Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
How do you manage cancer treatment-related cognitive change or "chemo brain?"
Chemo-brain is a vexing and complicated diagnosis. In most cases, you don't know the baseline neurocognitive function of individuals with cancer. Many conditions that are associated with chemotherapy like fatigue, depression, and aging can mimic chemo-brain. Estimates are that about 20% of individua...
What criteria is needed in relapsed/refractory B-cell ALL to choose CAR-T therapy over conventional stem cell transplant as destination therapy?
Currently, there are no standard criteria used to choose CAR-T over conventional stem cell transplant as destination therapy. However, there are many factors that often push us in one direction or the other. As we learn more about outcomes after CAR-T cell therapy, there are many factors we know are...
Would you treat patient with early stage unfavorable classic Hodgkin lymphoma with 6 cycles instead of 4 cycles of Nivo-AVD to avoid mediastinal radiation in young female?
I would tailor the number of cycles to the clearance of PET positivity. If one is considering stopping at 4 cycles, I would do a PET scan after 2 cycles and only stop at 4 if it was negative. If it is positive after 2 cycles, I would repeat the PET scan after 4 cycles. If it is still positive, an al...
In a pregnant patient with cyclic neutropenia who has ANC nadirs <500/µL but no history of significant infections or other neutropenia-related complications, would you initiate G-CSF during pregnancy?
Understand that I am not an expert, but no, I would not. As long as she is asymptomatic, I would manage expectantly. If an expert recommends otherwise, I would defer without question.
How do you approach cardiac surveillance in an asymptomatic adult who received anthracycline-based chemotherapy for a childhood cancer and presents to you without an active survivorship program?
At our children's hospital, we are not allowed to follow patients >23 years old if they were not diagnosed and treated at our institution. However, we do offer a 1 time courtesy consultation in the survivor clinic. We request roadmaps and create a treatment summary for the patient, perform a history...
Do you routinely evaluate patients with collagen disorders or Ehlers-Danlos for platelet defects?
Yes, I routinely carry out a full hemostasis evaluation, including platelet aggregation and release studies, in patients referred to me with easy bruising and hypermobility with an increased Beighton score suggesting EDS and in those already diagnosed genetically with EDS. EDS patients typically hav...
Do you routinely consider FDG PET/CT imaging for workup of fever of unknown origin?
The landscape of FUO and IUO and our clinical approach to diagnosing its cause has changed significantly over the past several decades. More sensitive microbiologic screening for infectious etiologies, including syndromic molecular panels and next-generation sequencing are now clinically available a...
What prophylactic antimicrobial agents would you consider for an AML patient with history of levaquin resistant strep mitis?
First, confirm the prior isolate and susceptibility pattern to distinguish resistance to levofloxacin from broader fluoroquinolone resistance and look at β-lactam/vancomycin susceptibility. Individual prior microbiology and local antibiograms should strongly influence the choice. Cefpodoxime is a co...
Under what circumstances do you consider valacyclovir for the management of VZV disease of the CNS?
If the patient has encephalitis would use IV acyclovir and only transition to high dose valcyclovir (2 g every 8 or every 6 hs depending on weight) after improvement. Although there is PK data to support these high doses, I would not use it initially. Immunosuppressed patients have a higher likeliho...
Is there specific data on using luspatercept for sickle beta+ thalassemia with transfusion-dependent anemia?
The mechanism of action of luspatercept is to trap and remove ligands of the TGF beta superfamily of ligands, specifically the growth and development factors (GDFs) 11 nd 15. This allows more maturation and differentiation of the erythroid precursors, and an increase in red cell production and relea...