Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
What dose of PEG-asparaginase do you recommend for teens with high BMI treated on a pediatric ALL regimen?
The peg-asparaginase dosing we use in ALL regimens for B and T cell is below: Patients less than 21 years old – 2500 units/m2 Patients 21 years and older – 2000 units/m2 For obese patients (defined as > 95% BMI for patients less than 20 years old or BMI > 30 for patients 20 years and older), ...
How would you approach chronic isolated severe non-cyclic neutropenia with negative bone marrow and rheumatologic work-up?
My preference would be to use G-CSF at the lowest effective dose, i.e., the dose that maintains the ANC >1000. The risk of inducing leukemia is low in individuals with idiopathic, chronic neutropenia, but it is positively correlated with the G-CSF dose. There are also other side effects like bone pa...
How do you manage cancer treatment-related cognitive change or "chemo brain?"
Chemo-brain is a vexing and complicated diagnosis. In most cases, you don't know the baseline neurocognitive function of individuals with cancer. Many conditions that are associated with chemotherapy like fatigue, depression, and aging can mimic chemo-brain. Estimates are that about 20% of individua...
What surveillance plan would you recommend for stage IV melanoma patients who achieve a CR or stable PR response with immunotherapy?
If melanoma patients have achieved CR or PR after a year of immunotherapy treatment, I highly recommend participation in this ongoing ECOG cooperative study: EA6192 / PET-Stop Educational Materials - ECOG-ACRIN Cancer Research Group (NCT04462406). The study uses PET scans in combination with contras...
What further genetic testing would you perform on a pediatric patient with cyclic neutropenia who is negative for the most common associated mutations?
Virtually all autosomal dominant cyclic neutropenia is due to mutation in the ELANE gene. However, all neutropenia that varies over time is not necessarily hereditary cyclic neutropenia, even though the family history suggests so. It would be helpful to know if the family history follows an AD inher...
What is the preferred regimen for AYA patients with T-Cell Lymphoblastic Lymphoma?
In my opinion, I would treat with an AALL1231 based induction with a single dose of asparaginase, followed by AALL0434 arm B-like regimen post-induction; Capizzi MTX with single IM and 2 years maintenance boys and girls. I would not administer XRT unless the patient is CNS3. Transplant is recommende...
With new data showing similar outcomes of mismatched unrelated donor and haploidentical related donor allogeneic transplants using post transplant cyclophosphamide, how does one decide which donor is optimal?
It is certainly an unresolved question, and the short answer is that either would be an acceptable option with post-transplant cyclophosphamide (and I have used both). All recipients of mismatched donor transplants should be tested for the presence of donor specific antibodies, and their presence co...
How do you approach relapsed hepatocellular malignant neoplasm NOS after transplant in pediatric or AYA patients?
There exist no standards of care for patients with HCN NOS after front-line therapy has failed. Considerations include response to prior therapy, agents used front-line/not used, sites of disease, surgical options, and molecular findings of the tumor itself. Platinum/anthracycline-based therapy, car...
How is pediatric and young adult primary bone lymphoma risk stratified?
I can only talk to the pediatric experience. Studies done a number of years ago showed that multiple bone lymphoma does not give a poorer prognosis and therefore in Pediatric NHL, even widespread bone is not stage IV or FAB LMB Group C. If B-lineage, it would be stage III or Group B hence 4 courses ...