Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
When are increased flank doses beneficial in Stage III Wilms tumor?
The current standard of care in North America for radiotherapy dose in the treatment of Wilms tumor (WT) has been established by the National Wilms Tumor Study (NWTS)-3. This study randomized Stage III favorable histology patients to 1000 cGy vs. 2000 cGy as well as 2 drugs (actinomycin D and vincri...
Are there any situations you would recommend prophylactic anticoagulation for a patient with Factor V heterozygosity?
In short, no. Thrombotic risk is a complex variable with many contributing components. The presence of a single FVL allele, while it appears to increase the risk somewhat, is not sufficiently predictive of overall risk to provide a basis for administering prophylactic anticoagulation in a clinical s...
Do you routinely recommend proton therapy for whole ventricular radiation for intracranial germinoma after chemotherapy?
The pattern of failure data from SIOP GCT '96 (Calaminus et al., PMID 23460321) and the SFOP-90 experience (Alapetite et al., PMID 20716594) in which patients with localized CNS germinoma were treated with induction chemotherapy followed by focal radiotherapy was predominantly intraventricular. Ther...
What is your local therapy paradigm for unresectable pelvic EWS cases?
Unresectable pelvic Ewing sarcoma tumors are treated with definitive radiation therapy. The Children's Oncology Group local failure analysis of patients treated on INT-0091, INT-0154, and AEWS0031 demonstrated pelvic tumors treated with radiation therapy alone had a local failure incidence of 22.4% ...
What are the current frontline treatment options for newly diagnosed pediatric AML patients with high FLT3/ITD allelic ratio and IDH2 mutation?
This is an interesting question. Since IDH2 mutations are so rare in pediatrics, we don't yet have enough information to determine their impact on the outcome. Also, targeted agents for IDH2 mutations are still in early investigational phases for pediatrics, so I would not necessarily include enasid...
What is your approach to a patient with positive antiphospholipid antibodies who otherwise do not meet clinical criteria for APS?
As antiphospholipid antibodies constitute a diagnostic criterion of SLE, such patients may need to be evaluated and monitored long term for both SLE and APS.
Is there a role for radiation therapy in the treatment of a lymphoproliferative disorder involving the orbit?
When I don't have pathology/flow/PCR reports diagnostic of malignancy, I have treated patients with "lymphoid atypia", "atypical lymphoid infiltrate", or "lymphoproliferative disorder" with symptomatic disease to 4 Gy in 2 fractions. I have a collection of such patients (about a dozen), almost all o...
Is placing a VP shunt a major risk to spread medulloblastoma or other malignant brain tumors into the gut?
While most malignant primary brain tumors will NOT spread to the gut via VPS, case reports of pediatric brain tumors dominate the literature regarding this risk. Germ cell tumors are probably most commonly reported, followed by PNETs and medulloblastomas [Piatt and Garton, PMID 18431216, Kay et al.,...
Would you use a myeloablative or reduced intensity conditioning regiment for a pediatric or AYA patient who does not recover their counts after treatment for AML, but remains disease free?
I would use a myeloablative regimen, if medically fit and eligible. In fact, I would worry that there is a residual disease (that you're unable to detect) behind the lack of CBC recovery which is another reason to use a myeloablative regimen.
How would you manage an unresectable central meningioma in a young patient with evidence of mild compression on the optic nerve and 4th ventricle involvement?
Sometimes, unresectability is in the eye of the beholder. In a young patient, with a decent size meningioma compressing the chasm and the 4th ventricle, there are several significant risks from not pursuing a surgical approach. Our first approach would be to get an expert opinion from a renowned men...