Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
How do you monitor risk of erythrocytosis from testosterone use for female to male transgender patients?
I utilize the Endocrine Society's guidelines for identifying secondary erythrocytosis secondary to gender affirming hormone therapy (GAHT) (PMID 28945902). For initial monitoring, at baseline and then every 3 month hematocrit for the first year and 1-2 times yearly thereafter is typically implemente...
How do you approach and manage anorexia and appetite loss in people with advanced cancer?
Anorexia/cachexia is often distressing to patients and families and it is this distress that is the target of many of the interventions for this syndrome as there are, in general, no effective therapies. Patients and families are routinely battling over the lack of eating as this causes further disc...
How would you approach treatment in a patient with Fanconi anemia and glioblastoma?
This is challenging due to the sensitivity of Fanconi anemia patients to DNA-damaging treatment. I would maximize resection if possible and then treat with radiation, since it is a mainstay of therapy, despite the risk. I would opt for proton radiation if possible to minimize exposure of normal tiss...
How would you approach a new pelvic mass in a patient with history of mixed germ cell tumor but normalized tumor markers?
By the type of treatment received, I assume this was likely a post-pubescent male, probably under 18? In my view, this sort of patient should be managed identically to what we do in the much larger populations of non-seminoma seen between 18-40. Clinical and biological evidence is mounting that post...
How do you approach the pharmacologic management of cancer-related fatigue?
After the above considerations mentioned in the question, management considerations regarding cancer-related fatigue depend on the stage of disease (advanced/metastatic disease vs not) and whether the patient is on active cancer therapy. For both groups, non-pharmacologic interventions have the high...
What is the preferred treatment for a patient with an EBV+ monomorphic PTLD (DLBCL) not currently on immunosuppressive therapy?
For patients who are candidates for an anthracycline-based regimen, R-CHOP is usually given if CD20+ PTLD. Patients whose tumors do not express CD20 are treated with CHOP chemotherapy alone. R-CHOP can lead to ~ 65% of CR (Trappe et al., PMID 22173060).
How would you treat a skull based chordoma in a pediatric patient?
Should adjuvant maintenance chemotherapy be provided to children with anaplastic ependymoma following radiation therapy?
We don't know yet, and this was the purpose of ACNS0831 (closed) and the rationale as well of the ongoing SIOP Ependymoma trial in Europe. In fact, the question is not whether we should offer chemotherapy to a child with anaplastic histology, as we know that anaplasia has very little meaning in this...
Would you start a patient with sickle cell disease and COVID-19 on prophylactic anticoagulation?
At what level of bone marrow disease would you agree to proceed with transplant for a patient with refractory AML?
Most transplant centers will settle on 5% or fewer blasts by morphology or flow cytometry as the cutoff for transplant. Exceptions or leeway is sometimes given for those undergoing myeloablative/full-intensity conditioning, and those with primary refractory disease. MRD typically refers to disease t...