Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
What infectious prophylaxis would you recommend in an infant with Wiskott-Aldrich syndrome during donor search and pre-transplant?
In infants with Wiskott-Aldrich syndrome, the degree of immune deficiency is variable and should be evaluated with a comprehensive assessment of both T-cell and B-cell immunity. Current testing typically includes lymphocyte subsets (CD3, CD4, CD8, CD19/20, NK cells), quantitative immunoglobulins (Ig...
How do you approach managing depression symptoms in patients who have had repeated high risk of bleeding?
Overall, evidence suggests that while SSRIs do increase the risk of bleeding. The absolute risk of a bleeding event remains low and is usually not serious. A 2017 meta-analysis by Laporte et al., suggested that overall bleeding risk is increased by at least 36% while other meta-analyses suggest that...
How do you address logistic barriers related to blinatumomab when treating relapsed B-ALL?
This is a very challenging issue that speaks to an incredibly important aspect of delivering not only this drug but others like it. Despite the strong evidence that supports the use of blinatumomab in a variety of clinical scenarios for patients with B-cell ALL [e.g., Gökbuget et al., PMID 29358182;...
What are your top takeaways in Hematologic Malignancies from ASCO 2026?
Phase III SENTRY study of ruxolitinib +/- selinexor in myelofibrosis - The combination arm met the spleen response endpoint, had similar rates of symptom improvement compared to ruxolitinib, and, with short follow-up, there appears to be a signal towards survival benefit. Longer-term follow-up will...
Do you use G-CSF for a patient with ALL admitted for febrile neutropenia with prolonged count recovery?
I agree with this response. To highlight one other consideration: G-CSF is not routinely given during COG-based, pediatric-inspired therapy like the C10403 regimen (Stock et al., PMID 30658992). However, when patients treated with this approach in our system develop neutropenic fever, we will usuall...
In pediatric patients with newly diagnosed B-cell ALL and underlying Lynch syndrome, how does the MMR deficiency inform your treatment planning and survivorship surveillance?
Treat B-cell ALL with chemotherapy appropriate for risk category and usual follow-up. MRI Brain Q 6 months up to age 20, then annually Colonoscopy annually starting at age 6 years Upper endoscopy at age 10 years and annually Whole body low dose MRI annually Physical examination and skin exam every ...
How do you approach chemotherapy-induced thrombocytopenia in patients who do not respond adequately to romiplostim?
That's definitely a difficult and highly nuanced clinical scenario, especially since it can hamper future delivery of chemotherapy and compromise disease outcomes. My approach to this question also depends on whether we are talking about patients with a hematologic or solid tumor malignancy. I will ...
Based on results of the PINES trial, have you shifted your practice to start treatment for newly diagnosed pediatric ITP with eltrombopag?
I would answer this, "yes and no." As many readers will already know, the PINES trial (Shimano et al., PMID 41123939) was a randomized trial of pediatric patients, between eltrombopag and standard care, in a 2:1 ratio, in newly diagnosed ITP and non-severe bleeding, who required pharmacologic therap...
Do you use specific scalp dosimetry constraints to prevent chronic alopecia when treating partial brain volumes with VMAT?
I have been using VMAT for 8 years to treat brain tumors, and permanent alopecia is rarely a complication in patients treated with doses of >50 Gy. For that reason, I personally do not use a scalp OAR constraint when planning a course of partial brain radiation. Prior to the adoption of VMAT, the oc...
Is there a role for nitazoxanide for treatment of norovirus gastroenteritis in immunocompromised patients?
There is no good-quality evidence supporting a role for nitazoxanide for treatment of norovirus gastroenteritis in immunocompromised patients. The efficacy of nitazoxanide in viral gastroenteritis is supported by a small manufacturer-sponsored randomized, double-blind trial in non-immunocompromised ...