Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
What is your preferred conditioning regimen for fit patients with high-risk MDS undergoing MUD allogeneic stem cell transplantation?
The short answer is whatever MAC regimen you and your center are familiar with and comfortable managing the side effects. I would definitely think of a myeloablative regimen rather than a reduced intensity one. For HLA-matched donor, I usually give MAC Bu4Flu with Bu PK to tailor the Bu dose. The BM...
How do you monitor risk of erythrocytosis from testosterone use for female to male transgender patients?
I utilize the Endocrine Society's guidelines for identifying secondary erythrocytosis secondary to gender affirming hormone therapy (GAHT) (PMID 28945902). For initial monitoring, at baseline and then every 3 month hematocrit for the first year and 1-2 times yearly thereafter is typically implemente...
How do you approach and manage anorexia and appetite loss in people with advanced cancer?
Anorexia/cachexia is often distressing to patients and families and it is this distress that is the target of many of the interventions for this syndrome as there are, in general, no effective therapies. Patients and families are routinely battling over the lack of eating as this causes further disc...
How would you approach treatment in a patient with Fanconi anemia and glioblastoma?
This is challenging due to the sensitivity of Fanconi anemia patients to DNA-damaging treatment. I would maximize resection if possible and then treat with radiation, since it is a mainstay of therapy, despite the risk. I would opt for proton radiation if possible to minimize exposure of normal tiss...
Would you recommend prophylactic cranial irradiation (PCI) for a teenager with a T cell acute lymphoblastic leukemia in remission?
No—modern systemic and CNS directed therapy is sufficient to mitigate the historic higher risk of CNS relapse (Vora et al., JCO 2016). While there is still a small risk of cranial relapse with modern systemic therapy, the improved success of response and risk adapted strategies utilizing varying deg...
How should patients be selected for metastatic-site directed radiotherapy in rhabdomyosarcoma?
Definitive therapy to sites of metastases at the time of diagnosis is recommended for all patients with metastatic disease on the most recent COG trials (both ARST1431 including intermediate risk patients and ARST0431 including high risk patients). We typically treat the metastatic sites at the end ...
Do you typically see peripheral neuropathy in patients with castleman syndrome?
Castleman's is a rare disorder. It has been associated with POEMS in which severe neuropathy is part of the syndrome, but is not as common an association as myeloma. But neurologists only see the patients who have neurologic symptoms. My brief look at review articles on Castleman's suggests that POE...
What is the role of local control +/- whole lung irradiation in a patient with relapsed/refractory Ewing sarcoma to the hilum plus multiple lung nodules?
I would boost residual thoracic disease to at least the usual Ewings gross disease dose of 55.8 (total, including WLI dose). Doses in this range are well known to be safe in the thorax and this multiply relapsed disease is likely to be more treatment refractory than primary disease. SBRT boost seems...
How common are nasal telangiectasia in patients with systemic sclerosis?
Telangiectasias, particularly “matted’’ ones are often seen in patients with Systemic sclerosis (SSc), both limited and diffuse cutaneous. They can also be seen in patients with MCTD, UCTD with SSc features, Lupus or Dermatomyositis (often periungual). In SSc, they are most commonly on the face and ...
How would you approach a low to moderate titer of one of the APLS antibodies in a patient with a strong family history but no personal history of thrombosis?
I do not do anything as there are no data to support intervention in this case.