Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
How has Wilms' tumor therapy evolved over the years?
Wilms' tumor therapy has studied different combinations of vincristine, dactinomycin, anthracyclines, and radiation in several different trials and protocols. The initial trial arm designations were based simply on the letters in the alphabet. We have found that pulse-intensive regimens of shorter t...
How do you manage real-time release of pathology and radiology results to oncology patients following enaction of the CURES act?
Even prior to the Cures Act, I worked in a place where lab and imaging results were immediately available to patients through their smartphone app. A few memorable encounters: Patient 1 - told me his favorable PSA result when I walked in the room and basically told me the plan going forward, (which ...
How do you interpret a Deauville score of 3 on PET when performing mid-treatment assessments in patients with Hodgkin lymphoma?
A Deauville score of 3 or less in an area of disease previously positive (Deauville score of 4 or 5) at interim assessment is considered to be a complete metabolic response (Lugano criteria, Cheson et al. JCO 2014). Some studies evaluating a de-escalation of therapy based on interim assessment may c...
Does R-CHOP provide durable remission in low-risk pediatric Burkitt or Burkitt-like lymphoma?
It depends on your definition of "low-risk". Historically, the FAB defined low risk as FAB Group A (resected Murphy stage 1 tumor and resected Murphy stage 2 abdominal primary). Gerard's paper in BJH in 2008 reported a 98% EFS with two cycles of COPAD (basically CHOP with fractionated cytoxan) and n...
When do you consider plasma exchange for multiorgan failure in a patient with sickle cell disease?
The first choice for treating multiorgan failure in sickle cell disease is exchange transfusion that should be started as soon as possible. Sometimes the clinical and hematologic features of sickle cell multiorgan failure resemble and overlap those of thrombotic microangiopathies like TTP. Also, tru...
Would you check vitamin B6 routinely in the work up of anemia?
I only consider it when I see ringed sideroblasts in the marrow. It is on the differential of things that lead to ringed sideroblasts. "Pyridoxine responsive anemia", which can be inherited or acquired. However, in my experience, it is very rare. Even the couple of people I have had with mildly decr...
Would you discontinue anticoagulation in patients with antiphospholipid antibody syndrome, who have a remote history of thrombotic events and are now negative for pathogenic antiphospholipid antibodies?
I would certainly consider stopping anticoagulation in selected patients after an in-depth discussion about potential risks and benefits. I would not consider stopping AC in patients with a history of recurrent events, arterial events, or multiple risk factors for thrombosis (e.g. nephrotic syndrome...
For a young male with Stage III intermediate risk NSGCT with active 1 ppd smoking history but normal PFTs and DLCO results, would you still consider use of BEP x 4?
I agree with Dr. @Dr. First Last. However, intermediate risk is between good risk and advanced disease, and in my opinion, despite the NCCN guidelines, I have never seen the logic nor the necessity of treating ALL intermediate patients the same as advanced disease with BEP X 4. Most of my intermedia...
Are there best practices or data regarding the use of open notes among oncology patients?
The 21st Century Cures Act regulation (effective April 2021) required that clinical notes such as consult and office notes be shared with patients, e.g. “open notes.” In general, surveys of patients with cancer and their clinicians suggest that open notes are viewed favorably (Salmi et al., PMID 330...
Do you treat stage 1 non-seminoma differently if there is a component of embryonal carcinoma?
No.