Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
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...
With the increased use of gemtuzumab in induction chemotherapy for children with acute myeloid leukemia, would you change conditioning regimens to help prevent sinusoidal obstruction syndrome during hematopoietic stem cell transplant?
The current use of Mylotarg uses lower doses of Gemtuzumab and also fewer doses (only in induction-1 in the current COG-AAML1831 clinical trial) which should be at least 2-3 months away from BMT and that's why we do not see a higher SOS rate, but more prospective studies will be needed to answer if ...
How would you manage a pediatric patient with immune thrombocytopenia who has severe thrombocytopenia without bleeding symptoms?
As posed according to current data and opinion (for best: see the TIKI trial), there is NOT an urgent reason to treat.However, choosing to observe rather than treat requires careful assessment of the patient and the family.Examples include: Does the patient have a headache? Did they receive ibuprofe...
Is there any role for direct oral anticoagulants in the treatment of antiphospholipid syndrome?
Triple-negative APS is a confusing category as includes seronegative APS, APS with non-conforming aPL such as anti-phosphatidylserine-prothrombin amongst others, and the universe of patients with thrombotic events unrelated to antibody-mediated hypercoagulable state (eg Protein S, C or anti-thrombin...
How do you choose chemotherapy for a pediatric patient with mixed-phenotype acute leukemia?
I would begin treatment with a high risk ALL regimen and monitor response closely. While there is not a standard regimen for the treatment of MPAL, in several retrospective analyses, rates of remission and outcomes have been shown to be superior with initial ALL vs. AML or hybrid (both ALL and AML) ...
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 should young patients with rhabdomyosarcoma be managed in the absence of a clinical trial?
The guiding principles of disease control while maintaining form, function, and quality of life drive the decision-making and management for patients with rhabdomyosarcoma.Regarding patients with paratesticular primary, inguinal orchiectomy with no scrotal invasion but tumor on the surface of the re...
How do you manage VTE in the setting of persistent severe thrombocytopenia?
The thrombosis versus bleeding risk ratio should be weighed. The risk of VTE recurrence or propagation is highest in the first 30 days and we know that thrombocytopenia does not attenuate this risk. Providers should favor anticoagulation. In the case of cancer-associated thrombosis and chemotherapy-...
How would you approach moderate neutropenia (ANC < 1000) in a solid organ transplant recipient?
There are limited data addressing the safety and efficacy of G-CSF in the solid-organ post-transplantation setting. Most case series report no increase in graft rejection with G-CSF treatment, although this question is not rigorously answered. Most cases of neutropenia in the post solid-organ transp...