Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
What bladder-filling protocol do you use when treating children with bladder neck rhabdomyosarcoma with definitive radiotherapy (VMAT)?
We have experiences from Proton beam therapy. Bladder filling protocol will depend on the tumor and age of the patient. Our preferred way is to do it via suprapubic catheter if the tumor is not interfering with the position of the catheter. Filling volumes may be around 150-200 ml (however, the age/...
How do you incorporate next gen sequencing results into your management of pediatric patients with B-ALL who have not been transplanted?
We enroll in the EndRAD SCT trial which is guided by NGS results.
Do you offer iron supplementation to a non-anemic adolescent athlete with a low ferritin?
I prefer having a TSAT on an overnight fast. Extreme athletes have increased hepcidin. If ferritin is greater than 30, my cut-off, no. If TSAT is 19 or less, yes. I would not criticize someone who gave iron, but PO iron is pretty tough to take. I would prefer staying within the current parameters of...
How does the loss of heterozygosity (LOH) of 1p or 16q affect the treatment options of stage II or III newly diagnosed Wilms Tumor?
For Wilms tumor patients with LOH at BOTH 1p and 16q, the COG has completed trials AREN0532 (included patients with stage 1/2 and LOH at both loci) and AREN0533 (included patients with stage 3/4 and LOH at both loci) and demonstrated an improved event free survival when therapy is intensified (to DD...
How do you manage a young patient with mediastinal nonseminomatous germ cell tumor that has relapsed after primary treatment with four cycles of VIP?
Patients with primary mediastinal nonseminomatous germ cell tumors (PMNSGCT) are at poor risk regardless of the size of the tumor or amplitude of AFP. Unfortunately, second-line therapy does very poorly. There would be zero curative value for TIP or VeIP after prior VIP, of course. Despite respectab...
What are the treatment options available for isolated extramedullary relapse of an AYA patient with AML following HSCT?
This is such a tough situation. Unfortunately, when a patient relapses after the second stem cell transplant, options are limited because a third transplant is rarely feasible and cure is not likely with medication alone. One could consider a Phase I trial if available and the patient is eligible. O...
When is a bone marrow biopsy indicated in the up-front evaluation of an AYA patient with Ewing sarcoma?
In general, I would not recommend a different approach to the initial staging evaluations for an AYA with a new diagnosis of Ewing sarcoma vs a younger child or an older adult. Although the standard approach that is most widely accepted would be to perform a bone marrow evaluation for all patients w...
Do you re-test patients who test positive for COVID-19 during or prior to starting cancer treatment?
Here is a summary from the CDC website supporting a 'symptom-based' approach with self-quarantine for ~10-14 days after symptoms (perhaps 21 if severely immunocompromised or severe COVID symptoms) without need for a negative test. From: https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolati...
Is a patient with secondary myeloid sarcoma a candidate for hematopoietic stem cell transplant?
There are circumstances where these patients would be candidates for stem cell transplant. The extramedullary presentation is thought to be a high-risk feature and many of these patients will have a relapse in marrow or other sites, so a stem cell transplant done after remission is achieved may help...
What therapy would you give to an AML patient with induction failure while awaiting HSCT?
I generally think of induction failure like relapse. You know you are dealing with chemoresistant disease so something from the "salvage" menu is appropriate. One of the most promising treatments to come along for relapsed/refractory disease in a long time is CPX-351 (Vyxeos). This was studied by th...