Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
Would use of proton radiation versus photon radiation in neuroblastoma patients post autologous stem cell transplant reduce the risk of transplant associated-TMA?
Transplant-Associated Thrombotic Microangiopathy arises partially due to injury to the endothelium; it is one of the “endothelial injury complications” of hematopoietic stem cell transplantation (HSCT), along with veno-occlusive disease (VOD) and engraftment syndrome (ES), among others. There is a w...
Does your evaluation of a young person with spontaneous upper extremity DVT vary as compared to lower extremity DVT?
The workup for a young adult with an upper extremity DVT differs for me in two ways: Venous thoracic outlet syndrome must be suspected and a careful history of repetitive overhead movements must be obtained. Consulting your vascular surgery team in these cases to ensure the anatomy does not put the...
When would you initiate exchange transfusion in babesiosis and significant hemolysis?
There are no studies that answer this question. Some people have extrapolated from the use of exchange transfusions for severe malaria to consider using this treatment with babesiosis, another intraerythrocytic protozoan infection. Unfortunately, though there are some studies on malaria, the results...
Does IVIG or subcutaneous Ig interfere with monoclonal antibody therapy (i.e. dupilumab, infliximab, rituximab, etc)?
I definitely agree with Dr. @Dr. First Last concerns. For what it’s worth, I use a lot of IVIG in combination with monoclonal medications in my myositis clinic, and have anecdotally noted multiple instances in which I feel that the efficacy of one of those monoclonals seems to have been worse when t...
What workup do you consider for a developmentally typical child with multiple large café au lait macules but no other signs of neurofibromatosis?
The likelihood that this is NF1 depends somewhat in part on the age of the child in question. In infants and toddlers, cafe-au-lait macules are usually the first and only clinical sign of NF1. Most children with NF1 will develop skin fold freckling in early childhood, and the majority (probably 60-7...
How would you counsel a female to male transgender patient regarding VTE risk with testosterone therapy, who has additional mild-moderate risk factors for thrombosis?
If physiologic concentrations of testosterone are not exceeded and the hematocrit is monitored to avoid a pathologic level of erythrocytosis, the risk for thrombosis from testosterone GAHT does not appear to in excess of the general population. I would refer you to the following two articles that pr...
How would you evaluate a pediatric patient referred to rule out cancer due to an isolated significantly elevated vitamin B12 level?
Do you recommend giving anti-complement therapy to a patient with approximately 20% PNH clones who has severe aplastic anemia but no other risks for thrombosis or hemolysis?
Depends on the age, the extent of hemolysis, dynamics of PNH clone over time, marrow findings and HSCT donor availability, and also if the patient responds to IST. If the patient has poor response to IST, good donor availability, and no severe hemolysis, I would go straight to transplant. If this i...
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...