Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
Is cross reactivity low enough to try cisplatin as an alternative for patients who experience hypersensitivity reaction to carboplatin?
A couple of preparatory comments. First, there is a reasonable review recently published about platinum sensitivity and management questions related to this (Makrilia et al., PMID 20886011). The second comment is that platinum sensitivity reactions can be quite severe, and are relatively rare with <...
How would you approach an early stage II unfavorable Hodgkins lymphoma following 6 cycles ABVD with persistent Deauville 5 with negative biopsy?
This is an active disease and should be treated accordingly. I would not wait. RT is certainly option number one now, but the patient has a considerable risk for recurrence even after RT, since he/she has Hodgkin‘s that is not responding adequately to treatment. Continuing with ABVD in a patient who...
When do you refer patients for germline testing when somatic tumor testing is negative for actionable mutations?
Somatic (tumor-only) testing should not be used to conclusively rule in or rule out the presence of a germline pathogenic/likely pathogenic alteration. While most germline sequence alterations (point mutations, small insertions/deletions) will be detected on tumor-only testing, this may miss chromos...
Do you hold IV iron in the setting of active infection?
While there is no evidence of harm, there is enough conjecture about the danger to make it prudent to wait until infection is controlled. So yes, I do. Further because of the iron restricted erythropoiesis during infection, the efficacy is likely to be blunted.
What recommendations do you have for a transgender female patient with history of prothrombin gene mutation who is interested in starting gender affirming hormone therapy?
A review of the literature suggests that the risk of VTE associated with hormone therapy in this setting is quite low, even in the presence of other risk factors for clotting (see, for example, Mullins et al., PMID 33753543). Furthermore, the presence of an asymptomatic prothrombotic genotype is rar...
Do you routinely send NGS testing from bone marrow samples in patients with unexplained cytopenia or cytoses?
For patients with unexplained cytopenias in whom I suspect MDS or MDS/MPN, I will often obtain a broad NGS panel for myeloid malignancy gene mutations. The goal is to aid in diagnosis (and prognosis once the diagnosis is made), but I do not rely on the NGS panel alone to make the diagnosis. A bone m...
Is there a role for IL2-receptor antagonists and TNF-alpha inhibitors in cytokine release syndrome as a complication of CAR-T or immunotherapy?
I came across a report from China regarding 3 patients who received BCMA CAR-T therapy, developed CRS, and were treated successfully with Etanercept based on elevated TNF-alpha. 2 of these patients did not receive tocilizumab before Etanercept which is not a standard practice. I'm not recommending u...
Do you feel that more frequent genomic sequencing will be cost-effective in the management of high-risk pediatric cancers?
Currently, the increased utilization of tumor genomic sequencing in pediatric cancer (which I assume you mean by “more frequent sequencing”) has resulted in more companies and academic practices implementing NGS platforms and on-site sequencing. This increased clinical use leads to an increased numb...
What is your current practice around genomic sequencing for pediatric cancers?
As mentioned in our article, we currently offer tumor genomic sequencing to patients who have high risk pediatric cancers at diagnosis who do not routinely undergo molecular characterization as a standard of care diagnostic procedure and for pediatric cancer patients whose tumors are refractory to t...
What are the perceived implications of broader genomic sequencing as it pertains to interpreting variants of unknown significance and germline predisposition mutations?
Variants of unknown significance (VUS) are constantly being revised when it comes to identifying “potentially pathogenic mutations.” We work with a molecular pathologist as well as the pathologists at Exact Sciences to understand in real time where VUSs fall in regards to their pathogenicity and act...