Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
What is the risk of secondary malignancy and/or conversion to MPNST for patients with NF-1 who undergo radiation?
Broadly speaking, this is certainly a possibility and this has been a reason why the community has triaged the application of radiotherapy to more high-risk cases (Williams et al., PMID 19117870). Just playing out the numbers independent of the application of radiotherapy, 100% of NF1 patients will ...
For which pediatric oncology patients do you start bacterial prophylaxis, inpatient or outpatient, and what is your antibiotic of choice?
Bacterial prophylaxis in pediatric oncology patients should be guided by the intensity of treatment, depth and duration of neutropenia, and individualized risk for invasive infection. Current evidence and expert consensus support targeted prophylaxis in children with the highest risk of life-threate...
What chemotherapy regimen would you use for a testicular cancer patient in need of BEPx3 but unable to use platinum based chemotherapy regimen due to cochlear implants?
To be succinct, the correct answer is BEP x 3 if he wants the therapy that would achieve optimal cure rate. If disease is limited to retroperitoneal nodes, especially if < 3 cm is the largest node and normal postorchiectomy, serum hCG and AFP, RPLND would then be the preferred option.
Are there any unique considerations for treating pediatric high grade glioma?
Trial availability, disease extent, age, specific molecular alterations, and family history should likely all play a role in choosing the most appropriate treatment paradigm.It’s expected that most future studies in pediatric high grade glioma will be stratified by their nascent biology, given that ...
When do you consider testing with stroke gene panels in young stroke patients?
Broadly, I ask for genetic testing only when I have a specific diagnosis in mind. This testing is not routine in my practice. Examples are: A patient is referred for white matter lesions found on brain MR and a transient neurological episode. The question of CADASIL(NOTCH-3) or related disorders is...
How would you manage a patient less than 40 years old with an incidentally found LGG, IDH mutated, 1p19q intact, s/p STR?
Update: On August 6, 2024, the FDA approved Vorasidenib for IDH-mutant low-grade gliomas based on findings from the INDIGO trial. This decision highlights the FDA's incompetence and lack of scientific integrity, clearly demonstrating that the agency prioritizes pharmaceutical companies' interests ov...
Would you use the pneumococcal conjugate-21 vaccine (Capvaxive) instead of the conjugate-20 (Prevnar-20) for routine vaccinations in immunosuppressed patients?
PCV-21 was recently approved by the FDA and supported by ACIP. At this early stage (August 2024), CDC has not finalized guidance on PCV-21, so we do not know how the vaccine schedule will be changed. An important distinction is that PCV-21 covers different serotypes of pneumococcus, as outlined in t...
Is there any benefit of using aspirin to mitigate VTE risk in testosterone-induced polycythemia?
Erythrocytosis is a common adverse effect of testosterone therapy, and results from several studies suggest an association between elevated hematocrit (Hct) and risk of VTE (Braekkan et al., PMID 19833630; Ory et al., PMID 35050717). There is currently no data to support the routine use of aspirin o...
What is your approach to an infant (<12 mo) with new onset petechiae and thrombocytopenia, with labs consistent with ITP?
In an older (1-6 year old) child with apparent ITP, less work up might be needed. While many tests are possible, in this case, labs consistent with ITP, I would interpret as including a CBC otherwise normal for age without blasts on a smear (if this is not true, the differential is much wider). If i...
Do you recommend salvage radiation therapy to limited recurrent Ewing's sarcoma bony lesions?
Depending on the age of the patient, size, and location of the tumor, SBRT is often an attractive option for re-irradiation for a limited volume recurrence from Ewing sarcoma that failed to respond to prior conventional treatment. There is data from Mayo Clinic (Brown et al., PMID 25548538) and MSK ...