Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
How would you approach patients with primary cardiac sarcomas for adjuvant systemic treatment?
Majority of these primary cardiac sarcomas tend to be angiosarcomas or UPS-variants. They inherently have a poor prognosis with high risk of metastases and death. Adjuvant XRT is generally difficult in this location. These also generally affect young individuals with o/w good PS/organ function. So w...
How would you work up and manage persistent lymphopenia in an asymptomatic patient?
Simple answer: refer to an immunologist, as this degree of lymphopenia is quite likely to represent a serious immunodeficiency. I would also send a next generation sequencing panel of immunodeficiency/immunoregulatory genes to be in process while awaiting the immunology consultation. Long answer (fr...
What are best practices for oncologists during the national platinum shortage?
In breast cancer, we are prioritizing patients with curable disease in which platinum agents are a critical part of the regimen or have actually shown a clear advantage (the only example of this is shown below in bold).Use an alternative to a carboplatin-based regimen whenever possible. If no altern...
Do you screen adults in your practice with sickle cell disease for silent cerebral infarcts?
The details of the ASH guidelines regarding adults are complex. It was not my practice to screen all patients. More than 50% of adults have silent infarction. Screening requires MRI and this, according to the guidelines, needs careful attention to many details before it is reliable. There are no pro...
Do you give post-operative radiation to Ewing sarcoma if there is poor histologic response to neoadjuvant therapy in a completely resected tumor?
US Ewing studies conducted through COG have used histologic response in more recent protocols to play a key role in how margins are assessed, such that patients with >90% necrosis and inflammatory or coagulative necrosis at the margin require RT, while those with bland scar or fibrous tissue do not....
What is your follow up schedule after completion of RT for pediatric rhabdomyosarcoma?
Imaging surveillance is an interesting and yet complicated issue. If a child is enrolled upon a prospective randomized trial for which informed consent has been given, then every effort should be made to follow the protocol guidelines, which are designed to answer a protocol question. However, patie...
Would you recommend prophylactic retro-peritoneal RT in an adolescent with paratesticular rhabdomyosarcoma, s/p radical inguinal orchiectomy without a lymph node dissection?
Ideally, in children over 10 years of age with a diagnosis of paratesticular RMS, a retroperitoneal LN sampling (taking 7-12 LNs) at diagnosis should be performed unless obvious gross disease in the nodal region is present. The risk of occult LN involvement is higher in those children 10 years or ol...
For patients on immune checkpoint inhibitors presenting with chest pain, dyspnea, fatigue, and troponin elevation, would you recommend early initiation of high dose steroids for empiric treatment of ICI myocarditis while pursuing workup with coronary angiogram, echocardiogram, and/or cardiac MRI, or wait until alternative etiologies have been ruled out?
This question raises an important point that the clinical presentation of ICI-associated myocarditis often overlaps with other cardiovascular disorders, including acute coronary syndrome, chronic CAD, congestive heart failure, and other nonischemic cardiomyopathies. Therefore, prompt initiation of w...
How do you manage patients blood pressures while on anti-angiogenic TKIs?
Advise patients to take BP daily, and inform us if the BP is high.
Should all patients with a remote history of immunotherapy, chemotherapy and/or radiation therapy have a baseline TTE regardless of ASCVD risk?
The current ASCVD risk assessment calculators we have available do not contain cancer-specific parameters and thus are inadequate for accurate assessment of a cancer survivor's risk of developing CHF and ischemic heart disease. If patients have received mediastinal radiation therapy or high-dose ant...