Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
What are your top takeaways in Lymphoma from ASH 2025?
Fixed-duration versus continuous targeted treatment for previously untreated chronic lymphocytic leukemia: Results from the randomized CLL17 trial — This trial may change practice by using the combination of BTK-I and Ven without CD20 antibodies. This time-limited option led to MRD, and I would expe...
How do you manage patients desiring home hospice but with severe thrombocytopenia and/or anemia due to advanced malignancy?
As a pediatric hematologist/oncologist and pediatric palliative care physician, I can only speak to our approach with children, which may be quite different than the adult world. In our community, we are not able to provide blood or platelet transfusions in the home. For children who are profoundly ...
Would you recommend anticoagulation prophylaxis for a pediatric patient admitted with COVID-19?
COVID-19 disease in children seems to be less severe than adults based on the current literature and our personal experience at Children's Hospitals. Among adults, the coagulopathy is beginning to be described with elevated inflammatory markers and other markers of coagulation activation, including ...
How do you counsel families of pediatric patients regarding risk of secondary malignancy or IQ changes with cranial radiation using photons?
It’s a great question as these are two of the scariest things that families face when you relay the potential risks of cranial radiotherapy. Simple things like timing of these topics in the consent discussion can make a difference. Don’t start with the scariest potential risk when doing the consent,...
In which patients with atypical HUS would you consider eculizumab discontinuation?
My approach to eculizumab cessation in aHUS is to at least consider cessation in all patients not only given the high cost of the drug, but also given the risk of meningococcemia, which is incompletely protected against by vaccines.In treating aHUS, I initiate eculizumab (and preventive therapy for ...
How do you manage symptomatic radiation necrosis not responsive to steroids?
I agree with the above recommendations. We review these cases at our brain tumor board. We often start off with confirming the diagnosis using MRI with perfusion. If perfusion is equivocal (hard to interpret or lesion is too small) and the patient is asymptomatic, we follow. If the patient is sympto...
How do you incorporate psychological care into the surveillance and treatment of a pediatric patient found to have a cancer predisposition syndrome?
Psychological care is critical for patients with a lifetime genetically increased risk for cancer, with different needs at different stages of life.This was recently explored in an excellent article published in Pediatric Blood and Cancer "How We Approach the Integration of Psychological Services in...
Do you scale up 2nd generation anti-histamines to 4x daily in acute urticaria in the pediatric population as you do in adults?
Severe urticaria is certainly a therapeutic challenge. Updosing 2nd generation antihistamines in children has been studied, more trials need to be done. For refractory urticaria in children, I will often recommend 2X the recommended dose of a 2nd generation antihistamine in the morning and maximize ...
How do you decide the right time to transition to hospice?
Talking about hospice is one of the hardest jobs we have. It's hard because we don't like doing it, because we often don't know how to do it well, and because we angst about doing it too early or too late. It's an important thing to think about. I actually think perhaps the most important factor in ...
When would you consider testicular RT prior to TBI for BMT?
In children with ALL treated with systemic chemotherapy alone (no transplant), the risk of testicular recurrence is ~15-20% (Br J Haematol 2003;123:396, Br J Haematol 1998;102:656). In adults with AML treated with standard chemotherapy, with or without transplant using a chemotherapy alone condition...