Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
When is a lumbar puncture indicated in a lymphoma staging work up for a pediatric or AYA patient?
LP is not necessary in any Hodgkin patient irrespective of stage. LP plus IT chemo is indicated in all advanced stage NHL. The one exception to that is primary mediastinal B-cell with sclerosis which is an intermediate grade lymphoma (similar to Hodgkin) and rarely spreads to CNS. It is true that ...
In what circumstances would you give G-CSF to a patient with severe neutropenia and HLH?
I am not aware of any direct clinical evidence that addresses this question. That said, I would be very reluctant to treat with G-CSF in the setting of HLH. G-CSF is an inflammatory cytokine that might aggravate HLH. Moreover, since the mechanism of neutropenia in HLH is thought to be increased neut...
What treatment approach would you use for patients with localized Wilms tumor which is unilateral, favorable histology, negative LOH, who develop a new lung nodule at the end of therapy?
First, I would confirm whether the new lung nodule represents recurrent disease by biopsy or resection. If positive for tumor, the treatment recommendation would depend on the initial therapy. For relapse after vincristine/dactinomycin (low-risk relapse), an accepted standard is "Regimen I" (vincris...
At what platelet count would you feel comfortable dosing aspirin 81 mg for coronary artery disease in a patient with ITP?
In a patient with ITP, I would certainly feel comfortable dosing aspirin 81mg daily at a platelet of 50,000 or greater. As you know, the risk of bleeding in a patient with ITP is less than would be expected at a particular platelet count because the circulating platelets in ITP are young and large. ...
Would you provide treatment dosing anti-coagulation for a pediatric patient who had an ischemic stroke and was found to have a heterozygous prothrombin gene mutation?
For sure, although it would be important to try to ascertain what kind of stroke this was: hemorrhagic? Thrombotic? Arterial? Precipitating factors? Anticoagulation is clear cut for VTE but not so much for the other types.
How would you approach a patient with metastatic alveolar rhabdomyosarcoma with progression on first-line therapy?
Progression while on therapy in the setting of initially metastatic rhabdomyosarcoma is a very unfortunate situation for which I would not consider there to be curative options. The first consideration I would give in this setting is to assess if there are any available clinical trials. If no clinic...
What is the typical time course of cytopenias after CAR-T therapy, and how do you treat them?
There are no specific guidelines but most patients will have some degree of count recovery week 4-6 but albeit not always the strongest recovery.Management of neutropenia varies widely from institution to institution with regards to utilization of GCSF. Some places will start it in a prophylactic ma...
How young is too young to treat a child's keloid with radiation?
I think this is a helpful question and I think the following questions appropriately highlight the considerations. We do not routinely see or manage these at our center, so I welcome comments from the invited respondents.This is a controversial area and I think there are certainly exceptions which s...
Is there experience/reports of using voxelotor in sickle cell patients who are Jehovah Witnesses with few crises but who have fatigue and/or dyspnea?
I would not hesitate to use voxelotor in most patients with sickle cell anemia, including Jehovah's Witnesses, if they have not responded to hydroxyurea with near cessation of acute vasoocclusive events and have continued hemolytic anemia. Voxelotor usually reduces hemolysis that results in an incre...
What is your preferred approach for patients with anti-phospholipid syndrome with recurrent thrombosis on coumadin and LMWH?
This is a difficult condition to manage and personalized approach/risk stratification is key. There are several potential considerations:Warfarin therapy could be intensified, anti-platelet agents could be considered (although not in combination with LMWH).For patients with an underlying autoimmune ...