Pediatric Oncology&nbsp;&nbsp;&nbsp;

What is your institutional approach to a restrictive “neutropenic diet”?

How do you prescribe a steroid taper for radiation and checkpoint inhibitor related pneumonitis?

I've seen a handful of fatal radiation pneumonitis associated with rapid steroid tapers by the non-treating physicians. How do you recommend prescribi...

How do you manage a patient with a history of high-risk leukemia who has increasing loss of donor chimerism in the post-transplant setting in the absence of disease relapse?

How does graft function play into your decision making? How do you utilize post allogeneic transplant chimerism in clinical practice? Do you obta...

How would you treat a patient with history of stage I seminoma s/p orchiectomy with enlarging periaortic node and normal tumor markers on surveillance?

Would you biopsy lymph node to confirm recurrence/histology? If confirmed, how do you decide between RT vs chemotherapy? If chemo - BEP x3 vs E...

5 Answers available

At what platelet count would you feel comfortable dosing aspirin 81 mg for coronary artery disease in a patient with ITP?

Presuming strong indication for ASA - eg history of NSTEMI

How has the virtual aspect of tumor boards impacted their educational quality in the Covid-19 era?

Is there any benefit to transplant patients with Ph+ ALL who have achieved MRD-negativity?

How do you manage insomnia in cancer patients that is refractory to traditional sleep aides?

In patients who continue to have insomnia despite diphenhydramine, benzos, and trazodone, are there other evidence based treatments that are helpful?

How do you manage real-time release of pathology and radiology results to oncology patients following enaction of the CURES act?

Do you routinely offer antiviral prophylaxis for patients receiving chemoimmunotherapy?

If so, what regimen do you utilize?

In a patient with stage 1 mixed germ cell tumor who cleared tumor markers post-orchiectomy but with subsequent rise to borderline abnormal within 6 weeks, would you treat with 3 cycles BEP as for S1 disease?

If serum markers were normal, how strongly do you consider 1 cycle of BEP for embryonal predominant pathology?

What are your recommendations for a male patient who was recently started on imatinib and wants to conceive?

Why do we use dexamethasone for CNS edema and prednisone for pneumonitis?

Is this an artifact of what agent prior clinical trials used or something to do with mechanism of action (ie less mineralocorticoid effect of dex)?

For a young male with Stage III intermediate risk NSGCT with active 1 ppd smoking history but normal PFTs and DLCO results, would you still consider use of BEP x 4?

VIP can be considered, but given complex psychosocial issues and limited community cancer treatment resources, this question is being asked.

Are there best practices or data regarding the use of open notes among oncology patients?

What is the impact among patients and providers? Has your documentation been adjusted now that patients can readily review?

How do you approach heparin management in patients who have suprathetherapeutic Xa levels on minimal heparin?

Do you treat stage 1 non-seminoma differently if there is a component of embryonal carcinoma?

Do you routinely check Pulmonary function testing prior to each cycle of BEP for young patients with testicular cancer with no pulmonary risk factors?

NCCN guidelines state check at baseline and then as clinically indicated. Some other sources state, can check prior to each cycle of BEP? What ...

What are some alternatives to dexamethasone for brain edema in patients who are allergic, have an intolerance, or refuse the medication?

5 Answers available

How do you incorporate denosumab into the surgical management of giant cell tumor of bone?

Does the degree of resectability affect your management?

Do you recommend routine use of Evusheld for pre-exposure prophylaxis for patients on immunosuppression?

Does treatment with B-cell depletion and/or negative anti-spike antibody status despite COVID mRNA vaccination influence your decision?

How would you approach breast cancer screening in an adolescent patient with a CDH1 mutation?

0 Answers available

How do you approach very treatment-refractory ITP?

Such as the case in which a patient is unresponsive to steroids, IVIG, TPO-agonist, rituximab, splenectomy, and even fostamitinib.

How do you manage drug-induced thrombocytopenia when the implicated drug is essential?

e.g. DITP from eptifibatide after a cardiac intervention

For treatment of ITP, what would you add to dexamethasone to achieve the fastest recovery in a patient waiting for a procedure?

IVIG, TPO, or other agents?

How do you approach therapy for a patient with stage IIIA NSGCT who received 4 cycles of EP followed by RPLND which revealed residual mixed teratoma and embryonal carcinoma?

