Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
How do you approach a young patient with undifferentiated pleomorphic sarcoma of the upper extremity who developed ifosfamide-induced nephrotoxicity after two cycles of adjuvant AIM chemotherapy?
In the adjuvant setting, I would suggest to stop further therapy and observe the patient. There is no clear survival benefit with the use of adjuvant therapy. However, I do say this with the knowledge that Sarculator-based analysis of EORTC-STBSG 62931 has demonstrated an OS benefit in patients rece...
How do you manage steroid-refractory acute GVHD following allogeneic transplant?
The short answer is to enroll the patient in a well-designed clinical trial, if available. If not, I would start with ruxolitinib based on the REACH2 trial (Zeiser et al., PMID 32320566) which was multicenter, randomized, open-label, phase 3 trial comparing the efficacy and safety of oral ruxolitini...
How do you approach autologous stem cell transplant in T-cell lymphomas/PTCL after induction chemotherapy with achievement of CR1?
Autologous SCT can be considered in PTCL in CR1 especially if the patient is MRD negative by PET and molecular testing (by checking for the persistence of clonal T cells, for example). Schmitz et al., PMID 33512419 If MRD positive CR or PR/SD, would consider allogeneic SCT instead. The main concern ...
In a young female with severe osteoporosis due to congenital estrogen deficiency, can estrogen be prescribed if genetic testing for congenital disorders reveals a heterozygous Factor V Leiden mutation?
First of all, I don't think testing for inherited thrombophilia is warranted in a patient with no personal or family history of thrombosis. Given the multigenic nature of thrombophilia and our limited ability to test for it, it's difficult if not impossible to determine an individual's risk of throm...
What is the risk of serious bacterial infection in a febrile solid tumor patient who has not yet started cancer-directed therapy and has normal cell counts with no central line?
This depends on the type of the tumor, the location, and the individual circumstances. It may not be wrong in this scenario to draw blood cultures and give a dose of ceftriaxone pending 24-hour results, but this practice may also vary based on these different variables e.g. RMS of paranasal-ear area...
Do you offer iron supplementation to a patient with iron studies that are normal (including normal ferritin) except for low iron saturation?
The answer is absolutely and positively yes. A low percent saturation of transferrin has an extremely high concordance with absent marrow hemosiderin and frankly, in today’s parlance is the best indicator of “iron need”. While the ferritin is marvelous at confirming iron deficiency if low (with or w...
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 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...
Is it acceptable to treat pediatric Hodgkin's lymphoma with an involved nodal field outside the setting of a clinical trial?
It probably is. Although not proven by randomized trial/s in pediatric patients, the practice is accepted in adults. In children where long term morbidity of radiation therapy is of greater concern, it would not be unreasonable to use involved nodal field in combination with chemotherapy.