Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
How would you approach the treatment of patients with von Willebrand disease or hemophilia A previously managed with intranasal DDAVP during the recall?
There are two separate questions here, one is easy and one complicated. Desmopressin challenges can be performed with intravenous desmopressin, 0.3 mcg/kg. It is not necessary to challenge a patient with IV who previously responded well to the nasal preparation, in my view. How to approach treatme...
What is the radiation volume for unresected gross paraaortic lymph node in a Wilms patient?
This depends on the presence/absence of diffuse anaplasia (See AREN0321 [NCT00335556]) and age/field extent.Patients with diffuse anaplasia who are Stage 3 due to the presence of residual nodal disease would receive 19.8 Gy to the flank, and then in the presence of residual disease, would receive a ...
How would you approach maintenance for high-risk B-ALL off study?
The frequency of VCR/steroid pulses question is a great one, and while I am a strong proponent of eliminating the extra year of therapy for boys and reducing the number of VCR/steroid pulses during maintenance, it can be a challenge to explain to families why we are changing something they likely vi...
How do you treat a primary pineal neoplasm of intermediate differentiation?
Pineal parenchymal tumors of intermediate differentiation (PPTID) represent a rare type of intracranial tumor that behaves somewhere between pineocytomas and pineoblastomas. Given the rarity of PPTID, data is limited to retrospective studies with no clear consensus on adjuvant therapy. In general, a...
When is a bilateral bone marrow aspirate/biopsy indicated in the initial diagnosis of pediatric NHL patients?
Bilateral bone marrow biopsies and aspirated are not required for diagnostic evaluation of pediatric non-Hodgkin lymphoma.
Is there a role for surgical resection in parameningeal rhabdomyosarcoma either at diagnosis or following initial therapy w/ VAC at week 12?
Not really. For rhabdomyosarcomas outside of the head and neck region, surgical resection often plays an important role in the treatment paradigm. However, given the anatomical constraints with paramenigneal tumors, gross total resection is often not possible without resulting in significant morbidi...
When would you perform a thrombophilia workup in a pediatric patient presenting with VTE?
I was trained to do workup in cases of unprovoked VTE and still practice that way mainly to guide the length of anticoagulation therapy as well as prophylaxis. I must admit though, in pediatrics I have come to realize there is more practice based on experience and extrapolation from adult data than ...
Are there any special considerations when evaluating patients with non-malignant hematologic or immunodeficiency disorders for allogeneic transplant?
In most malignant diseases, we prefer to take patients to allogenic transplant either in complete or partial remission as it will take few months before post-transplant immune-reconstitution results in effective graft-versus-disease response. In non-malignant diseases, we take patients to transplant...
How do you define bulky mediastinal disease in Hodgkin's lymphoma?
Bulk in HL (outside the mediastinum) has been defined variably. While Children's Oncology Group studies used a threshold of 6 cm recently, the European studies and medical oncology trials have often used 10 cm as the threshold. On the recently accrued AHOD1331 COG trial, bulk was defined as a contig...
What is the role of hydroxyurea in variant sickle cell genotypes?
I have had little success using hydroxyurea in my patients with hgb SC disease and at this point in patients with two or more acute visits over 12 months for pain, I am using crizanlizumab as some of the subjects in the phase 2 study on which the drug received FDA approval had SC disease (Ataga et a...