Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
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...
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...