Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
How would you treat an adolescent or young adult with newly diagnosed hepatosplenic T-cell lymphoma?
HSTCL accounts for <1% of lymphomas. It typically presents in young males, 10-20% of whom are on chronic immunosuppression such as TNF alpha inhibitors. The prognosis for hepatosplenic t-cell lymphoma is grim. Patients can achieve a CR, but relapse quickly with a short median OS. When possible, pati...
What is the flank radiation dose for recurrent Wilms?
For children with recurrent Wilms who had NO treatment with either chemo or RT, we recommend the lower doses mentioned in AREN0532 (NCT00352534). All treatment- recurrent Wilms should receive higher doses as stated in NWTS5 (NCT00002611).
Do you block kidney to meet kidney constraint when treating Wilms with diffuse unresectable peritoneal implants?
Yes, either block or use imrt.
What are the indications for RT for an alveolar FOX01 fusion positive, paratesticular rhabdomyosarcoma s/p radical inguinal orchiectomy and PLND showing pN0, group 1, stage 1 disease?
We have not radiated in this specific scenario. While there are still questions about the need and benefit for adjuvant RT in patients with completely resected alveolar histology or FOXO1+ disease, the absence of a clear target in patients with paratesticular primary involvement with complete resect...
How do you approach a patient with multiply relapsed germ cell tumor with rising tumor markers but no obvious site of disease?
From the description, it presumes that this is a patient who previously received BEP, high dose chemo with transplant, and "radiotherapy". Not sure whether that represents CNS mets that were radiated. The most important aspect is to be certain marker rise due to progressive cancer. hCG mildly elevat...
Is there a utility to initiating maintenance azacitidine therapy for a patient with a history of refractory AML who is now post-transplant?
This is an interesting question and unfortunately, there is no solid answer for it. There have been some studies of aza post-SCT for adults with AML or MDS. Most of these were small and not randomized, and different dosing schedules were used, so it's hard to draw firm conclusions. The balance of th...
At what point in a pediatric patient's cancer treatment should palliative care teams become involved in their care?
I believe palliative care involvement for newly diagnosed children with cancer should be the rule, not the exception. The concept of early involvement of palliative care teams for newly diagnosed patients with cancer stems largely from a landmark paper in the New England Journal of Medicine 10 years...
When do you evaluate or refer for a cancer predisposition syndrome in a young child diagnosed with a sarcoma?
There are a number of hereditary cancer syndromes associated with development of sarcoma in children, including Li-Fraumeni syndrome (LFS), DICER1 syndrome, Constitutional Mismatch Repair Deficiency (CMMRD), Neurofibromatosis 1, hereditary retinoblastoma, Beckwith Wiedemann syndrome, the RASopathies...
Is there a maximum ifosfamide cumulative dose in patients with normal kidney function?
Here are a number of references from osteosarcoma as well as rhabdo patients. There is no "lifetime limit" but the more you give the higher the risk of renal Fanconis or other renal dysfunction. 72 g/m2 is generally well-tolerated, but not in everyone. There is also no data comparing 14 g/m2/cycle t...
How would you modify Ewing sarcoma chemotherapy and timing of dialysis for a dialysis-dependent patient?
I would recommend a multidisciplinary approach from oncology, nephrology, and pharmacology to maximize drug exposure and minimize chemotherapy clearance. While EWS protocols do contain information about renal toxicity in the dose-modification sections, dialysis is not specifically addressed and more...