Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
How would you approach therapy for a young, fit patient with alveolar rhabdomyosarcoma involving the anterior nasal vault/sinuses in the absence of available clinical trials?
The patient should be risk stratified (as per the Intergroup Rhabdomyosarcoma Study Group classifications) and treated with multimodality therapy, including chemotherapy and likely definitive radiotherapy, depending on the specific location. Surgery is also a consideration, but these are generally c...
Would you recommend bone scan or PET-CT for detecting metastatic bony lesions in a patient with osteosarcoma?
The historical standard imaging study for bone metastasis in osteosarcoma is a bone scan. However, accumulating data supports the use of PET/CT. In my own practice, I typically obtain a PET/CT as part of staging evaluations, and if completed, I do not obtain a bone scan.
How would you manage a patient with severe aplastic anemia and a large PNH clone?
This depends on many factors: What age at diagnosis, how big is the clone, hemolytic PNH? (LDH/Bili?), thrombosis? When did it develop (was it at diagnosis, or after IST), what is the marrow picture (hypo or hypercellular), what options for treatment are available, what HSCT protocols do you have at...
Do you recommend that children with sickle cell disease refrain from returning to school during the COVID-19 pandemic?
If schools are open and there is no special infectious risk at the school in question, then it would likely be appropriate to send your child with sickle cell anemia to school. There is no evidence of extra risk of COVD in patients who have had an autosplenectomy and no evidence of particular proble...
Do children with intermediate-risk Burkitt lymphoma benefit from adding rituximab?
The answer is yes. The randomization to addition of Rituximab in the recently closed international study was done in intermediate risk patients with high LDH (Minard-Colin et al., PMID 32492302) The trial was stopped early because of the clear advantage in the Rituximab arm. The only patients not st...
Would you change TKIs in a patient with Ph-Like or Ph-positive B cell ALL who relapses on therapy (along with giving relapse chemotherapy)?
Mechanisms of resistance in Ph-like ALL have not been extensively studied and will definitively be an active area of research. Given the biological similarities between Ph+ ALL and Ph-like ALL, one could hypothesize that similar mechanisms of resistance could occur in both entities. Kinase domain (K...
How would you approach a patient with relapsed Ph+ ALL and MRD positive after blinatumomab?
There is currently no defined standard-of-care treatment for pediatric relapsed Ph+ ALL. Nevertheless, many patients with relapsed Ph+ ALL can be successfully salvaged in the TKI era (especially those who had not undergone HSCT in CR1) since the 5-year EFS of pediatric Ph+ ALL on the recently publis...
How would you manage relapsed desmoplastic small round cell tumor?
Unfortunately, recurrent DSRCT has a dismal prognosis and management is generally with palliative intent. In cases where recurrence is localized, consideration of aggressive local control should be given when possible. There are no established, reliable chemotherapeutic regimens for relapsed DSRCT a...
What treatment approach do you take in a pediatric patient less than 3 years old with malignant papillary epithelioid tumor within the pineal region?
This is an interesting case for a rare tumor, especially in the pediatric population. There is unfortunately no prospective data so clinical management would be drawing from small retrospective series with primarily adult patients. The youngest patient with PTPR in the current literature is 5 years ...
Would you consider salvage SRS in a young patient with locally recurrent ATRT?
Radiotherapy plays an important role in the curative management of ATRT.[Chi et al, JCO 2009; Reddy et al JCO 2020].When relapse occurs, even if it is local, the overall prognosis is often poor. However, I am assuming that this was previously treated, and I would consider re-irradiation with SRS as ...