Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
What surveillance plan would you recommend for stage IV melanoma patients who achieve a CR or stable PR response with immunotherapy?
If melanoma patients have achieved CR or PR after a year of immunotherapy treatment, I highly recommend participation in this ongoing ECOG cooperative study: EA6192 / PET-Stop Educational Materials - ECOG-ACRIN Cancer Research Group (NCT04462406). The study uses PET scans in combination with contras...
What further genetic testing would you perform on a pediatric patient with cyclic neutropenia who is negative for the most common associated mutations?
Virtually all autosomal dominant cyclic neutropenia is due to mutation in the ELANE gene. However, all neutropenia that varies over time is not necessarily hereditary cyclic neutropenia, even though the family history suggests so. It would be helpful to know if the family history follows an AD inher...
What is the preferred regimen for AYA patients with T-Cell Lymphoblastic Lymphoma?
In my opinion, I would treat with an AALL1231 based induction with a single dose of asparaginase, followed by AALL0434 arm B-like regimen post-induction; Capizzi MTX with single IM and 2 years maintenance boys and girls. I would not administer XRT unless the patient is CNS3. Transplant is recommende...
With new data showing similar outcomes of mismatched unrelated donor and haploidentical related donor allogeneic transplants using post transplant cyclophosphamide, how does one decide which donor is optimal?
It is certainly an unresolved question, and the short answer is that either would be an acceptable option with post-transplant cyclophosphamide (and I have used both). All recipients of mismatched donor transplants should be tested for the presence of donor specific antibodies, and their presence co...
How do you approach relapsed hepatocellular malignant neoplasm NOS after transplant in pediatric or AYA patients?
There exist no standards of care for patients with HCN NOS after front-line therapy has failed. Considerations include response to prior therapy, agents used front-line/not used, sites of disease, surgical options, and molecular findings of the tumor itself. Platinum/anthracycline-based therapy, car...
How is pediatric and young adult primary bone lymphoma risk stratified?
I can only talk to the pediatric experience. Studies done a number of years ago showed that multiple bone lymphoma does not give a poorer prognosis and therefore in Pediatric NHL, even widespread bone is not stage IV or FAB LMB Group C. If B-lineage, it would be stage III or Group B hence 4 courses ...
Would you consider bone marrow transplant in a pediatric patient with recurrent HLH with no identified exogenous trigger or HLH-associated mutation?
How would you treat refractory unresectable pulmonary metastases in high grade synovial sarcoma?
Unfortunately, the outcomes for patients described in this vignette are dismal. Complete pulmonary metastasectomy seems to be the most effective treatment for long-term survival in selected patients but this is usually only achievable in the setting of oligometastatic disease. In the largest series ...
How do you approach an isolated CNS relapse of AML in a young child under the age of 5?
Isolated CNS relapse in pediatric AML is a rare event. Relapses are usually in the bone marrow +/- CNS involvement, suggesting that AML is a systemic disease in need of systemic therapy. Having said that, there is evidence that local treatment with intrathecal (IT) therapy can be effective in an iso...
What strategies have you found to be most effective in engaging PCPs in a primary-care or shared-care model of survivorship for pediatric and AYA patients who will receive ongoing care in their communities away from their primary oncology treatment site?
This is a challenge for our center, and many other centers as well. The ideal approach would be to have adult primary care physicians associated with our center who have dedicated clinic time to care for cancer survivors, direct access to our expertise and medical records. While we haven't been succ...