Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
Would you recommend hematopoietic stem cell transplant for AYAs with Ph-like ALL?
There are very scarce data about transplant outcomes in patients with Philadelphia chromosome–like B ALL; therefore, the EBMT and ASTCT have no clear indications for HCT in patients with Philadelphia chromosome–like B ALL in CR1. There are multiple factors that can affect the decision on when to pro...
How do you approach evaluation and management of arthralgia in a patient after CAR-T cell therapy?
This is a great question - part of cytokine release at syndrome includes joint pain. So my questions are: How far after? What was the reason for the CAR-T? These are vital questions to understand first. To that be said - the answers will determine if you give a one-and-done treatment or long-term....
What is your approach to working up diarrhea in an immunocompromised patient?
Tough question and very common in clinical and research management. The approach is going to mirror any new complaint and start with a history. Diarrhea means many things to many patients/clinical trial subjects, so characterizing duration, frequency in a day, nocturnal events (diarrhea that occurs ...
How do you approach treatment of sub-total resected ZFTA fusion ependymoma after radiation therapy in a young adult?
Thank you for asking.ACNS0831 has shown that there is no benefit of adjuvant chemotherapy in patients with incomplete resection. This was based on a comparison between ACNS0121 where patients did not receive any chemo after XRT and ACNS0831 where all patients with residual received adjuvant chemothe...
How do you approach delivering ISRT to nodular lymphocyte predominant Hodgkin Lymphoma that has responded on FDG-PET/CT after chemotherapy?
The therapeutic algorithm in stage >I lymphocyte predominant HL is extrapolated from data on classic HL. Thus, I would use the same algorithm as in HL when evaluating RT indication and dose. Omitting radiotherapy is safe, if a favorable response has been documented on PET-CT and the patient has rece...
Does the presence of anaplasia in embryonal rhabdomyosarcoma change your treatment approach?
No. While there was concern in the past that ERMS with anaplasia may demonstrate a worse prognosis, more recent analyses have shown that isn't the case. A recent publication of the Children's Oncology Group experience by Shenoy et al. nicely summarizes the data from 5 recent RMS trials involving bot...
How would you approach patients with primary cardiac sarcomas for adjuvant systemic treatment?
Majority of these primary cardiac sarcomas tend to be angiosarcomas or UPS-variants. They inherently have a poor prognosis with high risk of metastases and death. Adjuvant XRT is generally difficult in this location. These also generally affect young individuals with o/w good PS/organ function. So w...
How would you work up and manage persistent lymphopenia in an asymptomatic patient?
Simple answer: refer to an immunologist, as this degree of lymphopenia is quite likely to represent a serious immunodeficiency. I would also send a next generation sequencing panel of immunodeficiency/immunoregulatory genes to be in process while awaiting the immunology consultation. Long answer (fr...
What are best practices for oncologists during the national platinum shortage?
In breast cancer, we are prioritizing patients with curable disease in which platinum agents are a critical part of the regimen or have actually shown a clear advantage (the only example of this is shown below in bold).Use an alternative to a carboplatin-based regimen whenever possible. If no altern...
Do you screen adults in your practice with sickle cell disease for silent cerebral infarcts?
The details of the ASH guidelines regarding adults are complex. It was not my practice to screen all patients. More than 50% of adults have silent infarction. Screening requires MRI and this, according to the guidelines, needs careful attention to many details before it is reliable. There are no pro...