Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
When would you consider transplant for a patient with a bone marrow failure syndrome (FA, DC, etc.)?
At the time of early bone marrow failure - before they become transfusion-dependent or develop a significant risk for infection and/or bleeding. With Fanconi's and BRCA2 mutation - would follow bone marrow carefully (2x a year) as they have a risk of AML. Because both FA and DK are systemic disorder...
How do you approach the pharmacologic management of cancer-related fatigue?
After the above considerations mentioned in the question, management considerations regarding cancer-related fatigue depend on the stage of disease (advanced/metastatic disease vs not) and whether the patient is on active cancer therapy. For both groups, non-pharmacologic interventions have the high...
Should adjuvant maintenance chemotherapy be provided to children with anaplastic ependymoma following radiation therapy?
We don't know yet, and this was the purpose of ACNS0831 (closed) and the rationale as well of the ongoing SIOP Ependymoma trial in Europe. In fact, the question is not whether we should offer chemotherapy to a child with anaplastic histology, as we know that anaplasia has very little meaning in this...
Would you start a patient with sickle cell disease and COVID-19 on prophylactic anticoagulation?
At what level of bone marrow disease would you agree to proceed with transplant for a patient with refractory AML?
Most transplant centers will settle on 5% or fewer blasts by morphology or flow cytometry as the cutoff for transplant. Exceptions or leeway is sometimes given for those undergoing myeloablative/full-intensity conditioning, and those with primary refractory disease. MRD typically refers to disease t...
With the increased use of gemtuzumab in induction chemotherapy for children with acute myeloid leukemia, would you change conditioning regimens to help prevent sinusoidal obstruction syndrome during hematopoietic stem cell transplant?
The current use of Mylotarg uses lower doses of Gemtuzumab and also fewer doses (only in induction-1 in the current COG-AAML1831 clinical trial) which should be at least 2-3 months away from BMT and that's why we do not see a higher SOS rate, but more prospective studies will be needed to answer if ...
How would you manage a pediatric patient with immune thrombocytopenia who has severe thrombocytopenia without bleeding symptoms?
As posed according to current data and opinion (for best: see the TIKI trial), there is NOT an urgent reason to treat.However, choosing to observe rather than treat requires careful assessment of the patient and the family.Examples include: Does the patient have a headache? Did they receive ibuprofe...
Is there any role for direct oral anticoagulants in the treatment of antiphospholipid syndrome?
Triple-negative APS is a confusing category as includes seronegative APS, APS with non-conforming aPL such as anti-phosphatidylserine-prothrombin amongst others, and the universe of patients with thrombotic events unrelated to antibody-mediated hypercoagulable state (eg Protein S, C or anti-thrombin...
How do you choose chemotherapy for a pediatric patient with mixed-phenotype acute leukemia?
I would begin treatment with a high risk ALL regimen and monitor response closely. While there is not a standard regimen for the treatment of MPAL, in several retrospective analyses, rates of remission and outcomes have been shown to be superior with initial ALL vs. AML or hybrid (both ALL and AML) ...
How would you approach a new pelvic mass in a patient with history of mixed germ cell tumor but normalized tumor markers?
By the type of treatment received, I assume this was likely a post-pubescent male, probably under 18? In my view, this sort of patient should be managed identically to what we do in the much larger populations of non-seminoma seen between 18-40. Clinical and biological evidence is mounting that post...