Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
Are there any reasons to consider a prolonged course of steroids with taper over a shorter course of pulsed steroids in the treatment of ITP?
As a general rule in pediatric ITP, I would say the answer is "no" but there are some exceptions. I'll defer to adult hematology colleagues to address this question for older patients, but some basic principles apply. 1. Steroid doses after an initial pulse, should be as low as possible because of ...
What is the appropriate radiation volume for a stage III, group III unresectable embryonal rhabdomyosarcoma originating from the bladder?
For bladder/prostate or pelvic tumors that displaced a significant amount of bowel which has then returned to its normal anatomic position after chemotherapy, GTV1 and CTV1 will be defined by the prechemotherapy extent of tumor excluding the component that is now normal intra-abdominal components (i...
What is the utility and optimal timing of histologic conformation of NGGCT?
This is a difficult topic and a great question. Unfortunately, the thresholds for tumor marker cut-off values vary internationally for germinoma and NGGCT. The Japanese, who do more aggressive surgeries and have a wealth of experience, use higher cutoff values for germinoma, however, they typically ...
How do you incorporate high-dose chemotherapy with autologous stem cell rescue for a patient with relapsed, metastatic Ewing sarcoma?
There are older single-arm studies indicating that incorporating autologous transplant into the treatment of relapsed Ewing sarcoma can lead to a 20-30% survival rate. Usually, a patient receives up to 3-5 rounds of reinduction with standard chemotherapy, followed by consolidation with autotransplan...
Do hemoglobin S levels always correlate with SCD phenotype?
The severity of sickle cell disease (SCD) is usually associated with the level of hemoglobin S (HbS). For example, HbSS and HbSB0 thalassemia, which generally have higher HbS levels, are usually more severe than HbSC and HbSB+ thalassemia. While patients with HbSC and HbSB+ thalassemia typically hav...
Is there a role for anti-neutrophil antibody testing in the workup of neutropenia?
In my view, anti-neutrophil antibodies add little to the work-up of neutropenia. Drs. @Dr. First Last and @Dr. First Last presented an abstract at ASH in 2015 that summarized restyles for 60 pediatric persons with a diagnosis of autoimmune or idiopathic neutropenia. The sensitivity and specificity o...
How would you incorporate whole abdomen radiation therapy after cytoreduction in an AYA patient with desmoplastic small round cell tumor?
We had one patient with DSRCT. Our group used IMRT for the abdominal radiotherapy while sparing much of the kidneys. The details are in a paper by Pinnix et el, Int J Rad Onc Bio Phys 83(1): 317-26, 2012. (Epub November 2011).
What modality (urine catecholamines, PET, MIBG) is the most sensitive for evaluation of treatment response in a patient with high-risk neuroblastoma?
Assessment of treatment response for patients with neuroblastoma has been formally defined with the International Neuroblastoma Response Criteria (INRC), most recently updated by Park et al., in 2017 (PMID 28471719). Overall response integrates tumor response in the primary tumor (by CT or MRI), sof...
What are your thoughts on adding mycophenolate to steroids in the first line treatment of ITP based on the results of the FLIGHT trial?
This was an impressive study that should alter how upfront ITP is managed. The study was well designed, with randomization against the current standard of care. Efficacy was clear with HR for treatment failure of 0.37 (p=0.0029). What is also nice is that unlike TPO agonists which do not have define...
How would you treat osteosarcoma that has relapsed with unresectable pulmonary metastatic disease?
Typically, I will discuss with the medical oncology team regarding systemic therapy options available as well as clinical trial options. With limited numbers of pulmonary metastases, you can consider SBRT and I have used a regimen of 60 Gy/5 fx.