Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
What is the ideal period to wait until curative surgery for patients with acute pulmonary embolism and solid malignancy?
This is a very important and practical question. As with most clinical circumstances, there is no evidence-based recommendation. The approach will vary with individual situations. For example: 1) Incidentally discovered subsegmental PE: my bias would be to proceed with curative surgery after one mon...
What is your preferred formulation of parenteral iron?
The question is not simple. The formulation I use the most is ferumoxytol because four insurance carriers allow a total dose infusion of 1020 mg in 20-30 minutes. This has been published twice (Auerbach et al., PMID 21922526 and Karki and Auerbach, PMID 31155744). Otherwise, it must be given as two ...
What is the radiation volume for M+ pure germinoma with brain only extra-ventricular mets and negative CSF/spine imaging?
In general, I wouldn't recommend chemo for M+ Germinoma kids because it does not favorably improve the therapeutic ratio based on the findings from GCT96 (NCT00293358).Independent of chemo, 24 Gy CSI with a boost to 36-40Gy is sufficient for cure. With chemo, 21 Gy CSI & an involved field boost to 3...
What treatment regimen would you recommend for young adults with platinum refractory relapsed germ cell tumors?
We assess the patient risk by IPFSG score, and if it is high score or has extragonadal primary site then we consider tandem high dose chemotherapy and autologous transplantation https://onlinelibrary.wiley.com/doi/full/10.1002/acg2.47 The data sometimes is unclear on the role of HDCT . - the larges...
What cardiac surveillance would you do for an asymptomatic male patient with a remote history of mantle field radiation for Hodgkin's lymphoma?
I would follow the long-term follow-up guidelines from COG based on heart dose - Children's Oncology Group (survivorshipguidelines.org)
How is transferrin saturation a reliable indicator for any parameter if serum iron is not reliable?
The question is a very good question. The Fe/TIBC must be drawn on an overnight fast including any vitamin pills containing iron. Otherwise, the serum iron is speciously elevated which in turn speciously elevates the TSAT. If those conditions are met, the TSAT is as good as the transferrin receptor ...
What subset of sickle cell disease patients are you offering sickle cell disease gene therapy?
All patients with Hgb SS and patients with Hgb SC who have had any significant complications, excluding chronic pain.
When do you refer AYA patients with newly diagnosed severe aplastic anemia for transplant?
In a young person, my first thought is to obtain telomere lengths to be sure he/she does not have a telomeropathy. This has significant implications both with and without transplantation. Certainly, if telomeres are short, allogeneic transplantation is preferred since there is less likelihood of res...
What was the rationale behind using RANO-HGG criteria instead of RAPNO criteria for the primary endpoint in the FIREFLY-1 trial for pLGG?
I think this was a mistake, but I understand that this was requested by the FDA. We all know that MEK and BRAF inhibitors change the pattern of enhancement within days/weeks after the beginning of the treatment. As RANO-HGG is essentially based on the assessment of enhancing measurable and nonmeasur...
How would you treat a stage 1a Sertoli-Leydig cell tumor with heterologous elements?
Assuming this is an ovarian tumor, the patient should be evaluated for a Dicer 1 mutation (Schultz et al., Clin Cancer Res 2018)If the tumor is completely resected and is a stage 1a tumor and the patient is well, then I would consider observing the patient after resection without further therapy (Sc...