Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
How has the virtual aspect of tumor boards impacted their educational quality in the Covid-19 era?
In my experience, tumor boards serve 2 purposes. Firstly, they are designed to bring multiple specialists and cancer providers together in real-time to facilitate patient care. Secondly, they help educate the various disciplines based on a robust interaction. Virtual conferences are complicated by d...
How do you manage a patient with a history of high-risk leukemia who has increasing loss of donor chimerism in the post-transplant setting in the absence of disease relapse?
Decline in donor chimerism is not very common in pediatric patients who underwent myeloablative conditioning regimen for hematologic malignancy, and if chimerism is initially 100% and subsequently falls, it usually represents a relapse of underlying leukemia, or a new malignancy. I always obtain lin...
How do you interpret elevations in antiphospholipid antibodies that are lower than Sapporo criteria?
I would refer to the following article that provides the most up-to-date definitions (including the definitions for low-level antibodies) and risk stratification tools including APL-S and GAPSS that are developed for people with autoimmune conditions. The article also discusses the levels of evidenc...
What is the role of stem cell transplant as a consolidation therapy in relapsed Wilm’s tumor?
The role for high-dose chemotherapy (HDT) followed by autologous stem cell rescue for Wilms tumor (WT) is uncertain. There has never been a randomized controlled trial and the available evidence is limited to case series, which are influenced by selection bias and lack of adequate control arms. Perh...
What is the benefit of cytoreduction with Hydroxyurea for patients with newly diagnosed chronic phase CML with a WBC count >100 prior to the initiation of a TKI?
For newly diagnosed patients with CML, there is no benefit to using hydroxyurea before TKI. Using HU oftentimes ends up causing cytopenias and it then makes it challenging to keep patients on their TKI when it is started. There are some scenarios where it is reasonable to use- if you don’t yet know ...
How do you define bulky disease for Hodgkin's lymphoma which is outside the mediastinum?
Definition of bulk in lymphoma is not homogenous among countries, study groups, and diseases.Overall, 10 cm is considered the cutoff by some. Recently, the cutoffs of 7 or 7.5 cm have been introduced, especially in DLBCL. The definition tends to be disease-specific sometimes, since landmark studies ...
In light of the recent rEECur trial interim analysis, would you offer high-dose ifosfamide to an AYA patient with relapsed Ewing's sarcoma who initially had a complete response to up-front therapy?
Yes, I would certainly consider offering high-dose ifosfamide to relapsed Ewing's sarcoma patients in light of the rEECur results [McCabe et al., J Clin Oncol 40, 2022 (suppl 17; abstr LBA2)]. The first line regimens I have traditionally offered to recurrent EWS patients have been topotecan/cyclopho...
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...