Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
How do you approach patients who are inappropriately worried/fixated on a test result that is flagged as abnormal but not clinically significant?
This happens all the time now. I tell them that those results were flagged as outside the reference range (I don't use the term abnormal) but that they are not clinically significant. It does not always work if there is a patient who is super anxious or hyper-focused. Typically, if they need a lot m...
For transplant-ineligible aplastic anemia planned for immunosuppression, how do you approach duration and tapering of cyclosporine and eltrombopag?
One of the most common mistakes in the management of AA is premature tapering of cyclosporine or tacrolimus. If there is a complete remission, and by that I mean normalization of counts, not complete remission as defined in some papers (e.g., ANC 1000, Plts 100,000, Hb 10 as in de Latour et al., PMI...
How will you utilize the PARADIGM study results from ASH 2025, comparing azacitidine/venetoclax to intensive induction chemotherapy for fit patients with newly diagnosed AML?
It was very exciting to see PARADIGM presented as a plenary at ASH, and I look forward to the manuscript! Interpreting the findings in the context of the enrolled patients is very important. The median age of enrolled patients was approximately 65 years in both arms, and ~75% of enrolled patients ha...
How would you approach adjuvant radiation therapy for a young adult woman with recurrent myxopapillary ependymoma?
Extraneural spread of a myxopapillary ependymoma is exceptionally rare. In this case, I would strongly favor adjuvant local radiotherapy to the postoperative sites, assuming they have not previously received prohibitive radiation doses (especially the pre-coccygeal site). The situation is different ...
How do you explain the use of an AI scribe to patients the first time it is used in their care?
I use an AI scribe in my outpatient clinic, and around 90–95% of my patients agree to it. I obtain consent at the start of each visit and make it clear that it's completely optional—that they can say no at the start or change their mind at any point in the visit, with no impact on their care. I also...
How would you manage a patient with HbSS and severe pulmonary hypertension on home oxygen?
This patient should be referred to a specialist in pulmonary hypertension in sickle cell disease for right heart catheterization and aggressive management of the pulmonary hypertension. As described, the patient is not a good candidate for lung transplant or gene therapy.
Between the MERLIN and CASTLE tests for melanoma, which do you prefer and why?
I prefer DecisionDx-Melanoma, without question. It’s the only test that prospectively met its primary endpoint, with SLN positivity below 5% in the low-risk group. Merlin’s CP-GEP did not meet that threshold in MERLIN_001. DecisionDx also goes beyond the SLNB decision by independently predicting rec...
How do you approach perioperative hemostatic management for a patient with severe factor 11 deficiency <1%, without inhibitor, who has a significant postoperative bleeding history despite FFP prophylaxis who is undergoing major ENT/skull-base surgery?
This is a complex group of patients. There are systematic reviews that one could look up (Al-Housni et al., PMID 42189746). They involve various combinations of FFP transfusion, rFVIIa, and antifibrinolytics. Our practice has been to risk stratify the surgery based on the patient's personal bleeding...
Is there any indication for IVIG in immunocompromised patients with only decreased IgM and/or IgA levels?
Nope. IVIG preparations contain IgG not IgA or IgM. Low serum IgA may or may not be associated with low IgA levels in mucosal surfaces leading to a risk of local infections. Low levels of one or both may be asymptomatic but in the right setting might suggest a need for evaluation of plasma cell dysc...
For iron deficiency anemia due to heavy menstrual bleeding, what is your preferred method of controlling heavy menses?
I definitely loop in my GYN friends for this one! According to ACOG: "Heavy menstrual bleeding is defined as excessive menstrual blood loss that interferes with a woman's physical, social, emotional, or material quality of life." The consequences of HMB are substantial and multifaceted, and, as we f...