Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
Is there any scenario where you would consider treating a relapsed AYA patient with Hodgkin Lymphoma without consolidative auto transplant?
Risk-adapted, response-based therapies for pediatric Hodgkin lymphoma have resulted in five-year survival exceeding 90%, even for high risk patients 1. High-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (HDCT/ASCT) is standard for adults with first relapse or refra...
Is an elevated CRP an expected finding in an otherwise healthy patient with hemoglobin S - alpha thalassemia?
If you Google "CRP levels in sickle cell disease", you will find a number of articles reporting that CRP levels are chronically elevated in many patients with SCD. This undoubtedly reflects the chronic inflammatory state that is part of the clinical milieu of SCD. Patients with Sickle - alpha thalas...
Do you recommend starting an antiplatelet for primary prophylaxis in post splenectomy thrombocytosis given there is some increased risk of venous thrombosis?
I do not recommend routinely initiating prophylactic antiplatelet therapy for post splenectomy thrombocytosis. First, in patients without a myeloproliferative neoplasm (MPN), the increase in platelet number post splenectomy is both delayed and mild, and there is no correlation between reactive throm...
Do you consider travel as a risk factor for DVTs in the absence of any other underlying predisposing factors?
Unfortunately, there are no strong guidelines around this topic. In general, I do not count long car rides as a risk factor unless there is something extremely unusual about the trip. Most people are going to get out and stretch their legs every couple of hours. Long flights are different. There are...
When using daratumumab in the setting of post-transplant red cell aplasia or post-transplant immune-mediated cytopenias, do you hold the drug for certain ANC parameters?
Typically, we do not hold until below ANC 500.
How do you approach steroid-refractory GVHD in patients who either cannot receive ruxolitinib or do not respond to ruxolitinib?
Both acute and/or chronic GVHD could be steroid-refractory. In patients with acute steroid-refractory GVHD, I would target therapy based on organ involvement. If skin is involved and the patient cannot take or get ruxolitinib, I would use ATG first, in particular if severe disease, but there is a nu...
What is your approach in a fit patient, advanced stage, bulky classical Hodgkin lymphoma who has decreased disease burden in areas but a persistent, hypermetabolic (Deauville 5) anterior mediastinal mass following two cycles of AAVD?
Biopsy!If persistent HL:I know it is only phase II data, but I've been impressed with the ORR and personal experience with pembro-GVD: Moskowitz et al., PMID 34170745.I hate radiating the chest, but one could argue that option as well.
How would you treat a locally-recurrent extraosseous (pulmonary) Ewing sarcoma?
It is possible to re-challenge the patient with the same regimen. Assuming EF and BNP are normal and can be followed, bolus Doxorubicin with Dexrazoxane would allow safe administration of additional doxorubicin. The alternative is to use high-dose Ifosfamide (14 g/m2/cycle). In the event of a good v...
In patients with severe hemophilia A on emicizumab for prophylaxis, in case of noncompliance leading to a lapse of more than 2-3 months off therapy, do you reload with emicizumab?
In general, you need to restart the four-week loading then follow with maintenance. First, you need to find out why they were noncompliant (e.g. did not like/could not do subcutaneous injections, did not work, always noncompliant). If they are planning to continue noncompliance, this is not a good ...
How do you discern whether elevated liver enzymes are from immunotherapy versus chemotherapy when a patient is on combination chemo/immunotherapy?
There is no consensus on the best method for distinguishing the cause of elevated liver enzymes in patients being treated with ICPi's when combined with various chemotherapies. Important considerations include time of onset, severity, and presence of hepatobiliary metastases. Hepatotoxicity from ICP...