Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
What radiation dose constraints should be used for the spinal cord in pediatrics?
As part of the PENTEC project (Constine et al., PMID 37999712), I had the privilege of finding all of the cases of pediatric radiation myelitis in the literature. This is modified from our published findings, I encourage you to read the full manuscript if you would like further details (Cooper et al...
What is your approach to treatment of infection-triggered HLH that does not respond to treatment of the underlying infection?
The algorithm our center follows is to Recognize hyperinflammation (see answer to question above -- in addition to baseline labs, we obtain an infectious disease consult) Look for and treat the trigger. A concern, if the patient is responding, is that we are missing a trigger (HLH does not occur sp...
Is there a concern for the potential of future congenital malformations in offspring when preservation of eggs and sperm is done AFTER cyclophosphamide treatment given that it is an alkylating agent?
No, there is not a significant risk of congenital malformations in embryos created with cryopreserved gametes or unassisted pregnancies AFTER cyclophosphamide use. While alkylating agents lead to both male and female infertility, congenital malformations from cyclophosphamide occur when conception h...
Is there an age cut off below you would not treat a keloid with radiation post surgical excision?
While radiotherapy is considered an extremely useful modality in the treatment of recurrent keloids in the adult population, most would contend that the risks do not justify the application of adjuvant radiotherapy in the pediatric population (PMID: 10703484) for a benign condition when other modali...
Can defibrotide be given safely for VOD in patients with refractory thrombocytopenia to platelet transfusions?
The short answer is "yes."The slightly longer answer is: “Yes, and in patients with veno-occlusive disease (VOD), the use of defibrotide is potentially life-saving (Richardson et al., PMID 26825712).” In the cited study, which led to its FDA approval for this indication, there was no significant dif...
What is the utility of granulocyte infusions in patients with neutropenia and severe infection?
Granulocyte transfusion is infrequently used for septic neutropenic patients given that the randomized trial (RING) that looked at this question did not show improved outcomes (with the caveat that the trial did not finish accrual (Price et al., PMID 26333778). Having said that, the criteria to cons...
What is your practice regarding giving G-CSF to patients with ALL during initial induction?
My colleagues and I do not use G-CSF in either ALL or AML unless the neutropenia is unusual and prolonged and associated with infection. The use of G-CSF has been shown to shorten neutropenia by a few days but does not prevent the drop and theoretically, at least it may prolong thrombocytopenia by p...
When would you consider radiation therapy for an optic pathway glioma in a pediatric patient?
Only if all previous lines of chemotherapy or targeted agents have been exhausted or failed.
How do you address logistic barriers related to blinatumomab when treating relapsed B-ALL?
This is a very challenging issue that speaks to an incredibly important aspect of delivering not only this drug but others like it. Despite the strong evidence that supports the use of blinatumomab in a variety of clinical scenarios for patients with B-cell ALL [e.g., Gökbuget et al., PMID 29358182;...
How would you treat a stage IIIB recurrent seminoma with early recurrence following first-line treatment with VIP?
If one is faced with recurrent stage IIIB seminoma, I recommend the following: Confirm the diagnosis and prior Rx - review initial pathology, staging, and dose/ intensity of Rx. Sometimes, another clinician has treated the wrong entity - where review shows that it was initially a nonseminomatous ge...