Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
How do you incorporate integrative medicine into the field of pediatric hematology/oncology?
Robust evidence is lacking on the potential benefit of integrative therapies for pediatric hematology/oncology patients. That being said, we have incorporated integrative therapies including massage, acutherapy, and animal-assisted therapy (and soon aromatherapy) into both the inpatient and outpatie...
How would you treat stage II pediatric type follicular lymphoma that is not amenable to surgical resection in an adolescent and young adult patient?
PTFL is recently distinguished as a distinct histopathological and clinical entity in the 2016 WHO Classification of Hematopoietic and Lymphoid Tissues. As such, previous reviews of pediatric follicular lymphomas include patients with other types of NHL which do not meet the definition. The best rev...
How long do you continue caplacizumab in relapsed refractory TTP?
While there are no data from studies to guide our answer, general practice is to continue caplacizumab until the ADAMTS13 activity is at least 20% on two occasions, or greater than 30% assuming it was measured at least 4-5 days after the last plasma exchange procedure. The goal is to have stable rec...
What is your perioperative approach for a patient with severe hemophilia?
The optimal management of people with hemophilia is complex. Planning for elective surgery should include the patient, family/caregivers, and all relevant clinicians to ensure that best practices are followed. Collaboration with experts from a hemophilia treatment center to develop a hemostatically ...
How do you help your patients with relapsed/refractory/terminal osteosarcoma who want to donate their tumor for research?
In these cases, one should identify: A) Whether the patient is enrolled on COG study APEC14B1 Project: EveryChild (eligibility up to age 25), B) Whether they are interested in donating tissue that is already banked or to be banked, C) Whether the patient is planning on having an autopsy performed af...
What is the role of upfront addition of an ALK inhibitor in an ALK positive mature B Cell lymphoma in an AYA patient?
Crizotinib has gained FDA approval in pediatric patients > 1 as monotherapy for relapsed anaplastic large cell lymphoma (ALK+) based on the COG ADVL0912 study. The agent was subsequently studied in upfront ALCL with aggressive chemotherapy based on the European ALCL99 regimen in ANHL12P1 but there w...
How would you approach immunosuppression for patients with severe aplastic anemia who are not transplant or ATG candidates?
There are relatively few alternatives. One is just supportive care with transfusion, antibiotics, etc. Many patients will adapt to low Hb and do ok with low platelets and do not require therapy. A calcineurin inhibitor alone or with eltrombopag can also be used - the response rate is not as good as ...
How would you manage asymptomatic brain metastases from testicular non-seminomatous germ cell tumor with a choriocarcinomatous component?
Despite the obvious issue of the blood brain barrier, BEP chemo alone (or VIP) is sufficient for treating such patients. We would, however, repeat head MRI just before starting second course of cisplatin combination chemotherapy to ensure appropriate response.
Should assessing for a MTHFR mutation be part of the thrombophilia evaluation in a patient presenting with a thrombus?
MTHFR mutation testing is of very little utility, given that the functional readout of MTHFR dysfunction is homocystinuria. The intake of the treatment of homocystinuria is folate, which is ubiquitous in the US diet. Thus, homocysteine levels would be adequate for testing, if such testing is indicat...
How would you manage metastatic alveolar soft part sarcoma in an young patient failing TKI?
I am going to assume that the patient has either progressive or symptomatic disease, or at least a legitimate concern for any impending complication/s requiring therapy. There is clearly an emerging body of data, presented and published, supporting activity of checkpoint inhibitors in ASPS. Prelimin...