Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
Is there a Mednet app?
Mednet app is here! Follow these links to download it for your iOS and Android devices.
In what clinical scenario would you consider liver transplant evaluation for a patient with sickle cell hepatopathy?
I would do a concurrent stem cell transplant - in an effort to cure the underlying problem of sickle cell disease. Ideally, the same donor to prevent graft rejection.
Is there any indication for IVIG in immunocompromised patients with only decreased IgM and/or IgA levels?
Nope. IVIG preparations contain IgG not IgA or IgM. Low serum IgA may or may not be associated with low IgA levels in mucosal surfaces leading to a risk of local infections. Low levels of one or both may be asymptomatic but in the right setting might suggest a need for evaluation of plasma cell dysc...
How will you use Pola-R-CHP in the frontline treatment of DLBCL?
Given the comparable toxicity profile and the lower rate of treatment failure, the number needed to treat (n=16) is low enough that this is very appropriate to be the new standard of care. Although overall survival was not different, fewer patients treated with the Pola-R-CHP regimen required subseq...
How would you counsel a woman with a strong family history of thrombosis about oral contraceptives?
This can be a complex question for which there are likely no specific data or guidelines upon which to base a recommendation. ASH has published guidelines on thrombophilia testing in VTE (Middeldorp et al., PMID 37195076). They specifically recommend against testing prior to COC prescription. The ra...
Is your standard of care for newly diagnosed advanced classical Hodgkin now nivolumab-AVD based on SWOG 1826?
I think the new standard of care for newly diagnosed patients with advanced classical Hodgkins Lymphoma is now nivolumab-AVD based on the early data from SWOG 1826. While we often wait for more mature data, the early improvement in PFS and the more favorable toxicity profile of this regimen over BvA...
Do you offer fertility preservation to patients prior to CAR-T therapy?
There is no evidence yet about the impact of CAR-T itself on fertility, and this will be difficult to study in isolation in this population. Many CAR-T patients have been heavily pre-treated, so semen cryopreservation and oocyte harvesting may not be successful; but if feasible they should be attemp...
What is your approach to chronic non-immune mediated thrombocytopenia management in children?
There are whole textbook chapters on this topic, and we use a variant of this question to review the differential diagnosis of thrombocytopenia with our fellows as a didactic exercise. So I take from this question, which is an important one, what might be a framework to consider the differential dx ...
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...
How would you manage a child with subtotal resection of an atypical choroid plexus papilloma?
Data from the SickKids Hospital study strongly suggest that the extent of resection is prognostic in atypical CPP, and in the presence of GTR, chemotherapy may be avoided or skipped entirely (Browne-Farmer et al., PMID 34529227). The role of adjuvant treatment in the setting of incompletely resected...