Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
Can we use a linear accelerator to sterilize PPE?
Per FAQ's posted by ASTRO: "At this time, ASTRO does not recommend the use of clinical linear accelerators to sterilize PPE. While ionizing radiation is used for sterilization of blood and food products, this is achieved using industrial irradiators that use gamma irradiation at doses rates far grea...
What is your treatment approach for a pediatric patient with H3K27M-mutant diffuse midline glioma following progression after radiation therapy?
First, if the patient is at least six months from initial radiation and has had a reasonable initial response, reirradiation is the best proven treatment for recurrence. We would also encourage enrollment on a clinical trial (the DMG National Tumor Board is a helpful resource for determining for whi...
How would you manage a rare presentation of an older adult after gross total resection of an "infant-type hemispheric glioma" of the left frontal lobe, IDH1 negative and negative for MYB fusions?
Infant-type hemispheric gliomas (IHGs) are rare high-grade astrocytic tumors characterized by giant size and abundant vascularity, often with regions of cystic transformation. They are aggressive brain tumors that occur during early infancy, usually between 0 and 12 months of age. They are often ver...
What is your preferred treatment agent for type 1 von Willebrand patients needing minor procedures if they have a history of severe hyponatremia with DDAVP?
I would avoid DDAVP. I typically individualize hemostatic management based on the procedure- related risk of bleeding and severity of the VWD. For example, for dental extraction, tranexamic acid alone may suffice; however, communication with the proceduralist to use topical agents such as topical th...
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Should extra precautions be taken for pediatric oncology patients in light of the recent COVID-19 outbreak?
I have not personally seen cases. This is not surprising, however, because our patient population is more susceptible to severe outcomes from respiratory infections. This is compounded by weakened immune function and, for some patients, cardio respiratory damage.
In light of promising results of hydroxychloroquine in COVID-19, should we consider using it prophylactically in cancer patients, especially if immunocompromised?
At this time, as there is no good evidence available, I would not recommend the use of hydroxycholoroquine prophylactically in cancer patients. It is unclear whether it would prevent contagion, probably not, and we still don't know if it will have any effect on the course of COVID-19. We expect ther...
Should we be utilizing prophylactic G-CSF in our patients with intermediate risk of febrile neutropenia due to the COVID-19 pandemic?
There are many functions of G-CSF, including repression of T-cell and NK cell function. Unless you are certain that growth factors are not modifying the immune network to the detriment of viral clearance—there is no data that growth factors help clear viral infections.
Is there any consensus or guidance on how to manage germ cell tumor patients in the COVID-19 era?
Germ Cell Tumor Management in face of SARS-CoV-2: Safe, Rational Modifications to Standard GCT Practice to Protect Public Health, GCT Outcomes, GCT Patients, and Health Systems. This bulletin has been produced by a concerned group of international experts in germ cell tumors, has not undergone exten...
How do you choose first or second-line systemic therapy for fibrolamellar hepatocellular carcinoma?
Fibrolamellar carcinoma is histologically unique from hepatocellular carcinoma. The disease is correctly called fibrolamellar carcinoma, and not fibrolamellar hepatocellular carcinoma, or hepatocellular carcinoma fibrolamellar variant. Even though the latter may be permissive if the lack of cirrhosi...