Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
Do you use G-CSF for a patient with ALL admitted for febrile neutropenia with prolonged count recovery?
I agree with this response. To highlight one other consideration: G-CSF is not routinely given during COG-based, pediatric-inspired therapy like the C10403 regimen (Stock et al., PMID 30658992). However, when patients treated with this approach in our system develop neutropenic fever, we will usuall...
In pediatric patients with newly diagnosed B-cell ALL and underlying Lynch syndrome, how does the MMR deficiency inform your treatment planning and survivorship surveillance?
Treat B-cell ALL with chemotherapy appropriate for risk category and usual follow-up. MRI Brain Q 6 months up to age 20, then annually Colonoscopy annually starting at age 6 years Upper endoscopy at age 10 years and annually Whole body low dose MRI annually Physical examination and skin exam every ...
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...
How do you approach chemotherapy-induced thrombocytopenia in patients who do not respond adequately to romiplostim?
That's definitely a difficult and highly nuanced clinical scenario, especially since it can hamper future delivery of chemotherapy and compromise disease outcomes. My approach to this question also depends on whether we are talking about patients with a hematologic or solid tumor malignancy. I will ...
Based on results of the PINES trial, have you shifted your practice to start treatment for newly diagnosed pediatric ITP with eltrombopag?
I would answer this, "yes and no." As many readers will already know, the PINES trial (Shimano et al., PMID 41123939) was a randomized trial of pediatric patients, between eltrombopag and standard care, in a 2:1 ratio, in newly diagnosed ITP and non-severe bleeding, who required pharmacologic therap...
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...
Is there a role for nitazoxanide for treatment of norovirus gastroenteritis in immunocompromised patients?
There is no good-quality evidence supporting a role for nitazoxanide for treatment of norovirus gastroenteritis in immunocompromised patients. The efficacy of nitazoxanide in viral gastroenteritis is supported by a small manufacturer-sponsored randomized, double-blind trial in non-immunocompromised ...
What is your approach to iron supplementation when ferritin levels remain stagnant despite reported good compliance?
This is a really good question. From my reading of the literature, there seems to be an association between a low ferritin level and restless legs syndrome. Not true iron deficiency as defined by a low transferrin saturation, anemia, or a low MCV. I could not find any definitive evidence for a cause...
Do you routinely evaluate patients with collagen disorders or Ehlers-Danlos for platelet defects?
Yes, I routinely carry out a full hemostasis evaluation, including platelet aggregation and release studies, in patients referred to me with easy bruising and hypermobility with an increased Beighton score suggesting EDS and in those already diagnosed genetically with EDS. EDS patients typically hav...
Is there any consensus or guidance on how to manage germ cell tumor patients in the COVID-19 era?
Germ Cell Tumor Management in face of SARS-CoV-2: Safe, Rational Modifications to Standard GCT Practice to Protect Public Health, GCT Outcomes, GCT Patients, and Health Systems. This bulletin has been produced by a concerned group of international experts in germ cell tumors, has not undergone exten...