Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
How do you approach a patient with metastatic rhabdomyosarcoma complicated by sinusoidal obstruction syndrome (SOS) after neoadjuvant chemotherapy and radiation therapy?
This is a challenging and unfortunate complication of therapy. Based solely on the information provided and with only 3 fractions left, it sounds like the patient received the majority of radiation therapy, and I would forgo the remainder despite the recovery on defibrotide. However, I would conside...
How do you manage leptomeningeal disease in relapsed rhabdomyosarcoma?
I recently had such a case and consulted with a well-known colleague who only specializes in pediatric oncology. The recommendation was to treat with 30Gy in 10 fractions with CSI, which I did. The patient is 5 months post this treatment and is disease-free in the CNS.
How would you treat a young patient with symptomatic Rosai-Dorfman disease who has recurrent, life-threatening pericardial and pleural effusions?
Rosai-Dorfman disease is the most tricky one of the top 3 histiocytosis (ECD, LCH, and RDD). It can behave as benign or as an aggressive disease. Given the rarity of the disease, there are no great prospective studies to guide optimal treatments. First-line treatment includes prednisone or other imm...
Would you give dasatinib to a standard risk pre-B ALL patient with an ABL1 mutation?
I would like to revise my previous answer to this excellent question slightly. While we still do not have solid data to know how to manage such patients, the COG Ph+ B-ALL study (AALL1631) is now open to enrolling Ph-like B-ALL patients with ABL-class fusions regardless of NCI status. Thus, I would ...
How do you treat pediatric AML that has relapsed after transplant?
Until we have more effective therapies, a cure after relapse for a child with AML can only be achieved with stem cell transplant, best done after achieving a second remission. The same is true for relapse after transplant, although in that situation the options may be a bit different. The following ...
How do you manage newly diagnosed stage IV embryonal rhabdomyosarcoma?
Given stage 4 FOX01- RMS, I think you can either use protocol ARST0431 which has 10.8g/m2 (>4y) or 360 mg/kg (<4y) of CPM, or ARST1431 (8.4g/m2) since cumulative CPM dosing is not that much different. I do not dose modify CPM based on the primary site.
When would you consider transplant for a patient with a bone marrow failure syndrome (FA, DC, etc.)?
At the time of early bone marrow failure - before they become transfusion-dependent or develop a significant risk for infection and/or bleeding. With Fanconi's and BRCA2 mutation - would follow bone marrow carefully (2x a year) as they have a risk of AML. Because both FA and DK are systemic disorder...
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...
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...