Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
What is the role of stem cell transplant as a consolidation therapy in relapsed Wilm’s tumor?
The role for high-dose chemotherapy (HDT) followed by autologous stem cell rescue for Wilms tumor (WT) is uncertain. There has never been a randomized controlled trial and the available evidence is limited to case series, which are influenced by selection bias and lack of adequate control arms. Perh...
What is the benefit of cytoreduction with Hydroxyurea for patients with newly diagnosed chronic phase CML with a WBC count >100 prior to the initiation of a TKI?
For newly diagnosed patients with CML, there is no benefit to using hydroxyurea before TKI. Using HU oftentimes ends up causing cytopenias and it then makes it challenging to keep patients on their TKI when it is started. There are some scenarios where it is reasonable to use- if you don’t yet know ...
How do you define bulky disease for Hodgkin's lymphoma which is outside the mediastinum?
Definition of bulk in lymphoma is not homogenous among countries, study groups, and diseases.Overall, 10 cm is considered the cutoff by some. Recently, the cutoffs of 7 or 7.5 cm have been introduced, especially in DLBCL. The definition tends to be disease-specific sometimes, since landmark studies ...
In light of the recent rEECur trial interim analysis, would you offer high-dose ifosfamide to an AYA patient with relapsed Ewing's sarcoma who initially had a complete response to up-front therapy?
Yes, I would certainly consider offering high-dose ifosfamide to relapsed Ewing's sarcoma patients in light of the rEECur results [McCabe et al., J Clin Oncol 40, 2022 (suppl 17; abstr LBA2)]. The first line regimens I have traditionally offered to recurrent EWS patients have been topotecan/cyclopho...
Is rituximab for refractory ITP contraindicated in the setting of an active COVID infection, particularly in a patient with asymptomatic COVID?
Given that we would delay rituximab treatment for many active infections, I would recommend that we apply the same restrictions. I would hold the rituximab for ten days after covid test confirmation.
What is your institutional approach to a restrictive “neutropenic diet”?
Simple answer: never. The "neutropenic diet" has no efficacy and may actually be nutritionally AND microbially inferior to normal diet. This has been shown by multiple studies. I like the title of the review, "Things We Do For No Reason: Neutropenic Diet." Ma et al., PMID 35356218. Radhakrishnan et ...
Which, if any, young/fit intermediate-risk AML patients would you not offer allogeneic transplant to in MRD- CR1?
At our center, we routinely offer the option of allogeneic stem cell transplant to younger fit patients with intermediate and poor risk AML. The only individuals that we would not offer this to are those with biallelic CEBPalpha mutant AML or NPM1 mutant/FLT3 wildtype AML without a matched sibling d...
How soon do you anticipate response to cyclosporine in red cell aplasia and what cyclosporine trough levels do you target?
I typically use tacrolimus rather than cyclosporine. I find it has fewer off target effects and is easier to maintain blood levels. Trough blood level is 5-10. Cyclosporine levels are 100-400 which is too broad. I would give it at least 3 months. If not done already, I would do for LGL.
What is your approach to using medications that can cause bone marrow suppression in SLE patients who have persistent leukopenia?
I am so glad someone asked this question. I have heard some peers state that they are reluctant to use immunosuppressants in this situation. However, I do not agree with this. The whole reason our systemic lupus (SLE) patients have leukopenias is due to their autoimmunity (but make sure drugs, infe...
How do you approach anticoagulation in the setting of HIT and thrombocytopenia?
This is a very relevant but rather broad question. On a day-to-day basis, the decision on whether one is dealing with HIT vs other causes of thrombocytopenia can be complex. Applying the 4Ts score is easier in retrospect, but in real life patient management, the score has the potential to change alm...