Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
What is your hemoglobin transfusion threshold for asymptomatic pediatric solid tumor patients during radiation?
We aim for a Hb of 10g/dL whenever possible. This is not based on any data from pediatrics, but from data in adult patients (Prognostic value of hemoglobin concentrations and blood transfusions in a retrospective study of 386 patients).
How many years of oral antibiotics prophylaxis do you recommend for a teenager with hereditary spherocytosis post-splenectomy?
If older than 5 and vaccinated, no proph.
How do you counsel patients who are candidates for a clinical trial regarding their options?
I typically discuss the option with patients as early as possible in their diagnosis, and explain that at some point during their treatment they may become a candidate for a clinical trial. I discuss resources to look into clinical trials and what they mean for patients. We discuss patient website r...
In patients with autoimmune cytopenias, is there any reservation for COVID vaccination?
No... benefit outweighs risk. Evidence of benefit (and its magnitude) is clear without proven evidence of risk in this population (save for potential for increased bruising in setting of severe thrombocytopenia).
What is the evidence/rationale for not treating neuroblastoma metastatic sites which are MIBG negative after induction chemo?
A clinically meaningful number of high-risk neuroblastoma patients are curable, which in part justifies metastasis-directed local therapy. It can be difficult though to balance the toxicity of multi-site irradiation with maximum control of sites of metastatic disease. Metastases that persist after i...
What is the volume and dose for a rhabdo bone met showing complete response to chemo?
On ARST1431, the GTV2 for a bone met in CR should be defined as the residual bone abnormality as seen by CT/MRI at the time of RT planning. SBRT to bony metastases is optional on 1431 and the decision may vary based on patient age and other factors. On the upcoming high risk protocol, where SBRT to ...
What dose do you treat the involved lymph node chain to in definitive radiation for rhabdomyosarcoma?
In our trials, we have used 36 Gy for microscopic nodal disease treatment (either the CTV surrounding gross lymph node involvement or for nodal regions where resection has been performed - e.g. paraaortic LNs in paratesticular primary disease). The extent of this 36Gy treatment volume in the H&N reg...
Is there a role for G-CSF treatment for SLE patients with persistent neutropenia?
There may be a role for G-CSF for treatment of SLE-related neutropenia, though would recommend using with caution only for severe neutropenia (ANC less than 500) and at lowest dose. The use of G-CSF has been looked at in small case series over the years for both SLE patients with neutropenia and Fel...
What is the utility of immunotherapy in management of malignant peripheral nerve sheath tumors?
The correct answer would be "unknown" or "TBD". Enrollment on clinical trials, even broad phase 1 trials, would be encouraged in cases where SOC therapy has failed.
When would you recommend using a DOAC in a pediatric patient with VTE?
None of the DOACs are approved as of yet below the age of 18 in the United States. However, results of the phase 3 Einstein Junior study (Rivaroxaban) have been published and the FDA application for approval is pending - the hold up is awaiting results of the Rivaroxaban Fontan surgery study to be a...