Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
Is placing a VP shunt a major risk to spread medulloblastoma or other malignant brain tumors into the gut?
While most malignant primary brain tumors will NOT spread to the gut via VPS, case reports of pediatric brain tumors dominate the literature regarding this risk. Germ cell tumors are probably most commonly reported, followed by PNETs and medulloblastomas [Piatt and Garton, PMID 18431216, Kay et al.,...
Would you use a myeloablative or reduced intensity conditioning regiment for a pediatric or AYA patient who does not recover their counts after treatment for AML, but remains disease free?
I would use a myeloablative regimen, if medically fit and eligible. In fact, I would worry that there is a residual disease (that you're unable to detect) behind the lack of CBC recovery which is another reason to use a myeloablative regimen.
How would you manage an unresectable central meningioma in a young patient with evidence of mild compression on the optic nerve and 4th ventricle involvement?
Sometimes, unresectability is in the eye of the beholder. In a young patient, with a decent size meningioma compressing the chasm and the 4th ventricle, there are several significant risks from not pursuing a surgical approach. Our first approach would be to get an expert opinion from a renowned men...
How would you approach the treatment of patients with von Willebrand disease or hemophilia A previously managed with intranasal DDAVP during the recall?
There are two separate questions here, one is easy and one complicated. Desmopressin challenges can be performed with intravenous desmopressin, 0.3 mcg/kg. It is not necessary to challenge a patient with IV who previously responded well to the nasal preparation, in my view. How to approach treatme...
What is the radiation volume for unresected gross paraaortic lymph node in a Wilms patient?
This depends on the presence/absence of diffuse anaplasia (See AREN0321 [NCT00335556]) and age/field extent.Patients with diffuse anaplasia who are Stage 3 due to the presence of residual nodal disease would receive 19.8 Gy to the flank, and then in the presence of residual disease, would receive a ...
How would you approach maintenance for high-risk B-ALL off study?
The frequency of VCR/steroid pulses question is a great one, and while I am a strong proponent of eliminating the extra year of therapy for boys and reducing the number of VCR/steroid pulses during maintenance, it can be a challenge to explain to families why we are changing something they likely vi...
How do you treat a primary pineal neoplasm of intermediate differentiation?
Pineal parenchymal tumors of intermediate differentiation (PPTID) represent a rare type of intracranial tumor that behaves somewhere between pineocytomas and pineoblastomas. Given the rarity of PPTID, data is limited to retrospective studies with no clear consensus on adjuvant therapy. In general, a...
When is a bilateral bone marrow aspirate/biopsy indicated in the initial diagnosis of pediatric NHL patients?
Bilateral bone marrow biopsies and aspirated are not required for diagnostic evaluation of pediatric non-Hodgkin lymphoma.
Is there a role for surgical resection in parameningeal rhabdomyosarcoma either at diagnosis or following initial therapy w/ VAC at week 12?
Not really. For rhabdomyosarcomas outside of the head and neck region, surgical resection often plays an important role in the treatment paradigm. However, given the anatomical constraints with paramenigneal tumors, gross total resection is often not possible without resulting in significant morbidi...
When would you perform a thrombophilia workup in a pediatric patient presenting with VTE?
I was trained to do workup in cases of unprovoked VTE and still practice that way mainly to guide the length of anticoagulation therapy as well as prophylaxis. I must admit though, in pediatrics I have come to realize there is more practice based on experience and extrapolation from adult data than ...