Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
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...
When using daratumumab in the setting of post-transplant red cell aplasia or post-transplant immune-mediated cytopenias, do you hold the drug for certain ANC parameters?
Typically, we do not hold until below ANC 500.
How do you approach steroid-refractory GVHD in patients who either cannot receive ruxolitinib or do not respond to ruxolitinib?
Both acute and/or chronic GVHD could be steroid-refractory. In patients with acute steroid-refractory GVHD, I would target therapy based on organ involvement. If skin is involved and the patient cannot take or get ruxolitinib, I would use ATG first, in particular if severe disease, but there is a nu...
What is your approach in a fit patient, advanced stage, bulky classical Hodgkin lymphoma who has decreased disease burden in areas but a persistent, hypermetabolic (Deauville 5) anterior mediastinal mass following two cycles of AAVD?
Biopsy!If persistent HL:I know it is only phase II data, but I've been impressed with the ORR and personal experience with pembro-GVD: Moskowitz et al., PMID 34170745.I hate radiating the chest, but one could argue that option as well.