Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
How do you manage incidentally identified pituitary lesions on brain imaging?
Pituitary lesions are among the most common incidentalomas seen on brain MRIs. Various studies cite numbers as high as 10- >30% for pituitary lesions found incidentally on brain imaging, with the higher incidence rates emerging in the era of high-resolution MRIs. In pediatric neurology/neuro-oncolog...
Under what circumstances would you consider omitting radiation in patients with early stage, unfavorable (bulky) Hodgkin Lymphoma?
We should first acknowledge that combined modality therapy improves progression-free survival in early-stage HL compared with chemotherapy alone. Stated more succinctly- if you give combined modality therapy, there is a lower risk of relapse; if you give chemotherapy alone, there is a higher risk of...
What is your strategy for optimizing hydroxyurea dosage in patients with symptomatic sickle cell disease, particularly for genotypes HbSS and HbS/Beta thal?
I am far, far more worried about underdosing than overdosing. Although HgF is the traditional lab parameter, it may not go up in all patients. I also look for a decrease in reticulocytes, LDH, indirect bili (less hemolysis), less inflammation (WBC and platelets), and a lowering of MCHC (i.e., fewer ...
How would you approach an adolescent patient with stage IIIC serous borderline tumor, s/p fertility sparing surgical staging with unilateral salpingo-oophorectromy, who presents with an enlarging contralateral ovarian mass and additional pelvic disease on imaging?
I would attempt cystectomy and debulking of pelvic disease. If ovarian salvage is not possible, then I would prioritize saving the uterus. If final pathology continued to show borderline tumor, then I would observe. If low-grade serous or high grade serous on final pathology, then I would treat with...
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...