Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
What are the current official guidelines regarding COVID-19 vaccination for patients with cancer or for hematologic conditions?
There are a number of resources available to guide clinicians on these decisions. I recommend the COVID-19 Resources webpage curated by the American Society of Hematology (COI, I'm the editor of that website). https://www.hematology.org/covid-19 This website includes guidance on immunizations in the...
Would you offer immunotherapy for recurrent metastatic Ewing sarcoma if the tumor is MSI high or has high TMB?
Limited data available (e.g.from SARC 028 - Tawbi et al., PMID 28988646) does not suggest any reasonable activity of CPI in Ewing sarcoma subset. Treating the patient on a "basket trial" of TMB-H or MSI-H would be reasonable, but not as standard of care.
Can therapy safely be reduced to 2 years for males with pediatric T-cell leukemia?
It is an open research question and it cannot be assumed that T cell ALL would have the same outcome. Given that the salvage rate for relapse T cell ALL is so low, this should be addressed in a clinical trial.
How can healthcare providers better serve as allies of the sickle cell community?
Yes, the medical community should absolutely advocate for our patients with sickle cell disease (SCD). The vast majority of Americans with SCD are of African or Hispanic descent, and the overlay of racial inequality and healthcare disparities negatively impact their health outcomes (1-5). In additio...
Should patients receive thrombophilia testing in the setting of a provoked VTE secondary to hormonal therapy/OCPs?
Given that oral contraceptives are considered a provoking event (Ortel et al., PMID 33007077), ASH Choosing Wisely guidelines recommend against thrombophilia testing since the recommended duration of anticoagulation is only 3 months. (Hicks et al., PMID 24307720 & Hicks et al., PMID 25472968).
What is your approach for salvage therapy in a patient with Relapsed/Refractory Primary Mediastinal B-Cell Lymphoma that has received a Rituximab-containing upfront regimen?
First, it is important to distinguish refractory from relapsed. If the patient has PET positive disease remaining in mediastinum, but TMV (tumor metabolic volume) has decreased significantly, there is sometimes a long period before PMBCL will go fully negative on a PET, especially very bulky tumors....
Is there utility in metronomic chemotherapy in adolescent and young adult patients with refractory sarcoma?
I agree with Dr. @Dr. First Last. In the absence of a standard second or beyond-line therapy in the sarcoma relapse setting, particularly one in which the outcome is expected to be especially poor, one must balance a number of factors in selecting a salvage regimen. One of the most important of thes...
Should end-of-therapy echocardiograms be obtained for AYA patients with sarcomas who have received high-dose anthracyclines?
Exposure to anthracyclines will predispose cancer survivors to cardiomyopathy in a dose dependent manner, both alone and in combination with radiation therapy to the chest. While cumulative doses > 250 mg/m2 are associated with increasing risk of cardiomyopathy, lower doses have been implicated as w...
What are the current appropriate planning margins for Wilms tumor in lymph node negative cases?
I would recommend treating with the AREN1921 treatment volumes as these are the most updated version of the treatment guidelines. The block should extend 1cm beyond vertebral body. Always treat the entire LN chain.
Do you offer whole lung radiation with metastatic recurrence of Wilm's Tumor (FH, no LOH 1p16q)?
WLI should certainly be administered alongside salvage chemotherapy for metastatic recurrence. There are no definitive data on timing, but the earlier the better.See the relapse arm of NWTS-5 (Malogolowkin et al., PMID 17539021, Green et al., PMID 16547940) and AREN1921 for details regarding integra...