Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
Is rituximab for refractory ITP contraindicated in the setting of an active COVID infection, particularly in a patient with asymptomatic COVID?
Given that we would delay rituximab treatment for many active infections, I would recommend that we apply the same restrictions. I would hold the rituximab for ten days after covid test confirmation.
What is your institutional approach to a restrictive “neutropenic diet”?
Simple answer: never. The "neutropenic diet" has no efficacy and may actually be nutritionally AND microbially inferior to normal diet. This has been shown by multiple studies. I like the title of the review, "Things We Do For No Reason: Neutropenic Diet." Ma et al., PMID 35356218. Radhakrishnan et ...
Which, if any, young/fit intermediate-risk AML patients would you not offer allogeneic transplant to in MRD- CR1?
At our center, we routinely offer the option of allogeneic stem cell transplant to younger fit patients with intermediate and poor risk AML. The only individuals that we would not offer this to are those with biallelic CEBPalpha mutant AML or NPM1 mutant/FLT3 wildtype AML without a matched sibling d...
How soon do you anticipate response to cyclosporine in red cell aplasia and what cyclosporine trough levels do you target?
I typically use tacrolimus rather than cyclosporine. I find it has fewer off target effects and is easier to maintain blood levels. Trough blood level is 5-10. Cyclosporine levels are 100-400 which is too broad. I would give it at least 3 months. If not done already, I would do for LGL.
What is your approach to using medications that can cause bone marrow suppression in SLE patients who have persistent leukopenia?
I am so glad someone asked this question. I have heard some peers state that they are reluctant to use immunosuppressants in this situation. However, I do not agree with this. The whole reason our systemic lupus (SLE) patients have leukopenias is due to their autoimmunity (but make sure drugs, infe...
How do you approach anticoagulation in the setting of HIT and thrombocytopenia?
This is a very relevant but rather broad question. On a day-to-day basis, the decision on whether one is dealing with HIT vs other causes of thrombocytopenia can be complex. Applying the 4Ts score is easier in retrospect, but in real life patient management, the score has the potential to change alm...
Is there any scenario where you would consider treating a relapsed AYA patient with Hodgkin Lymphoma without consolidative auto transplant?
Risk-adapted, response-based therapies for pediatric Hodgkin lymphoma have resulted in five-year survival exceeding 90%, even for high risk patients 1. High-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (HDCT/ASCT) is standard for adults with first relapse or refra...
Is an elevated CRP an expected finding in an otherwise healthy patient with hemoglobin S - alpha thalassemia?
If you Google "CRP levels in sickle cell disease", you will find a number of articles reporting that CRP levels are chronically elevated in many patients with SCD. This undoubtedly reflects the chronic inflammatory state that is part of the clinical milieu of SCD. Patients with Sickle - alpha thalas...
Do you recommend starting an antiplatelet for primary prophylaxis in post splenectomy thrombocytosis given there is some increased risk of venous thrombosis?
I do not recommend routinely initiating prophylactic antiplatelet therapy for post splenectomy thrombocytosis. First, in patients without a myeloproliferative neoplasm (MPN), the increase in platelet number post splenectomy is both delayed and mild, and there is no correlation between reactive throm...
Do you consider travel as a risk factor for DVTs in the absence of any other underlying predisposing factors?
Unfortunately, there are no strong guidelines around this topic. In general, I do not count long car rides as a risk factor unless there is something extremely unusual about the trip. Most people are going to get out and stretch their legs every couple of hours. Long flights are different. There are...