Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
Is dexrazoxane recommended for cardioprotection in AYA patients with Hodgkin lymphoma who are receiving anthracyclines as part of their upfront therapy?
This is a good question that reflects the growing body of evidence in favor of dexrazoxane cardioprotection being safe and beneficial (Chow et al., PMID 26014292; Getz et al., PMID 32343641). For AYAs with Hodgkin lymphoma, doxorubicin remains a key component of therapy even for lower stage disease ...
Can an AYA patient with newly diagnosed AML safely sperm bank after starting cytoreduction with hydroxyurea or cytarabine?
Thanks for the question. Unfortunately, there is not a lot of data available to answer this question with certainty. Because of that, I err on the side of saying that this should not be done. The concern lies with the possible impact on the sperm DNA, and the subsequent effect that might have on a p...
What is your response to the question, "Is this terminal?"
Thanks for this question, it's really important. This question comes up in two distinct scenarios: when a person is first diagnosed and when a person is nearing the end of her life. Let's talk about them in sequence. 1). At diagnosis: When a person is first diagnosed, this question is part of "getti...
How do you present the trade off between a small chance of a sustained response for a new drug at the expense of potential worsening quality of life?
Since we now have an increasing number of treatments at our disposal, this becomes an ever more frequent conversation in oncology. This question gets at several Shared Decision Making (SDM) model steps. Usually in this scenario, there are not routine standard of care options and highlighting the pat...
Do you use specific scalp dosimetry constraints to prevent chronic alopecia when treating partial brain volumes with VMAT?
I have been using VMAT for 8 years to treat brain tumors, and permanent alopecia is rarely a complication in patients treated with doses of >50 Gy. For that reason, I personally do not use a scalp OAR constraint when planning a course of partial brain radiation. Prior to the adoption of VMAT, the oc...
Would you recommend anticoagulation prophylaxis for a pediatric patient admitted with COVID-19?
COVID-19 disease in children seems to be less severe than adults based on the current literature and our personal experience at Children's Hospitals. Among adults, the coagulopathy is beginning to be described with elevated inflammatory markers and other markers of coagulation activation, including ...
How should dose homogeneity across bone be handled in pediatric patients?
The radiation-associated bone damage can be affected by many factors, including total radiation dose, fractionation schedule, treatment volume, age of the child, symmetry of the delivered dose over vertebrae, developmental status of the irradiated growth plates, treatments such as chemotherapy or su...
What is your approach to optimizing pre-operative hemoglobin in patients with sickle cell disease?
This is always a question that has to be hyper-individualized. The research, and therefore the associated professional guidance, is thin. The American Society of Hematology (ASH) 2020 Guidelines for Sickle Cell Disease: Transfusion Support and the NHLBI Expert Panel Report (2014) are the only profes...
How do you counsel families of prepubertal girls with an oncologic diagnosis about cryopreservation of ovarian tissue?
One of the biggest current issues with ovarian cryopreservation (OTC) in the US is that there is no consensus yet about who should receive OTC, and practice varies across the country. In addition, many patients are diagnosed and treated at centers that do not have oncofertility programs and do not o...
Do you offer IV iron first line to women with iron deficiency anemia from heavy menstrual bleeding?
I offer first-line IV iron because oral iron cannot keep up with the losses from heavy menstrual bleeding, and the majority can't tolerate it. I routinely give a gram of LMW iron dextran in one hour, Feraheme (not ferumoxytol generic) 1,020 mg in 30 minutes, or ferric derisomaltose 1 gram in 30 minu...