Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
What treatment would you recommend to effectively treat a pediatric patient newly diagnosed with low risk Hodgkin's lymphoma while minimizing the risk of late toxicity?
COG and we try to limit radiation whenever possible. The intermediate risk HD study show early responders (PET negative after 2 cycles of ABVE-PC) could skip radiation—personally I have a long discussion about the long term risks of radiation, particularly breast cancer, leukemia and heart damage, a...
What systemic therapy do you recommend for a patient with a local relapse of ewing sarcoma who previously received VDC-IE?
With great respect, this is a question that should neither be asked nor answered in this forum. Recurrent Ewing sarcoma is a complex subject. While the prognosis is poor, it is not monolithically poor. There are a host of factors which influence the choice of therapy for a patient with recurrent Ewi...
How do you manage a pediatric patient less than 3 years old with first relapse of medulloblastoma?
I am going to assume that this child was treated with high dose chemotherapy and no cranio-spinal irradiation prior to this progression since this is the most often used approach albeit not the only one. As all practicing pediatric Neuro-oncologists are aware, this age group is one of the most chall...
What treatment would you give to a pediatric patient with first relapse of wilms tumor?
First consideration should be to review and treat as per NWTS-5 relapse arm. Prior chemo will dictate which chemo should be selected at relapse (*i.e. if prior Dox then Cyclo/Etop alt w/Carbo/Etop vs. no Dox = regimen I). Don't forget to address local and metastatic disease w/Surgery+/-RT using prot...
What do you counsel the families of pediatric cancer patients who want to take probiotics while receiving chemotherapy?
I allow all pediatric oncology patients to take pre and probiotics if they desire although our bone marrow transplant colleagues are more hesitant. There is no good evidence (yet) that probiotics improve the gut microbiome or have any other significant effects on complications of childhood cancer, b...
Can acupuncture be safely used in a pediatric oncology patient with severe thrombocytopenia or neutropenia?
I would allow acupuncture in patients with platelets >30 uL and ANC >250. There is very little published information about whether acupuncture is safe in patients with neutropenia or thrombocytopenia. Adult studies suggest that acupuncture is safe with platelets of <50/uL (Cybularz et al., PMID 2640...
What systemic therapy would you offer to a pediatric patient with fibrolamellar hepatocellular carcinoma after an initial partial surgical resection?
My most commonly used systemic therapy for FLHCC is 5FU+IFN. Since FLHCC patient get excluded from HCC trails, there is no standard here.
What treatment would you recommend to a pediatric patient newly diagnosed with unresectable, symptomatic desmoid tumor?
Although it is a seemingly simple question, the answer is quite complicated and multi-faceted. In general terms, we try to recommend active surveillance with supportive care management of symptoms upfront due to a percentage of these tumors that will spontaneously regress with time. If therapy is fe...
Do you recommend using cell-free BRAFV600E to track response to therapy in pediatric patients with langerhans cell histiocytosis?
Would you offer liver transplant to a pediatric patient with unresectable fibrolamellar hepatocellular carcinoma?
It’s a trial setting for sure, so prospectively enroll patients and follow their outcome. FLHCC patients usually get excluded form trials for HCC, given their different natural history and disease course. This is also applicable to transplant setting. One can argue to proceed if the tumors meet Mila...