Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
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...
What neoadjuvant, adjuvant chemotherapy regimen or targeted therapy can be used in paediatric patients with pelvic peripheral medulloepithelioma?
We published this paper that may help you:Presacral Medulloepithelioma: Case Report and Literature Review.Honnorat M, Al-Karmi S, Hawkins C, Johnston D, Gerstle T, Schechter T, Huang A, Bouffet E.J Pediatr Hematol Oncol. 2020 Apr;42(3):244-247. doi: 10.1097/MPH.0000000000001460.I would be happy to s...
What is your preferred adjuvant chemotherapy for a pediatric patient less than 1 year old who had a gross total resection of a localized intracranial ependymoma, and will not be receiving radiation therapy due to his/her young age?
Based on the results of the St Jude multi-institutional clinical trial for young children with ependymoma, SJYC07, the results of which were published recently in the neuro-oncology journal, we would recommend systemic therapy with a combination of methotrexate, vincristine, cisplatin and cyclophosp...
What treatment do you offer to a pediatric patient with an optic pathway glioma with a BRAFV600E mutation who progressed despite receiving conventional chemotherapy, BRAF/MEK inhibitors, and radiation therapy?
These cases are often tough, especially in this location. I assume the patient does not have NF1? Most patients with NF1 will not have concurrent specific BRAF mutations. One alternative therapy is a combination of bevacizumab and irinotecan (published by Gururangan et al). Also, if the patient prev...
Should I wear gloves during a routine physical exam on an asymptomatic patient with no risk factors for COVID-19?
As per FAQ’s posted by ASTRO: There is no reason to do so at this time. Be vigilant re: hand hygiene and wiping down any equipment that touches the patient (stethoscope, etc.). Additionally, any equipment that touches mucosa/secretions of the patient must be sterilized (rhinolaryngoscope, etc.). For...
How do you treat late medullary relapsed B-ALL in a patient with Down Syndrome?
I have had this exact case. My patient did not tolerate (nearly died of sepsis) with the relapsed ALL COG therapy - so I used standard risk Down syndrome ALL therapy just like a newly diagnosed ALL, standard risk DS - after that, I have kept her on pseudo-maintenance (just 6MP & po MTX) for 5 years ...