Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
When during ALL induction therapy are you checking for MRD?
It is generally advisable to measure MRD from a bone marrow aspirate at the end of the first course of therapy for ALL. If a pediatric-inspired regimen such as CALGB 10403 is being used, undetectable MRD after Remission Induction (i.e., approximately Day 28) is associated with an excellent rate of d...
How do you treat a pediatric patient with t(17;19) acute lymphoblastic leukemia?
ALL with t(17;19) is a rare subtype and known to be associated with extremely worse outcomes compared with other subtypes, regardless of intensification of chemotherapy and transplant. These patients should be treated with conventional chemotherapy first, and if there is a sign of poor response, oth...
What treatment would you offer a young pregnant woman with a symptomatic midline low grade glioma?
The question is really in the biology of this midline low grade glioma, in particular K27M status and BRAF status, amongst others. It is very challenging to answer without a clear idea of the tumor and ongoing symptoms. It would also be important to have a look at the MRI scan. Eric Bouffet eric.bou...
Would you hold rituximab for newly diagnosed B-cell lymphoma if the patient is COVID-19 positive?
The question of how best to manage ongoing lymphoma therapy in the face of SARS-CoV-2 infection remains unanswered. That said, centers are developing guidance for clinicians based upon available and emerging data. Newer data from MSKCC suggest that recent treatment (within the last 30 days) is not a...
What is your approach to unresectable metastatic rhabdomyosarcoma transformed from an embryonal cell germ cell tumor?
More information would be helpful. I infer this is a patient who underwent an orchiectomy for a more typical histology of germ cell cancer, probably with elements of teratoma. He may or may not have had elevated hCG or AFP. He may or may not have received BEP or similar chemotherapy. Perhaps he had ...
What are best practices for pediatric hematology/oncology patient and staff precautions with the COVID-19 pandemic?
Some guidance is provided by pediatric hematology/oncology physicians in Italy: https://www.ncbi.nlm.nih.gov/pubmed/32298461
How do you clearly communicate to parents that the main purpose of a phase I trial is to find the best dose of a new drug with the fewest side effects rather than treating the patient's cancer?
Just with any communication, check first to see what their understanding is. Then, see if they are ready to hear what you have to say. Say it and then have them repeat it. When discussing trials, this conversation occurs over more than once. At the first conversation, one may be trying to lay out op...
What is your first choice TKI for pediatric patients with Ph+ ALL who are not on a study?
The first choice for TKI in children/adolescents with Ph+ ALL should be dasatinib based on a recent study published in JAMA Oncology (Shen et al).
How do you treat metastatic epithelioid sarcoma in pediatric patients?
The outcomes for pediatric patients with metastatic epithelioid sarcoma are dismal. Although generally considered chemotherapy and radiotherapy insensitive, consideration could be given for their combined use in a neoadjuvant fashion based on some reported responses that may allow for delayed surgic...
What is the role for adjuvant monoclonal antibody therapy with radiation for diffuse intrinsic pontine glioma?
There are several publications showing a small synergy when combining RT with immunotherapies—thought to be effective largely by the induction of a pro-inflammatory response.There are actually several different aspects to note for use of mAbs in the brain. The biggest argument you'll hear is likely ...