Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
How do you approach managing depression symptoms in patients who have had repeated high risk of bleeding?
Overall, evidence suggests that while SSRIs do increase the risk of bleeding. The absolute risk of a bleeding event remains low and is usually not serious. A 2017 meta-analysis by Laporte et al., suggested that overall bleeding risk is increased by at least 36% while other meta-analyses suggest that...
Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?
Interesting question. Not being an endocrinologist, I don't have the expertise to advise but the reference below makes the statement that even short-term steroids can be an issue. I suspect that if you have to stop abruptly from 60 mg daily for 2 weeks, it would probably be fine in most instances bu...
Are you altering your use of immune checkpoint inhibitors given the risk of immune-related pneumonitis and the COVID-19 outbreak?
Nivolumab can be used every 4 weeks rather than every 2 weeks. We have to be flexible and change our approach according to circumstances.
Is there any consensus or guidance on how to manage germ cell tumor patients in the COVID-19 era?
Germ Cell Tumor Management in face of SARS-CoV-2: Safe, Rational Modifications to Standard GCT Practice to Protect Public Health, GCT Outcomes, GCT Patients, and Health Systems. This bulletin has been produced by a concerned group of international experts in germ cell tumors, has not undergone exten...
Is there any outpatient protocol for cisplatin/doxorubicin neoadjuvant chemotherapy for osteosarcoma?
Outpatient administration of cisplatin/doxorubicin (albeit at a slightly reduced cisplatin dosage of 100 mg/m²) protocol is documented in the BC Cancer out in Vancouver, British Columbia. We offer this at Roswell, with the addition of mannitol, but it is a long 8-hour day, and close follow-up is rec...
How should you manage a pediatric oncology patient who has an ANC > 500 and a normal chest x-ray but is confirmed to be infected with COVID-19 and is immunosuppressed from chemotherapy?
The treatment for pediatric patients with cancer who develop COVID-19 is very poorly defined. The risk of severe disease is unknown because although adults with cancer appear to have worse outcomes than those without, non-immunocompromised children seem to have few severe outcomes from the disease a...
Should we be utilizing prophylactic G-CSF in our patients with intermediate risk of febrile neutropenia due to the COVID-19 pandemic?
There are many functions of G-CSF, including repression of T-cell and NK cell function. Unless you are certain that growth factors are not modifying the immune network to the detriment of viral clearance—there is no data that growth factors help clear viral infections.
What is the best way to support a pediatric oncology survivor with fears about 2nd neoplasm or relapse?
Many survivors of childhood cancer are managing ongoing post-traumatic stress, which can include the persistent concern for relapse or a second neoplasm. It is important to note that these are rational concerns - the risks of relapse or second malignancies are real and can give survivors a sense of ...
How do you approach adjuvant therapy for resected Stage I Ewing sarcoma of the kidney?
From a chemotherapy standpoint, all stages of Ewing Sarcomas are approached the same way. There are differences in surgical approach between localized disease versus metastatic disease. We give VAC alternating with IE for six cycles, each. Since this is resected, this regimen should be given in the ...
Should extra precautions be taken for pediatric oncology patients in light of the recent COVID-19 outbreak?
I have not personally seen cases. This is not surprising, however, because our patient population is more susceptible to severe outcomes from respiratory infections. This is compounded by weakened immune function and, for some patients, cardio respiratory damage.