Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
Would you change therapy for a CML patient in hematologic remission on imatinib found with positive qualitative BCR-ABL1 for the p230 protein?
It would depend on how long the patient has been on imatinib and the sensitivity of PCR testing. Being able to monitor the p230 transcript at the level of 0.1% or even deeper would be helpful to characterize if the patient has achieved a major molecular response or not. This publication outlines the...
Are you including Bortezomib as standard of care in the upfront treatment of T lymphoblastic-lymphoma?
We do use bortezomib in the upfront treatment of T-cell lymphoblastic lymphoma in children and AYA. For those familiar with the topic, the results of two successive large clinical trials in T-LLy done by COG, AALL0434, and AALL1231, were confusing. Due to the rarity of the disease, overlapping trial...
Is it acceptable to do IFRT rather than whole posterior fossa boost for high risk medulloblastoma?
Based on dosimetric patterns of failure and early pilot studies of tumor bed boost from the University of Michigan and Memorial Sloan Kettering, respectively, the recently completed ACNS0331 clinical trial randomized patients with average risk medulloblastoma to whole posterior fossa or tumor bed bo...
Is there any indication for hydroxyurea in patients with sickle cell trait?
No. Of course, be sure it is the correct diagnosis and not HgA + HgS (beta+) which, as you know, shows HgA and HgS on electrophoresis and can/will be called trait if not looked at by someone experienced to note if A> S or if S > A. If MCV is low. If HgA2 is up. HgF up etc... If indirect Bili/LDH/AST...
How do you manage arthritis resulting from deferiprone in transfusion dependent thalassemia?
The precise pathophysiology of deferiprone associated arthropathy is not well understood but some reports have suggested that there may be some deposition of iron in the synovial membranes, and some subchondral bone damage. Unfortunately, there is no specific treatment for this arthritis, other than...
How do you manage mild Type 1 von Willebrand disease undergoing wisdom teeth removal?
This depends on the patient's past personal and family bleeding history with past challenges and on the VWF levels. If past challenges are known and no bleeding has occurred, and if the VWF levels are 30 IU/dL or greater, I would give only EACA p.o. pre and post. Intranasal DDAVP 2 hours prior and 4...
Is there a correlation between spleen size and degree of thrombocytopenia?
In a normal individual, approximately 1/3 of total body platelets are sequestered in the spleen at any given time. As the size of the spleen increases, so too does the proportion of platelets in the spleen increase. This is due to the total volume of the spleen, not just longitudinal measurement. It...
Would you consider continuing or re-trialing hydroxyurea for sickle cell patients after development of a leg ulcer?
I do not think HU is the cause of leg ulcers, neither does ASJ. Habibi et al., Blood 2023 Most cases of ulcers are multifactorial and studies have also included patients with thrombocytosis (even myeloproliferative disorders!!). Low nitric oxide is part of the cause of leg ulcers in most cases. HU r...
How do you manage prophylactic antimicrobial medications in patients who undergo ATG/cyclosporine/eltrombopag induction for severe aplastic anemia?
Yes for prophylactic antibacterials after ATG/cyclosporine and eltrombopag treatment of AA. Antiviral with valtrex 500mg oral twice daily and PJP prophylaxis while on immunosuppression with cyclosporine.Antibacterial with levofloxacin and antifungal prophylaxis with posaconazole 300mg oral daily or ...
Is it appropriate to substitute vincristine for vinblastine in ABVD for systemic therapy of Hodgkins lymphoma?
I would give vinorelbine.