Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
In patients with autoimmune cytopenias, is there any reservation for COVID vaccination?
No... benefit outweighs risk. Evidence of benefit (and its magnitude) is clear without proven evidence of risk in this population (save for potential for increased bruising in setting of severe thrombocytopenia).
What is the evidence/rationale for not treating neuroblastoma metastatic sites which are MIBG negative after induction chemo?
A clinically meaningful number of high-risk neuroblastoma patients are curable, which in part justifies metastasis-directed local therapy. It can be difficult though to balance the toxicity of multi-site irradiation with maximum control of sites of metastatic disease. Metastases that persist after i...
What is the volume and dose for a rhabdo bone met showing complete response to chemo?
On ARST1431, the GTV2 for a bone met in CR should be defined as the residual bone abnormality as seen by CT/MRI at the time of RT planning. SBRT to bony metastases is optional on 1431 and the decision may vary based on patient age and other factors. On the upcoming high risk protocol, where SBRT to ...
What dose do you treat the involved lymph node chain to in definitive radiation for rhabdomyosarcoma?
In our trials, we have used 36 Gy for microscopic nodal disease treatment (either the CTV surrounding gross lymph node involvement or for nodal regions where resection has been performed - e.g. paraaortic LNs in paratesticular primary disease). The extent of this 36Gy treatment volume in the H&N reg...
Is there a role for G-CSF treatment for SLE patients with persistent neutropenia?
There may be a role for G-CSF for treatment of SLE-related neutropenia, though would recommend using with caution only for severe neutropenia (ANC less than 500) and at lowest dose. The use of G-CSF has been looked at in small case series over the years for both SLE patients with neutropenia and Fel...
What is the utility of immunotherapy in management of malignant peripheral nerve sheath tumors?
The correct answer would be "unknown" or "TBD". Enrollment on clinical trials, even broad phase 1 trials, would be encouraged in cases where SOC therapy has failed.
When would you recommend using a DOAC in a pediatric patient with VTE?
None of the DOACs are approved as of yet below the age of 18 in the United States. However, results of the phase 3 Einstein Junior study (Rivaroxaban) have been published and the FDA application for approval is pending - the hold up is awaiting results of the Rivaroxaban Fontan surgery study to be a...
What is your preferred oral iron formulation and dosing for treatment of iron deficiency anemia?
I recommend using ferrous sulfate given either every other day or twice weekly. (Powers and Auerbach, PMID 32844200)
How do you determine when to give a second CAR-T cell infusion to a pediatric or young adult patient with relapsed/refractory ALL?
Anti-CD19 CAR-T cell therapy has the capacity to induce high rates of clinical response in heavily pre-treated patients for CD19 expressing B-cell malignancies. Among those, B-cell ALL is a poster child for CAR T cell therapy given the propensity for inducing high rates of MRD-negative complete resp...
How would you time COVID-19 vaccination with someone on R-CHOP chemotherapy?
It is really hard to time COVID vaccine while on chemo. Although ideal time would be as far away from chemo as possible (3-6 months) or 6 weeks before chemo starts, that is not practical in someone getting q 3 week R-CHOP. I would recommend giving it when available and if possible, time it on a diff...