Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
When should upfront molecular sequencing be performed in a pediatric or AYA patient with sarcoma?
There is no standard to be able to provide a clear answer and I believe that the decision to perform sequencing would need to be determined on an individualized basis. I would consider doing so in cases of advanced disease when standard therapies are less likely to provide benefit and there is a ho...
Do you think there is any compelling data to support giving brentuximab as frontline therapy for pediatric patients with Hodgkin lymphoma?
Yes and no. It is clear that you can cure patients with pediatric HL without the use of brentuximab vedotin. While I believe it is safe and effective, if it is not covered by insurance, I would not advocate for its use in low and intermediate risk pediatric patients.However, for HR pediatric patient...
When is a TIPS procedure indicated for a pediatric patient with sinusoidal obstructive syndrome?
TIPS (transjugular intrahepatic portosystemic shunt) procedure is not indicated in children with sinusoidal obstructive syndrome and most literature on this topic (in adults) dates prior to 2000. In the largest adult series using TIPS for VOD in adults (D'Azoulay et al., PMID 10800068), out of 10 pa...
How do you approach the use of low-dose aspirin for primary prevention in non-pregnant patients with SLE and positive aPL antibodies, without clinical criteria for APS?
I personally do not put all asymptomatic SLE patients with aPL labs on low dose aspirin. This is a somewhat controversial topic. Most of the data we have are from observational studies and results are mixed in regards to efficacy of low dose aspirin for primary prevention in this population. SLE pat...
Would you use autologous hematopoietic stem cells collected from a HR neuroblastoma patient found to be COVID positive after harvest?
While the safest approach might be to try to do another collection once the patient has recovered, that may not be feasible or lead to delays in the transplant. I would use this product since transmission of SARS-CoV-2 is not systematic and there is no evidence of SARS-CoV-2 transfusion transmission...
Should a teenager diagnosed with CML in blast crisis go to transplant once MRD is negative?
I would take the patient to BMT now. Survival of patients who received BMT for blast crisis is dependent on the pre-BMT remission status (Radujkovic et al., PMID 31271884), but I am not aware of data showing benefit of giving consolidation when a patient has negative MRD. Best results of BMT are ach...
Do you recommend the use of dexamethasone and anakinra as upfront treatment in a pediatric patient with secondary HLH (nonrheumatic) who is too ill to tolerate etoposide?
If there is no concern for new malignancy or systemic infection, then glucocorticoids are reasonable. I use methylprednisolone up to 30 mg/kg/day (max. one gram). Anakinra is a safe and often effective therapy for secondary HLH. It is quick acting and has a short half-life so I use it early. I gener...
What dose of PEG-asparaginase do you recommend for teens with high BMI treated on a pediatric ALL regimen?
The peg-asparaginase dosing we use in ALL regimens for B and T cell is below: Patients less than 21 years old – 2500 units/m2 Patients 21 years and older – 2000 units/m2 For obese patients (defined as > 95% BMI for patients less than 20 years old or BMI > 30 for patients 20 years and older), ...
How would you approach chronic isolated severe non-cyclic neutropenia with negative bone marrow and rheumatologic work-up?
My preference would be to use G-CSF at the lowest effective dose, i.e., the dose that maintains the ANC >1000. The risk of inducing leukemia is low in individuals with idiopathic, chronic neutropenia, but it is positively correlated with the G-CSF dose. There are also other side effects like bone pa...
How do you manage cancer treatment-related cognitive change or "chemo brain?"
Chemo-brain is a vexing and complicated diagnosis. In most cases, you don't know the baseline neurocognitive function of individuals with cancer. Many conditions that are associated with chemotherapy like fatigue, depression, and aging can mimic chemo-brain. Estimates are that about 20% of individua...