Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
What is your approach to screening a cancer survivor for iron overload, and what is your treatment of choice?
We check the ferritin level after completion of chemotherapy. If ferritin is >1,000 ng/ml, we recheck the level as it can be falsely elevated with inflammation/infection. If ferritin is >1,000, we obtain a liver MRI with iron quantification. If liver iron concentration (LIC) is > 5 mg/g dry weight, ...
Do you discuss fertility preservation options with all pediatric oncology patients at the time of diagnosis, and if not, what determines who and when you discuss options?
Yes. We now have a formal fertility preservation program in our institution that was started by and is based in our oncology division. The goal is to discuss fertility preservation options with all patients at the time of diagnosis, regardless of age or prognosis.
How do you approach the treatment of HSCT-associated thrombotic microangiopathy?
TMA can be due to multiple insults: If the patient is on tacrolimus or cyclosporine, the dose should be reduced. These drugs cause the renal afferent arterioles to spasm, and RBC fragmentation can occur on that basis. It typically responds to a dose reduction If the patient was conditioning with TB...
How do you approach deciding which patients with hemophilia B to recommend for gene therapy?
There is no standard protocol for who gene therapy is recommended for, but certainly, potential candidates must meet all criteria according to the manufacturer's recommendations. Gray areas may exist if there is some preexisting liver disease, where hepatology consultation is desired to help determi...
What is your approach to managing iron overload in children with transfusion-dependent beta thalassemia who have adherence challenges or toxicity with standard chelation regimens?
I would divide the adherence issues into two populations. The younger children where a caregiver is responsible for administering the chelation, and adolescents where caregivers have passed on the responsibility to the patient. For the former, adherence is reinforced with an explanation of the possi...
What screening measure on an echocardiogram is most helpful for identifying anthracycline-induced cardiomyopathy?
Cardiotoxicity following cancer treatment can manifest as a range of complications, including left ventricular dysfunction, cardiomyopathy, heart failure, myocarditis, valvular disease, and arrhythmia. Accordingly, careful evaluation of cardiac function in patients receiving chemotherapy is essentia...
How do you screen (imaging, modality) for bone density changes following oncologic treatment in childhood cancer survivors?
Certain survivors of childhood cancer are at risk for reduced bone mineral density, especially those exposed to extensive corticosteroids or radiation, hypogonadism, growth hormone deficiency, and those who have had reduced weight-bearing/mobility for an extended period of time. It is important to s...
Do you initiate hormone replacement therapy in a young woman with treatment-induced primary ovarian insufficiency after childhood cancer?
Yes, absolutely. In patients who are at high risk for POI (i.e., received high doses of alkylators or undergone BMT), we follow estrogen, FSH, LH, and AMH levels yearly. These survivors are seen by a pediatric endocrinologist in a survivor clinic, and (depending on parental preference) may be referr...
What resources/ancillary staff do you utilize for school re-entry after cancer treatment to decrease anxiety, improve self-confidence, and support emotional functioning?
Facilitating school re-entry for children and adolescents undergoing cancer treatment is an important component of comprehensive care. Maintaining engagement in school can help preserve a sense of normalcy and mitigate feelings of isolation and loneliness. However, the transition back to school may ...
What are the main barriers you encounter in enrolling pediatric oncology patients on clinical trials?
Medical mistrust: We have a large Native American population at our institution, and they tend not to enroll in clinical trials. We also have a large population of anti-vaxx parents who tend not to want to enroll patients in clinical trials. Language barrier: 1/3 of our patients' parents are Spanis...