Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
Should patients with bleeding disorders increase their home supplies of clotting factors foreseeing a possible shortage of product availability due to COVID-19?
No. The Medical and Scientific Advisory Council (MASAC) for the World Federation of Hemophilia recommends against increasing the already recommended home supply of clotting factors: One month worth of regular prophylaxis doses if on a prophylactic regimen; and one major correction dose, and two mino...
Are patients with bleeding disorders receiving plasma-derived products at increased risk of acquiring COVID-19?
No. The current process of manipulation of plasma derived products eliminates SARS-Cov-2. SARS-CoV-2 is a large virus (120 nm diameter) with a lipid envelope. Therefore, it is highly susceptible to processing steps used in processing such as solvent-detergent, low pH incubation, caprylate-pasteuriza...
How do you treat a patient with a history of clinical stage IIb cN2, mixed germ cell embryonal carcinoma treated with BEP and RPLND five years ago, who now has signet ring cell adenocarcinoma with abdominal carcinomatosis with an unknown primary?
My experience would suggest that this is a second primary unrelated to his germ cell tumor. I would predict that the i12p will be negative and, if it were available, the MiR371 would be negative. I presume his current AFP and HCG are negative. I have seen this situation once with a young man almost ...
When during ALL induction therapy are you checking for MRD?
It is generally advisable to measure MRD from a bone marrow aspirate at the end of the first course of therapy for ALL. If a pediatric-inspired regimen such as CALGB 10403 is being used, undetectable MRD after Remission Induction (i.e., approximately Day 28) is associated with an excellent rate of d...
How do you treat a pediatric patient with t(17;19) acute lymphoblastic leukemia?
ALL with t(17;19) is a rare subtype and known to be associated with extremely worse outcomes compared with other subtypes, regardless of intensification of chemotherapy and transplant. These patients should be treated with conventional chemotherapy first, and if there is a sign of poor response, oth...
What treatment would you offer a young pregnant woman with a symptomatic midline low grade glioma?
The question is really in the biology of this midline low grade glioma, in particular K27M status and BRAF status, amongst others. It is very challenging to answer without a clear idea of the tumor and ongoing symptoms. It would also be important to have a look at the MRI scan. Eric Bouffet eric.bou...
Would you hold rituximab for newly diagnosed B-cell lymphoma if the patient is COVID-19 positive?
The question of how best to manage ongoing lymphoma therapy in the face of SARS-CoV-2 infection remains unanswered. That said, centers are developing guidance for clinicians based upon available and emerging data. Newer data from MSKCC suggest that recent treatment (within the last 30 days) is not a...
What is your approach to unresectable metastatic rhabdomyosarcoma transformed from an embryonal cell germ cell tumor?
More information would be helpful. I infer this is a patient who underwent an orchiectomy for a more typical histology of germ cell cancer, probably with elements of teratoma. He may or may not have had elevated hCG or AFP. He may or may not have received BEP or similar chemotherapy. Perhaps he had ...
What are best practices for pediatric hematology/oncology patient and staff precautions with the COVID-19 pandemic?
Some guidance is provided by pediatric hematology/oncology physicians in Italy: https://www.ncbi.nlm.nih.gov/pubmed/32298461
How do you clearly communicate to parents that the main purpose of a phase I trial is to find the best dose of a new drug with the fewest side effects rather than treating the patient's cancer?
Just with any communication, check first to see what their understanding is. Then, see if they are ready to hear what you have to say. Say it and then have them repeat it. When discussing trials, this conversation occurs over more than once. At the first conversation, one may be trying to lay out op...