Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
How do you address non-adherence to medical treatment in adolescent and young adult oncology patients due to mental illness such as depression?
The best answer, I think, is to obtain a thorough child psychiatric evaluation. Noncompliance may arise from a number of different issues, some of which may relate to major mental illnesses such as major depression or anxiety disorders, or more cognitively based concerns such as ADHD or executive fu...
How do you approach the work-up for a patient with iron deficiency anemia who is not responding to oral iron therapy?
Have the patient's iron loss sources been controlled? GI blood loss due to gastritis, IBD, and other issues is the number one cause. Menstrual bleeding is common in post-menarchal girls. I really like the menstrual chart in the Better You Know campaign from the CDC and NBDF. This can identify bleedi...
For a patient with May-Thurner syndrome and DVT, would you recommend anticoagulation for 3-6 months or indefinitely?
This is a very good question, there is little data on this and there are only a few case series. One case series of 8 patients showed a 25% risk of recurrence in one year with May-Thurner syndrome but too small of a sample to really know what the risk is, plus this probably included a heterogenous m...
In the era of MEK inhibitors and BRAF V600E-targeted therapy, what is the role of traditional vinorelbine/prednisone in the management of Langerhans cell histiocytosis?
A similar question came up during rounds this week, and I recalled seeing this question here.I assume the asker meant vinblastine, and not vinorelbine; the combination of vinblastine and prednisone is considered standard therapy, whereas vinorelbine has not generally been used in LCH.Let's first bet...
Do you recommend preloading with IV magnesium to decrease the risk of cisplatin nephrotoxicity?
Although there have been studies demonstrating that hypomagnesemia has been associated with an increased risk of AKI, there have been no clinical trials indicating preloading with mag prevents AKI. I would recommend to have the magnesium above 2mg/dl prior to cisplatin.
Do you routinely recommend loratadine for pegfilgrastim pain?
Despite its popularity, there is not good evidence that Loratadine improves bone pain from pegfilgrastim. There are small, uncontrolled studies that suggest a benefit, however a randomized trial of Loratadine vs. placebo did not show a difference between groups in bone pain or quality of life.
What are your top takeaways in Classical Hematology from ASH 2024?
In the category of continuing what I already do, ASH 2024 provided an important confirmatory study of how to approach the treatment of patients with high-risk venous thromboembolism (VTE).In the EINSTEIN CHOICE (Rivaroxaban) and the AMPLIFY-EXT (Apixaban) studies, extended reduced-dose anti-coagulat...
Do you recommend adjuvant radiotherapy for an adult patient with localized myxopapillary ependymoma, WHO Grade 2, status-post gross total resection?
I assumed that this is a case of spinal ependymoma. Myxopapillary ependymomas are rare tumors and optimal therapeutic strategy involves a Gross Total Resection (GTR). The more complete the surgery the better the outcome. The role of postoperative radiation after a GTR is somewhat controversial but I...
What is your approach to screening a cancer survivor for iron overload, and what is your treatment of choice?
Excellent article on this topic: Baskin-Miller et al., PMID 39096194
How do you decide between RPLND vs. chemotherapy in patients with Stage IIA mixed germ cell tumor as primary treatment?
I agree but would add a few comments: If there is a rising hCG or AFP above normal values, we prefer BEP X 3 rather than RPLND. If the patient > age 50, EP X 4. Also, we consider any AFP < 25 to be “ normal” despite many labs listing 0-8 as their normal range. Our group recently published data in J...