Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
How should patients be selected for metastatic-site directed radiotherapy in rhabdomyosarcoma?
Definitive therapy to sites of metastases at the time of diagnosis is recommended for all patients with metastatic disease on the most recent COG trials (both ARST1431 including intermediate risk patients and ARST0431 including high risk patients). We typically treat the metastatic sites at the end ...
How would you manage a pediatric patient with hypodiploid acute lymphoblastic leukemia?
There is some evidence that patients with hypodiploid ALL do not benefit from HSCT (Pui et al., JCO 2019, McNeer et al., JCO 2019), but it is important to keep in mind that these two studies were retrospective.
How do you approach treatment in an infant with metastatic atypical teratoid/rhabdoid tumor (ATRT) of the brain?
The term infants is, sometimes, used to describe children less than 3 years of age in the context of a brain tumor management. Hence, this response will cover the management of a child less than 3 years of age with metastatic ATRT with additional comments on infants less than 1 year of age.Unfortuna...
When do you offer hyperbaric oxygen therapy to a pediatric brain tumor patient with radiation injury/necrosis?
I really think it depends as much on the clinical setting as it does the imaging appearance. If you have a case where you are on the early end of the timeline for a CNS RN event (i.e. 3-4 mo post-RT) and the patient is high risk (due to location dose, re-RT, concurrent chemo, etc), then it's worth c...
How would you approach therapy for a young, fit patient with alveolar rhabdomyosarcoma involving the anterior nasal vault/sinuses in the absence of available clinical trials?
The patient should be risk stratified (as per the Intergroup Rhabdomyosarcoma Study Group classifications) and treated with multimodality therapy, including chemotherapy and likely definitive radiotherapy, depending on the specific location. Surgery is also a consideration, but these are generally c...
Would you recommend bone scan or PET-CT for detecting metastatic bony lesions in a patient with osteosarcoma?
The historical standard imaging study for bone metastasis in osteosarcoma is a bone scan. However, accumulating data supports the use of PET/CT. In my own practice, I typically obtain a PET/CT as part of staging evaluations, and if completed, I do not obtain a bone scan.
How would you manage a patient with severe aplastic anemia and a large PNH clone?
This depends on many factors: What age at diagnosis, how big is the clone, hemolytic PNH? (LDH/Bili?), thrombosis? When did it develop (was it at diagnosis, or after IST), what is the marrow picture (hypo or hypercellular), what options for treatment are available, what HSCT protocols do you have at...
Do you recommend that children with sickle cell disease refrain from returning to school during the COVID-19 pandemic?
If schools are open and there is no special infectious risk at the school in question, then it would likely be appropriate to send your child with sickle cell anemia to school. There is no evidence of extra risk of COVD in patients who have had an autosplenectomy and no evidence of particular proble...
Do children with intermediate-risk Burkitt lymphoma benefit from adding rituximab?
The answer is yes. The randomization to addition of Rituximab in the recently closed international study was done in intermediate risk patients with high LDH (Minard-Colin et al., PMID 32492302) The trial was stopped early because of the clear advantage in the Rituximab arm. The only patients not st...
Would you change TKIs in a patient with Ph-Like or Ph-positive B cell ALL who relapses on therapy (along with giving relapse chemotherapy)?
Mechanisms of resistance in Ph-like ALL have not been extensively studied and will definitively be an active area of research. Given the biological similarities between Ph+ ALL and Ph-like ALL, one could hypothesize that similar mechanisms of resistance could occur in both entities. Kinase domain (K...