Given persistent embryonal histology on RPLND, do you favor observation or TIP/VIP? What do you use to guide your decision?

What features help distinguish thyroid myopathy from immune checkpoint inhibitor-associated myopathy?

What is your strategy for breakthrough chemotherapy induced N&V in patients receiving highly emetogenic chemotherapy and already received a NK-1 antagonist, 5-HT3 antagonist, dexamethasone, and olanzapine?

How would you treat a young patient with classical intermediate-risk Hodgkin lymphoma who has an underlying DNA repair-deficiency disorder, such as congenital mismatch repair disorder or ataxia telangiectasia?

How does your treatment approach vary depending on the underlying predisposition?

How do you approach relapsed idiopathic HLH?

How will you use Pola-R-CHP in the frontline treatment of DLBCL?

Given the POLARIX study data presented at ASH 2021, will this replace R-CHOP as the standard of care therapy in your practice? If not, how will y...

What are contraindications for growth factors in patients with hematologic malignancies?

Do you routinely check platelet counts after COVID-19 vaccines in patients with chronic ITP?

How do you manage a patient with superficial venous thrombosis with close proximity (<3 cm) to deep veins and an inherited thrombophilia ?

Would you offer indefinite anticoagulation if the event is unprovoked and the patient has low bleeding risk?

What is the optimal age at which a patient with sickle cell disease should undergo allogeneic stem cell transplant?

Is there experience/reports of using voxelotor in sickle cell patients who are Jehovah Witnesses with few crises but who have fatigue and/or dyspnea?

Also is there value in using voxelotor for the purpose of reducing hemolysis, and if so what parameters do you use to determine when to initiate voxel...

What is your preferred approach for patients with anti-phospholipid syndrome with recurrent thrombosis on coumadin and LMWH?

How would you approach moderate neutropenia (ANC < 1000) in a solid organ transplant recipient?

Is there a particular sequence you would adjust contributing antirejection or antimicrobial medications? Is the use of G-CSF appropriate and at what c...

What is the role of hydroxyurea in variant sickle cell genotypes?

Hydroxyurea is demonstrated to reduce complications and improve long-term outcomes in severe genotypes HbSS and sickle beta0 thalassemia. What clinica...

In what circumstances would you give G-CSF to a patient with severe neutropenia and HLH?

How do you approach conversations regarding discontinuation of transfusions in patients with advanced hematologic malignancies who are otherwise appropriate for hospice?

Are there other supportive care interventions that would otherwise be covered by hospice?

Do you utilize D-dimer to inform anticoagulation duration in the treatment of VTE?

Provoked or unprovoked VTE: Do you use D-Dimer (or even repeat imaging to reassess residual clot) in any capacity to guide anticoagulation duration? E...

How would you manage VTE in a patient with bleeding disorder such as hemophilia?

Have you used anticoagulants other than coumadin? Or is that the only appropriate agent given monitoring is based on PT/INR?

How long should patients treated with frontline therapy for Hodgkin lymphoma wait before attempting to conceive a child?

Do your recommendations differ between those who receive ABVD and escalated BEACOPP? Do you recommend consultation with fertility specialists for all...

What regimen would you offer a young patient with T-cell ALL who recurred a short time after allo-transplant and was initially treated with CALGB10403?

Especially with the current drug shortage of nelarabine.

Would you start TKI therapy in a patient with new diagnosis of T-ALL without BCR-ABL gene rearrangement on FISH but found to have very low level p190 transcript on RT-PCR?

How do you approach management of sickle cell patients who mistrust Western medicine and prefer naturopathic therapies?

While building a trusting patient-physician relationship, what therapies could be discussed that may be aligned with naturopathic medicine? (i.e. L-gl...

How would you manage asymptomatic brain metastases from testicular non-seminomatous germ cell tumor with a choriocarcinomatous component?

In which patients with oncologic or hematologic disorders are you recommending a 3rd dose of mRNA COVID vaccine?

How do you approach treatment of a glioblastoma in pregnancy?

Do you use premedications (acetaminophen, diphenhydramine) before pRBC and plt transfusions to prevent febrile nonhemolytic transfusion reactions and allergic reactions?

Does manipulation of blood products (leukoreduction, irradiated) affect your approach? There is growing evidence that routine premedication (at least ...

