Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
In pediatric patients with newly diagnosed B-cell ALL and underlying Lynch syndrome, how does the MMR deficiency inform your treatment planning and survivorship surveillance?
Treat B-cell ALL with chemotherapy appropriate for risk category and usual follow-up. MRI Brain Q 6 months up to age 20, then annually Colonoscopy annually starting at age 6 years Upper endoscopy at age 10 years and annually Whole body low dose MRI annually Physical examination and skin exam every ...
Do you use specific scalp dosimetry constraints to prevent chronic alopecia when treating partial brain volumes with VMAT?
I have been using VMAT for 8 years to treat brain tumors, and permanent alopecia is rarely a complication in patients treated with doses of >50 Gy. For that reason, I personally do not use a scalp OAR constraint when planning a course of partial brain radiation. Prior to the adoption of VMAT, the oc...
How do you approach symptomatic thalassemia intermedia patients from beta thal trait with alpha gene duplication?
Individuals with the beta-thalassemia trait and alpha-globin gene duplication have an intermediate phenotype. The severity depends on the type of beta mutation and whether the duplication is of alpha-1 or alpha-2, since these determine the imbalance between alpha and beta globin production. Individu...
How do you approach treatment of a young adult with an intracranial anaplastic ependymoma and a single intradural cervical spine metastasis?
A high-grade tumor, such as anaplastic ependymoma, carries a higher risk of CSF seeding down the neuroaxis than lower grades. Secondary spinal drop metastases are considered a serious but relatively rare complication in this disease. Assuming that the metastasis was detected at the time of diagnosi...
What are effective ways to improve compliance/involvement in long-term cancer survivorship care for patients, particularly AYA patients?
As a consequence of exposure to chemotherapy, radiation, and surgery, many survivors of childhood cancer are at high risk for a myriad of chronic conditions compared to age-matched controls. Follow-up in a structured late-effects program can improve survivors' knowledge of their risks, assist with a...
How, if at all, do you anticipate incorporating Pixclara PET into the evaluation of suspected recurrent or progressive glioma after treatment?
In pediatric high-grade glioma, I think there's an opportunity to use it selectively when conventional MRI leaves uncertainty between true progression and treatment-related change (pseudoprogression), rather than as part of routine surveillance. The clearest need is in diffuse midline glioma after r...
How do you approach hormone replacement therapy for premenopausal patients following pelvic radiation therapy?
Most patients who undergo pelvic radiation will become menopausal. Physiologically, the outcome is similar to surgical menopause because sufficient doses of radiation result in complete loss of ovarian function. In contrast, after natural menopause, the ovaries continue some types of endocrine funct...
Do you offer IV iron first line to women with iron deficiency anemia from heavy menstrual bleeding?
I offer first-line IV iron because oral iron cannot keep up with the losses from heavy menstrual bleeding, and the majority can't tolerate it. I routinely give a gram of LMW iron dextran in one hour, Feraheme (not ferumoxytol generic) 1,020 mg in 30 minutes, or ferric derisomaltose 1 gram in 30 minu...
When would you use dexamethasone-free antiemetic prophylaxis with olanzapine in pediatric patients receiving highly emetogenic chemotherapy?
At our institution, our leukemia/lymphoma, bone marrow transplant, and neuro-oncology providers generally do not feel comfortable with the use of dexamethasone for the prevention of CINV in their patients. In addition, neuroblastoma patients receiving dinutuximab also do not receive dexamethasone. T...
How do you approach making an acute pain IV opioid plan for a new adult SCD patient who doesn’t remember what has worked for them in the past?
I create an FYI at the initial clinic visit and go over the FYI with them so that we are both comfortable with the plan and the patient knows their plan. The first thing I would do is look through outside records, for example, if they are available in Care Everywhere. If that is not available, then ...