Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
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In what clinical scenario would you consider liver transplant evaluation for a patient with sickle cell hepatopathy?
We have evaluated and transplanted patients with sickle cell hepatopathy with severe liver dysfunction but well-controlled sickle cell. These patients will typically have jaundice, coagulopathy, and biliary strictures. They should not have significant extrahepatic complications of the hematologic di...
Is there any indication for IVIG in immunocompromised patients with only decreased IgM and/or IgA levels?
Nope. IVIG preparations contain IgG not IgA or IgM. Low serum IgA may or may not be associated with low IgA levels in mucosal surfaces leading to a risk of local infections. Low levels of one or both may be asymptomatic but in the right setting might suggest a need for evaluation of plasma cell dysc...
Can an AYA patient with newly diagnosed AML safely sperm bank after starting cytoreduction with hydroxyurea or cytarabine?
Thanks for the question. Unfortunately, there is not a lot of data available to answer this question with certainty. Because of that, I err on the side of saying that this should not be done. The concern lies with the possible impact on the sperm DNA, and the subsequent effect that might have on a p...
Is dexrazoxane recommended for cardioprotection in AYA patients with Hodgkin lymphoma who are receiving anthracyclines as part of their upfront therapy?
This is a good question that reflects the growing body of evidence in favor of dexrazoxane cardioprotection being safe and beneficial (Chow et al., PMID 26014292; Getz et al., PMID 32343641). For AYAs with Hodgkin lymphoma, doxorubicin remains a key component of therapy even for lower stage disease ...
How will you use Pola-R-CHP in the frontline treatment of DLBCL?
Given the comparable toxicity profile and the lower rate of treatment failure, the number needed to treat (n=16) is low enough that this is very appropriate to be the new standard of care. Although overall survival was not different, fewer patients treated with the Pola-R-CHP regimen required subseq...
How would you counsel a woman with a strong family history of thrombosis about oral contraceptives?
This can be a complex question for which there are likely no specific data or guidelines upon which to base a recommendation. ASH has published guidelines on thrombophilia testing in VTE (Middeldorp et al., PMID 37195076). They specifically recommend against testing prior to COC prescription. The ra...
Is your standard of care for newly diagnosed advanced classical Hodgkin now nivolumab-AVD based on SWOG 1826?
I think the new standard of care for newly diagnosed patients with advanced classical Hodgkins Lymphoma is now nivolumab-AVD based on the early data from SWOG 1826. While we often wait for more mature data, the early improvement in PFS and the more favorable toxicity profile of this regimen over BvA...
Do you offer fertility preservation to patients prior to CAR-T therapy?
There is no evidence yet about the impact of CAR-T itself on fertility, and this will be difficult to study in isolation in this population. Many CAR-T patients have been heavily pre-treated, so semen cryopreservation and oocyte harvesting may not be successful; but if feasible they should be attemp...
What is your approach to chronic non-immune mediated thrombocytopenia management in children?
There are whole textbook chapters on this topic, and we use a variant of this question to review the differential diagnosis of thrombocytopenia with our fellows as a didactic exercise. So I take from this question, which is an important one, what might be a framework to consider the differential dx ...