you manage AEDs in patients with malignant brain tumors?
Use of prophylactic anti-seizure drugs in patients with primary malignant brain tumors is not recommended and has been evaluated in multiple systematic reviews and guidelines including a recent systematic review and well-done guideline paper from SNO and EANO published by Tobias Walbert, Elizabeth G...