Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
Does R-CHOP provide durable remission in low-risk pediatric Burkitt or Burkitt-like lymphoma?
It depends on your definition of "low-risk". Historically, the FAB defined low risk as FAB Group A (resected Murphy stage 1 tumor and resected Murphy stage 2 abdominal primary). Gerard's paper in BJH in 2008 reported a 98% EFS with two cycles of COPAD (basically CHOP with fractionated cytoxan) and n...
When do you consider plasma exchange for multiorgan failure in a patient with sickle cell disease?
The first choice for treating multiorgan failure in sickle cell disease is exchange transfusion that should be started as soon as possible. Sometimes the clinical and hematologic features of sickle cell multiorgan failure resemble and overlap those of thrombotic microangiopathies like TTP. Also, tru...
Would you check vitamin B6 routinely in the work up of anemia?
I only consider it when I see ringed sideroblasts in the marrow. It is on the differential of things that lead to ringed sideroblasts. "Pyridoxine responsive anemia", which can be inherited or acquired. However, in my experience, it is very rare. Even the couple of people I have had with mildly decr...
Would you discontinue anticoagulation in patients with antiphospholipid antibody syndrome, who have a remote history of thrombotic events and are now negative for pathogenic antiphospholipid antibodies?
I would certainly consider stopping anticoagulation in selected patients after an in-depth discussion about potential risks and benefits. I would not consider stopping AC in patients with a history of recurrent events, arterial events, or multiple risk factors for thrombosis (e.g. nephrotic syndrome...
For a young male with Stage III intermediate risk NSGCT with active 1 ppd smoking history but normal PFTs and DLCO results, would you still consider use of BEP x 4?
I agree with Dr. @Dr. First Last. However, intermediate risk is between good risk and advanced disease, and in my opinion, despite the NCCN guidelines, I have never seen the logic nor the necessity of treating ALL intermediate patients the same as advanced disease with BEP X 4. Most of my intermedia...
Are there best practices or data regarding the use of open notes among oncology patients?
The 21st Century Cures Act regulation (effective April 2021) required that clinical notes such as consult and office notes be shared with patients, e.g. “open notes.” In general, surveys of patients with cancer and their clinicians suggest that open notes are viewed favorably (Salmi et al., PMID 330...
Do you treat stage 1 non-seminoma differently if there is a component of embryonal carcinoma?
No.
What are your recommendations for a male patient who was recently started on imatinib and wants to conceive?
Great question. This comes up often. For males, they can continue to take their CML TKI and conceive a child. Of course, this is much more complicated for women as they should not be pregnant while taking a TKI. I would say that if the patient is having difficulties conceiving, he should undergo a ...
Would you consider using DOACs in a young patient with SLE and Libman-Sacks endocarditis, who is negative for APS?
In this scenario, our patient with lupus is young and does not have features of APS. Nevertheless, any patient with Libman Sacks endocarditis carries a heightened risk for embolization. Regarding anticoagulation, the literature on this subject is anecdotal and conflicting with some authors recommend...
In a patient with stage 1 mixed germ cell tumor who cleared tumor markers post-orchiectomy but with subsequent rise to borderline abnormal within 6 weeks, would you treat with 3 cycles BEP as for S1 disease?
Several points to begin with. My strong preference is to recommend active surveillance for all well documented clinical stage 1 nonseminoma whether or not there is embryonal predominance or lymphovascular invasion present. Second, I do not make treatment decisions based on borderline abnormal normal...