Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
How do you manage patients with a history of severe ifosfamide neurotoxicity who need additional ifosfamide?
Ifosfamide neurotoxicity is an idiosyncratic reaction. Methylene blue has been shown to be effective in this situation but has not been studied prophylactically. Given that there are no evidence-based guidelines for re-challenging a patient with prior ifosfamide neurotoxicity who again requires the ...
Is there data to support holding the 5th cycle of intensification for an AML patient with good prognosis and a history of significant infections and/or prolonged count recovery?
Great question. The answer is kind of. The COG studies AAML03P1 and AAML0531 gave 5 chemotherapy cycles to patients who did not go to transplant in first remission, but we know that some patients did not get the 5th cycle. As you suggested, most of the time the reason for stopping after 4 cycles was...
When can defibrotide be discontinued before the 21-day treatment course is completed in a pediatric patient with SOS?
There is no data to support the 21-day use in everyone. Also, some patients might even need a longer course than the prescribed 21 days if manifestations are ongoing. A good general rule of thumb would be to continue (provided no bleeding or other toxicities) for 3-5-7 days post resolution of ong...
What additional testing, if any, should be performed for an adolescent patient with heavy menstrual bleeding and a negative von Willebrand disease evaluation?
I presume that the adolescent with heavy menstrual bleeding whose von Willebrand panel is negative has already had a CBC and baseline coagulation screen (prothrombin time, activated partial thromboplastin time, and fibrinogen or thrombin time) performed. If that is the case, I would suggest evaluati...
Would you start TKI therapy in a patient with new diagnosis of T-ALL without BCR-ABL gene rearrangement on FISH but found to have very low level p190 transcript on RT-PCR?
I would not. I don't necessarily have any evidence to support this, so this is simply an opinion. I have seen this a couple of times in my clinical practice. If there is truly BCR-ABL present in this patient's leukemia, the level of it would have to be extremely low to only be detectable at this rep...
Should targeted therapies such as Brentuximab or Crizotinib be used in the upfront management of anaplastic large cell lymphoma in a pediatric or AYA patient?
Good question. Importantly, I am assuming that the question is for ALK+ patients who have systemic disease because ALK inhibitors have no role in ALK- disease and cutaneous only ALCL is really an entirely different entity.In fact, the question is the primary aim of COG trial ANHL12P1 which uses eith...
What surveillance imaging do you obtain for stage III melanoma patients after completing systemic adjuvant therapy?
I agree with Dr. @Dr. First Last. The guidelines for surveillance allow some personalization based on patient specific characteristics. For stage III melanoma patients on adjuvant therapy (or not), we scan with CT scans every 3 months for 2 years, every 6 months up to 5 years. If there is something ...
Do you routinely check platelet counts after COVID-19 vaccines in patients with chronic ITP?
Yes. the side effects of COVID vaccines are still evolving. Mild to moderate thrombocytopenia was noted and severe thrombocytopenia is extremely rare. I would follow an abundance of caution and do weekly complete blood counts, especially in the ITP patient.
What are your indications for starting emicizumab in pediatric patients with Hemophilia A?
Emicizumab can be used for prophylaxis in the following situations: Motivated patient Patient that isn't very active Patient with Hemophilia A with inhibitors Emicizumab seems to be equivalent to regular factor. It is not a substitution for factor during bleeding episodes or for surgery.
How do you approach fertility preservation in a young child with cancer?
After the diagnosis is known, we meet with the families to discuss the known risks for infertility based on what we know about the treatment regimen they are to receive. For example, a patient with Ewing's sarcoma will receive high dose alkylators and therefore, is at significant risk for future inf...