Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
How do you manage a patient with superficial venous thrombosis with close proximity (<3 cm) to deep veins and an inherited thrombophilia ?
I would treat the patient for 3 months with a DOAC and then repeat the scan. If the clot is resolved, I would order a d-dimer and Factor VIII level on anticoagulation. If the tests are negative, I would stop the DOAC and retest at 30, 90, and 180 days. If tests remain negative then stay off anticoag...
What is the preferred radiation delivery technique for whole abdominal or flank RT in childhood cancers?
The rationale for using less sophisticated techniques to treat flank and whole abdominal fields has largely been centered on reducing the potential for growth discrepancies by treating with homogeneous doses across bony structures, most notably the spinal column and pelvic bones. The use of AP/PA fi...
How would you approach local control in a patient with extra-osseous metastatic Ewing sarcoma of the kidney?
I would follow general guidelines for Ewing sarcoma – if the tumor is completely resected, no RT. If spread outside post surgery, then would follow Ewing Sarcoma dosing guidelines.
How would you treat a young patient with classical intermediate-risk Hodgkin lymphoma who has an underlying DNA repair-deficiency disorder, such as congenital mismatch repair disorder or ataxia telangiectasia?
It depends on the DNA repair disorder.
What are contraindications for growth factors in patients with hematologic malignancies?
This is a challenging question where little data exist to support a good conclusion. In real world situations, patients with cytopenias and suggestion of TR-MN warrant aggressive antibodies find yourself deciding which is the "best of class" in its nature. John
Would you change chemotherapy to VIP in a young patient with stage IIIB intermediate risk non-seminomatous germ cell tumor with borderline DLCO after one cycle of BEP?
The term “borderline DLCO” needs to be taken into context. The test is not completely reliable and one needs to consider the DLCO result in the clinical setting - has the patient been a heavy smoker, does he have known respiratory disease, does he have any limitation in effort tolerance, and who/whi...
What is your practice for work up and treatment of incidental splenic infarcts with or without splenomegaly in patients without sickle cell disease?
I obtain CBC/diff, CMP, and LDH in all patients. I assume a CT of the abdomen has already been done because that is what usually leads to the diagnosis of incidental infarcts. Of course, it is important to rule out intra-abdominal pathology which should be visible by CT. I obtain a thrombophilia scr...
What features help distinguish thyroid myopathy from immune checkpoint inhibitor-associated myopathy?
Immune checkpoint inhibitors (ICIs) can cause myositis (ICI-myositis). Since ICIs can also induce hypothyroidism, myopathy secondary from hypothyroidism can also be associated with ICI therapy. Different from thyroid myopathy, patients with ICI-myositis barely have myoedema or muscle pseudohypertrop...
For treatment of ITP, what would you add to dexamethasone to achieve the fastest recovery in a patient waiting for a procedure?
I usually use IVIG, particularly if the patient has responded in the past.
How do you approach therapy for a patient with stage IIIA NSGCT who received 4 cycles of EP followed by RPLND which revealed residual mixed teratoma and embryonal carcinoma?
This is a query that can never be answered by evidence based medicine. Instead, all we have is (very old) historical data and perhaps common sense and logic. In 1974, we initiated our phase II study of PVB, with 4 courses of induction chemo followed by 2 years of maintenance vinblastine. That was ou...