Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
Do you screen children with sickle cell disease for silent cerebral infarcts?
We screen children with sickle cell disease for SCIs at our center. This is because data suggest that silent cerebral infarcts (SCIs) are much more common than overt stroke and the long-term negative impacts of SCIs are significant. There are also treatments (e.g., chronic transfusion and stem cell ...
What is your approach to IV fluid resuscitation during a sickle cell vaso-occlusive crisis?
My approach to IV fluid resuscitation in vaso-occlusive crisis is cautious and individualized. Adequate hydration is important to prevent further sickling, but I avoid aggressive fluid loading because of the risks of pulmonary edema and acute chest syndrome. I typically use isotonic balanced crystal...
How would you work up a patient with cutaneous mastocytosis?
In adults, consider mastocytosis as being systemic until you prove it is not. A single normal or low-elevated tryptase does not eliminate the possibility of systemic mastocytosis. All patients should go to Heme/Onc for consideration of bone marrow biopsy and ideally high-sensitivity PCR to look for ...
What tips do you provide patients on therapeutic LMWH who have difficulty with injections and are bothered by bruising?
I counsel patients that injection site bruising is extremely common and should be expected. To try to limit the impact, they should make sure they are avoiding injection into the superficial blood vessels on either side of the abdomen. Sometimes moving to thighs or upper arms can help. If injections...
How would you manage a patient less than 40 years old with an incidentally found LGG, IDH mutated, 1p19q intact, s/p STR?
Update: On August 6, 2024, the FDA approved Vorasidenib for IDH-mutant low-grade gliomas based on findings from the INDIGO trial. This decision highlights the FDA's incompetence and lack of scientific integrity, clearly demonstrating that the agency prioritizes pharmaceutical companies' interests ov...
Would you consider a cycle of EP in a patient with good risk stage IIIB seminoma on BEP but with bleomycin omitted for cycle 3?
There are many aspects to this question. Good risk stage II seminoma has a 90-99% cure rate. I presume he has had all 3 five day courses of the EP component and 6 of 9 weeks of bleomycin. An ECOG study from about 30 (!) years ago compared BEP X 3 versus 3 courses EP for all types and histologies of...
How do you approach DOAC dose reduction for secondary prophylaxis of VTE in cancer-associated thrombosis?
Data from the API-CAT trial (Mahé et al., PMID 40162636) show that de-escalation of apixaban after 6 months was non-inferior compared to the standard dose with respect to recurrent VTE. Although there was no difference in major bleeding, the lower dose of apixaban was superior from the clinically re...
What strategies do you find helpful in advanced care planning with patients/families who are very "miracle" centered?
Hope for the miracle yourself! Broaden: “Are there any other things you are hoping for?” Hope for the best, prepare for the worst: “I see how much you want a miracle. I wonder if we can talk about what we should do if this doesn’t happen.” Consider involving a religious leader if relevant.
What is your surveillance regimen for children with nephroblastomatosis?
First, it is important to clarify that there are multiple forms of nephroblastomatosis and multiple clinical contexts in which surveillance for nephroblastomatosis may occur, and the medical literature has not always clearly defined discrete forms.Nephroblastomatosis was originally defined as multip...
Is there any utility for proton beam radiation to replace whole abdominal radiation for patients with Wilms tumor?
It is important to clarify that “whole abdominal radiation” (aka whole abdominal irradiation, or WAI) is a field of radiation therapy (RT) used to treat some Wilms tumor patients. Proton beam RT is a modality of RT delivery, with the main alternative being photon RT. But both photon (more commonly u...