Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
When do you offer adjuvant radiation therapy for high grade non-rhabdomyosarcoma soft tissue sarcoma (NRSTS) in a skeletally mature teenager or young adult?
ARST0332 tested whether a risk stratification system based on clinical prognostic factors would separate young patients with non-rhabdo STS into different prognostic subgroups and whether each factor used for allocation would be a strong predictor of outcome. A combination of factors was used to ass...
What is your approach to adjuvant treatment for stage IA small cell carcinoma of the ovary, hypercalcemic type, after fertility sparing surgical staging?
Due to the rarity of small cell carcinoma of the ovary hypercalcemic type (SCCOHT), limited prospective data exists to inform treatment decisions. Like other malignancies in the malignant rhabdoid tumor (MRT) family including renal and extra-renal MRT and atypical teratoid rhabdoid tumors (ATRT), SC...
When would you consider stopping chronic transfusion therapy in a sickle cell patient with history of abnormal TCDs but no stroke?
Fortunately, we have good data to answer this question. The TWiTCH trial aimed to determine the efficacy of hydroxyurea at maintaining TCD velocities after discontinuation of initial transfusion therapy to prevent primary stroke. Patients on this non-inferiority trial with a history of abnormal TCD ...
What guidance do you give to patients and families regarding resuming vaccination after completion of chemotherapy?
In our practice, for vaccine series that have not been started or only a single prior dose has been administered, we recommend a new vaccine series according to the CDC regular or catch up schedule. For vaccine series that have been started with at least 2 prior doses, or completed, we recommend a s...
In patients who develop a VTE, what conditions do you consider as persistent, provoking risk factors, and at what point are they controlled enough to stop anticoagulation?
Not a lot of controlled trials that address each situation so we rely on expert consensus and judgement, and more importantly, balancing the risk of hemorrhage vs thrombosis. ASH guidelines define chronic persistent risk factors as 1) Active cancer (e.g., ongoing chemotherapy; recurrent or progressi...
How do you manage a patient with superficial venous thrombosis with close proximity (<3 cm) to deep veins and an inherited thrombophilia ?
I would treat the patient for 3 months with a DOAC and then repeat the scan. If the clot is resolved, I would order a d-dimer and Factor VIII level on anticoagulation. If the tests are negative, I would stop the DOAC and retest at 30, 90, and 180 days. If tests remain negative then stay off anticoag...
What is the preferred radiation delivery technique for whole abdominal or flank RT in childhood cancers?
The rationale for using less sophisticated techniques to treat flank and whole abdominal fields has largely been centered on reducing the potential for growth discrepancies by treating with homogeneous doses across bony structures, most notably the spinal column and pelvic bones. The use of AP/PA fi...
How would you approach local control in a patient with extra-osseous metastatic Ewing sarcoma of the kidney?
I would follow general guidelines for Ewing sarcoma – if the tumor is completely resected, no RT. If spread outside post surgery, then would follow Ewing Sarcoma dosing guidelines.
How would you treat a young patient with classical intermediate-risk Hodgkin lymphoma who has an underlying DNA repair-deficiency disorder, such as congenital mismatch repair disorder or ataxia telangiectasia?
It depends on the DNA repair disorder.
What are contraindications for growth factors in patients with hematologic malignancies?
This is a challenging question where little data exist to support a good conclusion. In real world situations, patients with cytopenias and suggestion of TR-MN warrant aggressive antibodies find yourself deciding which is the "best of class" in its nature. John