Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
Are there any special considerations when evaluating patients with non-malignant hematologic or immunodeficiency disorders for allogeneic transplant?
In most malignant diseases, we prefer to take patients to allogenic transplant either in complete or partial remission as it will take few months before post-transplant immune-reconstitution results in effective graft-versus-disease response. In non-malignant diseases, we take patients to transplant...
How do you define bulky mediastinal disease in Hodgkin's lymphoma?
Bulk in HL (outside the mediastinum) has been defined variably. While Children's Oncology Group studies used a threshold of 6 cm recently, the European studies and medical oncology trials have often used 10 cm as the threshold. On the recently accrued AHOD1331 COG trial, bulk was defined as a contig...
What is the role of hydroxyurea in variant sickle cell genotypes?
I have had little success using hydroxyurea in my patients with hgb SC disease and at this point in patients with two or more acute visits over 12 months for pain, I am using crizanlizumab as some of the subjects in the phase 2 study on which the drug received FDA approval had SC disease (Ataga et a...
What bladder-filling protocol do you use when treating children with bladder neck rhabdomyosarcoma with definitive radiotherapy (VMAT)?
We have experiences from Proton beam therapy. Bladder filling protocol will depend on the tumor and age of the patient. Our preferred way is to do it via suprapubic catheter if the tumor is not interfering with the position of the catheter. Filling volumes may be around 150-200 ml (however, the age/...
How do you incorporate next gen sequencing results into your management of pediatric patients with B-ALL who have not been transplanted?
We enroll in the EndRAD SCT trial which is guided by NGS results.
Do you offer iron supplementation to a non-anemic adolescent athlete with a low ferritin?
I prefer having a TSAT on an overnight fast. Extreme athletes have increased hepcidin. If ferritin is greater than 30, my cut-off, no. If TSAT is 19 or less, yes. I would not criticize someone who gave iron, but PO iron is pretty tough to take. I would prefer staying within the current parameters of...
How does the loss of heterozygosity (LOH) of 1p or 16q affect the treatment options of stage II or III newly diagnosed Wilms Tumor?
For Wilms tumor patients with LOH at BOTH 1p and 16q, the COG has completed trials AREN0532 (included patients with stage 1/2 and LOH at both loci) and AREN0533 (included patients with stage 3/4 and LOH at both loci) and demonstrated an improved event free survival when therapy is intensified (to DD...
How do you manage a young patient with mediastinal nonseminomatous germ cell tumor that has relapsed after primary treatment with four cycles of VIP?
Patients with primary mediastinal nonseminomatous germ cell tumors (PMNSGCT) are at poor risk regardless of the size of the tumor or amplitude of AFP. Unfortunately, second-line therapy does very poorly. There would be zero curative value for TIP or VeIP after prior VIP, of course. Despite respectab...
What are the treatment options available for isolated extramedullary relapse of an AYA patient with AML following HSCT?
This is such a tough situation. Unfortunately, when a patient relapses after the second stem cell transplant, options are limited because a third transplant is rarely feasible and cure is not likely with medication alone. One could consider a Phase I trial if available and the patient is eligible. O...
When is a bone marrow biopsy indicated in the up-front evaluation of an AYA patient with Ewing sarcoma?
In general, I would not recommend a different approach to the initial staging evaluations for an AYA with a new diagnosis of Ewing sarcoma vs a younger child or an older adult. Although the standard approach that is most widely accepted would be to perform a bone marrow evaluation for all patients w...