Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
Do you check asparaginase levels for all patients receiving receiving E. coli-derived products, or only in certain clinical situations?
Yes, we do. We routinely check levels one week after each dose of long-acting asparaginase. There are several recent reviews which make this recommendation. The main reason is to detect silent inactivation, which is reported to occur after 1-5% of administrations. In some obese patients especially w...
Do you recommend continued PCR testing in a CML patient who underwent allogeneic stem cell transplantation with an identical match about 20 years ago?
If the patient was transplanted in chronic phase and has not experienced relapse post alloSCT nor h/o BCR-ABL1 Q-PCR/FISH positivity post alloSCT, I do not believe that there is much value for continuous PCR testing 20 years later as the vast majority of the relapses occur the 1st few years post all...
Can Hodgkin-like PTLD be treated with Rituximab and weaning of immunosuppression, or is Hodgkin-directed chemotherapy necessary for cure?
PTLD presenting as classic Hodgkin lymphoma is one of the most rare types of PTLD. As such, there are no clinical trials addressing this condition. Pediatric approaches to polymorphic PTLD, in general, include reduction of immunosuppression, rituximab monotherapy, or rituximab with "light" chemother...
Do you routinely use G-CSF post-allogeneic transplant for non-haploidentical transplants?
Yes, we do. Although when we do reduced intensity transplants, we delay until after methotrexate is complete. Often counts recovery before the GCSF starts.
How common are nasal telangiectasia in patients with systemic sclerosis?
Telangiectasias, particularly “matted’’ ones are often seen in patients with Systemic sclerosis (SSc), both limited and diffuse cutaneous. They can also be seen in patients with MCTD, UCTD with SSc features, Lupus or Dermatomyositis (often periungual). In SSc, they are most commonly on the face and ...
How do you manage severe hypertriglyceridemia in the adolescent & young adult population receiving chemotherapy for ALL, in the absence of complications related to hypertriglyceridemia?
Not sure what the adults do but in the pediatric/AYA population, I stop the drugs most likely to cause this - often a combination of steroids and asparaginase, consult one of our cardiologists who has a major interest in hyperlipidemia and in the asymptomatic patient, he almost always cautions again...
How would you approach microcytosis without anemia with high TSAT and ferritin?
This is likely thalassemia trait with iron overload. I would look at the smear to confirm, consider hemoglobin electrophoresis. Sometimes HFE mutations are cofactors that can add to the iron overload so I look for those. If the ferritin is >300, I consider careful phlebotomy to assess mobilized iron...
Would you consider post-BMT maintenance therapy for patients with Ph-like ALL with a JAK2 mutation?
In brief, I would not.Here is the evidence I have that leads to this conclusion: The activity of targeted therapy for Ph-like ALL has not been established. There are a number of ongoing studies that are attempting to address this (e.g., AALL1521/INCB18424-269; see Tasian et al., ASH 2022). What data...
How soon after CAR T-cell therapy can salvage radiation be delivered?
This is another important question. In our practice, the earliest we have treated patients is after their first post-CAR-T PET/CT at day 30. An abstract presented in an oral presentation at this year's ASTRO meeting by Dr. @Dr. First Last describes that radiation to sites of incomplete response at t...
In a patient with recurrent fibrolamellar HCC a year after upfront resection (previously refused adjuvant therapy) with a solitary abdominal mass, would you offer neoadjuvant therapy to assess response?
Recurrent disease is the best care for under clinical trials for FLC. There are not many, sadly because of limited support. But there are some, like NCT03860272.