Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
How do you counsel patients with elevated factor VIII levels for their thrombosis risk?
I don't check the factor VIII level as part of a thrombosis workup because the result rarely if ever affects my management of these patients. I would explain to the patient that factor VIII levels are a function of several variables, including age, vascular health (and hence blood pressure, smoking,...
How do you decide between HSCT and immunosuppressive therapy for treating hepatitis associated aplastic anemia?
For young people with a donor, the primary therapy is transplantation. It is curative in the vast majority of patients, hepatitis-associated AA is much less likely to respond to immunotherapy.
How would you approach post-operative VTE prophylaxis for renal transplant in patients with a prior history of provoked VTE?
I am not aware of published systematic reviews, risk models, or evidence-based guidelines for post-operative prophylaxis in renal transplant patients. Given both increased risk for VTE and bleeding, it is not surprising that there is a large variation in practice (for relatively recent survey on t...
For patients diagnosed with T-cell lymphoblastic lymphoma with CNS involvement (CSF), what is your approach to the typical schedule for IT chemotherapy?
In general, the schedule of IT chemotherapy is dictated by the systemic chemotherapy regimen chosen. For example, with a pediatric-inspired regimen like C10403, those with CNS involvement receive more LPs during the Remission Induction course. For hyperCVAD, the historical approach has been to give ...
How would you treat a patient with Hodgkin lymphoma who has an isolated relapse within the CNS?
It's challenging to offer specific advice in this situation without knowing a lot more. First, it's important to recognize that CNS involvement by classical Hodgkin lymphoma is extremely rare and strictly requires a brain biopsy to make a diagnosis (even in a patient with active systemic CHL, a seco...
Would you treat with AZA + venetoclax to achieve CR2 before proceeding to allogeneic stem cell transplant in a young, fit patient with favorable risk AML who relapsed within a year after 7+3 and HIDAC consolidation?
It would be important to know what type of "favorable risk" AML the patients had and also what the current NGS shows. I would wait on NGS results to return to see what the options are first in targeted therapies a potential option. If the patient had Core Binding Factor (CBF) AML, a high dose cytara...
What special considerations do you take when treating cancer patients with severe intellectual disabilities?
Caring for patients with any type of disability is both a privilege and a challenge. Severe intellectual disability poses additional challenges due to logistical, ethical, and moral dilemmas. Additional factors including patients' socioeconomic status, support system, language spoken to individuals ...
What are common indications for ordering NGS of peripheral blood?
I am delighted that someone posed this question because, in my experience as a consultant hematologist, it appears that advances in DNA sequencing technology have outstripped the knowledge base of many practitioners. This is not due to lack of interest or due diligence on their part, but rather beca...
Would you change therapy for a CML patient in hematologic remission on imatinib found with positive qualitative BCR-ABL1 for the p230 protein?
It would depend on how long the patient has been on imatinib and the sensitivity of PCR testing. Being able to monitor the p230 transcript at the level of 0.1% or even deeper would be helpful to characterize if the patient has achieved a major molecular response or not. This publication outlines the...
Are you including Bortezomib as standard of care in the upfront treatment of T lymphoblastic-lymphoma?
We do use bortezomib in the upfront treatment of T-cell lymphoblastic lymphoma in children and AYA. For those familiar with the topic, the results of two successive large clinical trials in T-LLy done by COG, AALL0434, and AALL1231, were confusing. Due to the rarity of the disease, overlapping trial...