Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
How do you counsel male-to-female transgender patients on the VTE risk of hormonal therapy?
Overall, there are minimal data in pediatric populations, but the data from adult populations suggests that in the vast majority of cases, it is safe from a VTE standpoint to administer estrogen therapy in male-to-female transgender patients. The current formulations of estrogen that are recommende...
When would you consider splenectomy or other immunosuppressive/cytotoxic therapy for steroid-refractory warm autoimmune hemolytic anemia?
If it is refractory to prednisone, my next approach is Rituxan. If it fails to respond to Rituxan, I have had luck with Daratumumab. I avoid splenectomy since the response rate is no better than 30%.
What are your indications for pursuing a rheumatologic workup in a pediatric patient with ITP?
In regard to pediatric ITP patients and a rheumatologic workup, first, there is no data comparing pediatric ITP patients of all ages and both genders as to the exact rates of positivity and the implications of the positivity in any group. Having said that, there is some consensus that adolescent fem...
How do you incorporate denosumab into the surgical management of giant cell tumor of bone?
Denosumab forever. Giant cell tumors of bone have a clonal cancer component and then osteoclasts that are hypnotized by the cancer. Denosumab works on the osteoclasts so they quit listening to the cancer and then the whole thing turns to bone. Denosumab does not kill anything and the cancer cells ar...
When should a gallium-dotatate scan be incorporated into the initial evaluation of a patient with a carcinoid tumor of the appendix?
Good question! I would first refer the reader to my two favorite papers on appendiceal NETs (Rault-Petit et al., PMID 29557879; Landry et al., PMID 18645109) to understand and help determine: 1) which patients are at highest risk of lymph node metastasis and thus require a right hemicolectomy, and 2...
How would you treat an adolescent or young adult with newly diagnosed hepatosplenic T-cell lymphoma?
HSTCL accounts for <1% of lymphomas. It typically presents in young males, 10-20% of whom are on chronic immunosuppression such as TNF alpha inhibitors. The prognosis for hepatosplenic t-cell lymphoma is grim. Patients can achieve a CR, but relapse quickly with a short median OS. When possible, pati...
What is the flank radiation dose for recurrent Wilms?
For children with recurrent Wilms who had NO treatment with either chemo or RT, we recommend the lower doses mentioned in AREN0532 (NCT00352534). All treatment- recurrent Wilms should receive higher doses as stated in NWTS5 (NCT00002611).
Do you block kidney to meet kidney constraint when treating Wilms with diffuse unresectable peritoneal implants?
Yes, either block or use imrt.
What are the indications for RT for an alveolar FOX01 fusion positive, paratesticular rhabdomyosarcoma s/p radical inguinal orchiectomy and PLND showing pN0, group 1, stage 1 disease?
We have not radiated in this specific scenario. While there are still questions about the need and benefit for adjuvant RT in patients with completely resected alveolar histology or FOXO1+ disease, the absence of a clear target in patients with paratesticular primary involvement with complete resect...
How do you approach a patient with multiply relapsed germ cell tumor with rising tumor markers but no obvious site of disease?
From the description, it presumes that this is a patient who previously received BEP, high dose chemo with transplant, and "radiotherapy". Not sure whether that represents CNS mets that were radiated. The most important aspect is to be certain marker rise due to progressive cancer. hCG mildly elevat...