Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
How would you treat refractory unresectable pulmonary metastases in high grade synovial sarcoma?
Unfortunately, the outcomes for patients described in this vignette are dismal. Complete pulmonary metastasectomy seems to be the most effective treatment for long-term survival in selected patients but this is usually only achievable in the setting of oligometastatic disease. In the largest series ...
How do you approach an isolated CNS relapse of AML in a young child under the age of 5?
Isolated CNS relapse in pediatric AML is a rare event. Relapses are usually in the bone marrow +/- CNS involvement, suggesting that AML is a systemic disease in need of systemic therapy. Having said that, there is evidence that local treatment with intrathecal (IT) therapy can be effective in an iso...
What strategies have you found to be most effective in engaging PCPs in a primary-care or shared-care model of survivorship for pediatric and AYA patients who will receive ongoing care in their communities away from their primary oncology treatment site?
This is a challenge for our center, and many other centers as well. The ideal approach would be to have adult primary care physicians associated with our center who have dedicated clinic time to care for cancer survivors, direct access to our expertise and medical records. While we haven't been succ...
How do you incorporate integrative medicine into the field of pediatric hematology/oncology?
Robust evidence is lacking on the potential benefit of integrative therapies for pediatric hematology/oncology patients. That being said, we have incorporated integrative therapies including massage, acutherapy, and animal-assisted therapy (and soon aromatherapy) into both the inpatient and outpatie...
How would you treat stage II pediatric type follicular lymphoma that is not amenable to surgical resection in an adolescent and young adult patient?
PTFL is recently distinguished as a distinct histopathological and clinical entity in the 2016 WHO Classification of Hematopoietic and Lymphoid Tissues. As such, previous reviews of pediatric follicular lymphomas include patients with other types of NHL which do not meet the definition. The best rev...
How long do you continue caplacizumab in relapsed refractory TTP?
While there are no data from studies to guide our answer, general practice is to continue caplacizumab until the ADAMTS13 activity is at least 20% on two occasions, or greater than 30% assuming it was measured at least 4-5 days after the last plasma exchange procedure. The goal is to have stable rec...
What is your perioperative approach for a patient with severe hemophilia?
The optimal management of people with hemophilia is complex. Planning for elective surgery should include the patient, family/caregivers, and all relevant clinicians to ensure that best practices are followed. Collaboration with experts from a hemophilia treatment center to develop a hemostatically ...
How do you help your patients with relapsed/refractory/terminal osteosarcoma who want to donate their tumor for research?
In these cases, one should identify: A) Whether the patient is enrolled on COG study APEC14B1 Project: EveryChild (eligibility up to age 25), B) Whether they are interested in donating tissue that is already banked or to be banked, C) Whether the patient is planning on having an autopsy performed af...
What is the role of upfront addition of an ALK inhibitor in an ALK positive mature B Cell lymphoma in an AYA patient?
Crizotinib has gained FDA approval in pediatric patients > 1 as monotherapy for relapsed anaplastic large cell lymphoma (ALK+) based on the COG ADVL0912 study. The agent was subsequently studied in upfront ALCL with aggressive chemotherapy based on the European ALCL99 regimen in ANHL12P1 but there w...
How would you approach immunosuppression for patients with severe aplastic anemia who are not transplant or ATG candidates?
There are relatively few alternatives. One is just supportive care with transfusion, antibiotics, etc. Many patients will adapt to low Hb and do ok with low platelets and do not require therapy. A calcineurin inhibitor alone or with eltrombopag can also be used - the response rate is not as good as ...