Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
How do you choose chemotherapy for a pediatric patient with mixed-phenotype acute leukemia?
I would begin treatment with a high risk ALL regimen and monitor response closely. While there is not a standard regimen for the treatment of MPAL, in several retrospective analyses, rates of remission and outcomes have been shown to be superior with initial ALL vs. AML or hybrid (both ALL and AML) ...
How would you approach a new pelvic mass in a patient with history of mixed germ cell tumor but normalized tumor markers?
By the type of treatment received, I assume this was likely a post-pubescent male, probably under 18? In my view, this sort of patient should be managed identically to what we do in the much larger populations of non-seminoma seen between 18-40. Clinical and biological evidence is mounting that post...
How should young patients with rhabdomyosarcoma be managed in the absence of a clinical trial?
The guiding principles of disease control while maintaining form, function, and quality of life drive the decision-making and management for patients with rhabdomyosarcoma.Regarding patients with paratesticular primary, inguinal orchiectomy with no scrotal invasion but tumor on the surface of the re...
How do you manage VTE in the setting of persistent severe thrombocytopenia?
The thrombosis versus bleeding risk ratio should be weighed. The risk of VTE recurrence or propagation is highest in the first 30 days and we know that thrombocytopenia does not attenuate this risk. Providers should favor anticoagulation. In the case of cancer-associated thrombosis and chemotherapy-...
How would you approach moderate neutropenia (ANC < 1000) in a solid organ transplant recipient?
There are limited data addressing the safety and efficacy of G-CSF in the solid-organ post-transplantation setting. Most case series report no increase in graft rejection with G-CSF treatment, although this question is not rigorously answered. Most cases of neutropenia in the post solid-organ transp...
When are increased flank doses beneficial in Stage III Wilms tumor?
The current standard of care in North America for radiotherapy dose in the treatment of Wilms tumor (WT) has been established by the National Wilms Tumor Study (NWTS)-3. This study randomized Stage III favorable histology patients to 1000 cGy vs. 2000 cGy as well as 2 drugs (actinomycin D and vincri...
Are there any situations you would recommend prophylactic anticoagulation for a patient with Factor V heterozygosity?
In short, no. Thrombotic risk is a complex variable with many contributing components. The presence of a single FVL allele, while it appears to increase the risk somewhat, is not sufficiently predictive of overall risk to provide a basis for administering prophylactic anticoagulation in a clinical s...
Do you routinely recommend proton therapy for whole ventricular radiation for intracranial germinoma after chemotherapy?
The pattern of failure data from SIOP GCT '96 (Calaminus et al., PMID 23460321) and the SFOP-90 experience (Alapetite et al., PMID 20716594) in which patients with localized CNS germinoma were treated with induction chemotherapy followed by focal radiotherapy was predominantly intraventricular. Ther...
What is your local therapy paradigm for unresectable pelvic EWS cases?
Unresectable pelvic Ewing sarcoma tumors are treated with definitive radiation therapy. The Children's Oncology Group local failure analysis of patients treated on INT-0091, INT-0154, and AEWS0031 demonstrated pelvic tumors treated with radiation therapy alone had a local failure incidence of 22.4% ...
What are the current frontline treatment options for newly diagnosed pediatric AML patients with high FLT3/ITD allelic ratio and IDH2 mutation?
This is an interesting question. Since IDH2 mutations are so rare in pediatrics, we don't yet have enough information to determine their impact on the outcome. Also, targeted agents for IDH2 mutations are still in early investigational phases for pediatrics, so I would not necessarily include enasid...