Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
What are your indications for radiotherapy in children with pleomorphic xanthoastrocytoma?
Pleomorphic Xanthoastrocytoma is unique among other pediatric low grade gliomas in that it there is a high frequency of targetable alterations including BRAF V600E alterations and that there appears to be an increased risk of transformation relative to other pediatric low grade glioma histologies (P...
Would you offer whole abdominal irradiation to a pelvic recurrence of rhabdomyosarcoma with tumor rupture / spillage?
I would be less inclined to use a large field / volume approach like whole abdominal RT in the setting of recurrent disease. While I don't know if prior RT was delivered or not, the outcome for children with a pelvic recurrence (especially is a local recurrence) is overall very poor with only 20-30%...
How would you manage a recurrent pineoblastoma following prior CSI?
Recurrent pineoblastoma following prior CSI represents a challenging clinical scenario. As there is very little published data to guide optimal management, our approach is adopted from recurrent medulloblastoma. The prognosis for patients with recurrent medulloblastoma/PNET is poor, with 5-year OS <...
What are the options of induction treatment of young AML patients who are on CRRT, continuous renal replacement therapy ?
Hypomethylating agent like decitabine and venetoclax will be good options. C1 decitabine for 10 days and venetoclax for 28 days. Then C2 decitabine for 5 days and venetoclax every 28 days. Bone marrow biopsy should be done on day 21. There is, however, no strong literature support regarding pharmaco...
What are indications for RT coverage of pleural cavity for margin positive resected Askin tumor after neoadjuvant chemotherapy?
Patients with malignant pleural effusion, pleural violation (2/2 chest tube placement through tumor) or pleural nodules at diagnosis should be considered for whole-pleural surface RT at the time of local RT to the chest wall. Of note, patients w/out + margins would also be considered for whole pleu...
How does the management of nasopharyngeal cancer in kids/young adults differ from adult patients?
The approach for managing pediatric patients with NPC has generally followed the recently published COG trial, at least in the United States. This approach uses induction chemotherapy with CDDP/5FU, followed by chemoradiation for the higher risk patients. Lower risk patients—Stage I/IIa or T2N0—can ...
Do you use hippocampal avoidance techniques when delivering PCI for high-risk leukemia?
I do not recommend hippocampal sparing cranial irradiation in leukemia patients. Unlike patients with solid malignancies, CNS failure in hematologic malignancies often involve eloquent areas like thalamus, hippocampus, hypothalamus, posterior chamber of the globe and the CSF. So these patients reall...
Do you have preferred regimens for young patients (<30 y/o) with early stage DLBCL?
For patients with early-stage, non-bulky disease, 3 cycles of R-CHOP + ISRT (30 Gy) provides excellent outcomes. This strategy is particularly attractive if the site(s) of disease requiring irradiation would engender a very low risk of late effects from RT (e.g., an inguinal lymph node). In the rand...
What treatment do you offer to a pediatric patient with metastatic ewing sarcoma who has completed VDC/IE chemotherapy?
The most important treatment to offer would be local control of metastatic sites (usually by radiation therapy); by convention, this therapy is usually delivered after completion of chemotherapy. This would be critical for any chance of prolonged disease remission. In terms of systemic therapy, at t...
What treatment do you offer to a pediatric patient with AML in first relapse who was previously treated with chemotherapy only (not transplanted)?
This is an excellent question, and there is no standard. The choices most often depend on cumulative anthracycline during de novo therapy and cardiac function. Many institutions have their own standards for childhood AML in first relapse, but it usually comes down to anthracycline vs non-anthracycli...