Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
What criteria is needed in relapsed/refractory B-cell ALL to choose CAR-T therapy over conventional stem cell transplant as destination therapy?
Currently, there are no standard criteria used to choose CAR-T over conventional stem cell transplant as destination therapy. However, there are many factors that often push us in one direction or the other. As we learn more about outcomes after CAR-T cell therapy, there are many factors we know are...
How would you manage a child with subtotal resection of an atypical choroid plexus papilloma?
Data from the SickKids Hospital study strongly suggest that the extent of resection is prognostic in atypical CPP, and in the presence of GTR, chemotherapy may be avoided or skipped entirely (Browne-Farmer et al., PMID 34529227). The role of adjuvant treatment in the setting of incompletely resected...
When do you consider including Rituximab into the treatment regimen for a pediatric or AYA patient with intermediate and advanced-stage nodular lymphocyte-predominant Hodgkin lymphoma?
First, I would want to make sure the diagnosis is correct as advanced stage NLPHL is extremely rare. T-cell rich B-cell lymphoma can look identical histologically. Either way, R-CHOP therapy is good therapy for both.
How would you manage a recurrent pineoblastoma following prior CSI?
Recurrent pineoblastoma following prior CSI represents a challenging clinical scenario. As there is very little published data to guide optimal management, our approach is adopted from recurrent medulloblastoma. The prognosis for patients with recurrent medulloblastoma/PNET is poor, with 5-year OS <...
Can aplastic anemia present with multiple infiltrative bone lesions, such as in the spine and pelvis?
There are several studies showing diffuse hypointense pictures with an infiltrative-like pattern on MRI in aplastic anemia and MDS. Some aplastic anemia and refractory cytopenia of childhood show patchy pattern of hematopoiesis with some regions having increased fat fraction and some remnants of hem...
What is your therapy of choice for relapsed metastatic alveolar rhabdomyosarcoma?
I will make just a couple of presumptions. First, I will presume that this alveolar rhabdo is FOXO1-fusion positive. If not, I would treat as I would an embryonal (fusion negative) rhabdo with vinorelbine/PO cyclophosphamide, vinorelbine/cyclo/temsirolimus, vincristine/irinotecan +/- temozolomide, c...
What is the role of radiotherapy in a newly diagnosed patient with parameningeal rhabdomyosarcoma w/ intracranial extension, a positive CSF but no extra-CNS metastases?
The question as to the role of RT in patients with parameningeal (PM) RMS with CNS leptomeningeal disease is complex and one lacking scientific evidence to support one’s answer. My response represents a historic viewpoint gained from hearing the discussions of the Intergroup Rhabdomyosarcoma Group (...
Under what circumstances do you consider valacyclovir for the management of VZV disease of the CNS?
If the patient has encephalitis would use IV acyclovir and only transition to high dose valcyclovir (2 g every 8 or every 6 hs depending on weight) after improvement. Although there is PK data to support these high doses, I would not use it initially. Immunosuppressed patients have a higher likeliho...
How do you approach relapsed idiopathic HLH?
If the patient was previously in remission after etoposide and steroids, they may well respond to etoposide and steroids again. I strongly consider hematopoietic stem cell transplant in anyone who relapses after an episode of HLH, since it is usually a harbinger of recurrent and potentially life-thr...
Do you initiate anticoagulation prophylaxis for pediatric patients with vascular compression secondary to solid tumor/lymphoma?
It is an interesting question, but lacks critical details. Of course, most cancers are prothrombotic, and anticoagulation can have risks: Is it arterial or venous compression? Complete obstruction? Acute or chronic? Collaterals? Is it compromising an organ? Is thrombus seen, or is there blood flow?...