What is the utility of immunotherapy in management of malignant peripheral nerve sheath tumors?

In particular, is there any data on the efficacy of Ipilimumab/Nivolumab?

Under what circumstances would you consider anticoagulation in a young female patient with persistently elevated factor XI activity?

While this is a known risk factor for venous [Meijers et al NEJM 2000] and potentially arterial [Yang et al, Am J Clin Pathol 2006] thrombosis, it is ...

How would you optimally manage a patient with a MDS/MPN overlap syndrome who has both transfusion-dependent anemia and marked thrombocytosis?

Would this change with someone who has a history of thrombosis (e.g. DVT/PE, MI, CVA)? Would this change with someone who is more fit vs more frail?

Do you think there is any compelling data to support giving brentuximab as frontline therapy for pediatric patients with Hodgkin lymphoma?

Results of AHOD1331 are not yet known, but adults have started using Brentuximab upfront for high risk patients

How would you approach immunosuppression for patients with severe aplastic anemia who are not transplant or ATG candidates?

Such as patients who are frail, elderly, renally impaired? Would you consider sirolimus over cyclosporine or tacrolimus for safer nephrotoxicity prof...

How long do you continue caplacizumab in relapsed refractory TTP?

How often do you monitor ADAMTS-13 levels off therapy?

Are there any reasons to consider a prolonged course of steroids with taper over a shorter course of pulsed steroids in the treatment of ITP?

For example, do we prefer one regimen over the other in patients with a bleeding history or who have relapsed after a lengthy remission?

What strategies have you found to be most effective in engaging PCPs in a primary-care or shared-care model of survivorship for pediatric and AYA patients who will receive ongoing care in their communities away from their primary oncology treatment site?

In follow up to @Jacqueline Casillas presentation at ASCO 2021 regarding models of survivorship care delivery for AYA patients.

With new data showing similar outcomes of mismatched unrelated donor and haploidentical related donor allogeneic transplants using post transplant cyclophosphamide, how does one decide which donor is optimal?

If given both options, which donor would one prefer: haploidentical related donor or 7/8 mismatched unrelated donor using post transplant cyclophospha...

How is pediatric and young adult primary bone lymphoma risk stratified?

NCCN guideline V4.2021 DLBCL page BCEL-3 states stage I-II, bulky >= 7.5cm should be treated with 6 cycles of RCHOP, but most bone lymphoma studies...

Would you consider bone marrow transplant in a pediatric patient with recurrent HLH with no identified exogenous trigger or HLH-associated mutation?

How would you approach chronic isolated severe non-cyclic neutropenia with negative bone marrow and rheumatologic work-up?

Is there a role for empiric antibiotics if there is history of opportunistic infection?

What dose of PEG-asparaginase do you recommend for teens with high BMI treated on a pediatric ALL regimen?

Would you plan straight pediatric dosing using 2500 Units/m2 or a cap of 3750 Units as used in some adult ALL regimens due to excess liver/pancreas to...

How would you treat an advanced stage small-cell carcinoma of the ovary, hypercalcemic type? (SCCOHT)?

s/p optimal debulking. If this was an early-stage cancer would it change your adjuvant therapy recommendations?

What treatment regimen would you recommend for young adults with platinum refractory relapsed germ cell tumors?

How do you approach the use of low-dose aspirin for primary prevention in non-pregnant patients with SLE and positive aPL antibodies, without clinical criteria for APS?

Do you follow the 2019 EULAR Guidelines that SLE patients with asymptomatic, positive aPL should be on low-dose ASA?

Should targeted therapies such as Brentuximab or Crizotinib be used in the upfront management of anaplastic large cell lymphoma in a pediatric or AYA patient?

What is the role of targeted therapy in relapsed/refractory ALK+ anaplastic large cell lymphoma?

Would you use ALK inhibitors such as crizotinib based on recent phase II data? Are there any research efforts to combine ALK inhibitors with current ...

Should high-dose methotrexate be used in the treatment of AYA patients with osteosarcoma?

What is the preferred treatment approach for an AYA patient with intermediate to high risk Hodgkin lymphoma: The pediatric approach (ABVE-PC +/- radiation) or the adult approach (ABVD with possible escalation to BEACOPP)?

When can defibrotide be discontinued before the 21-day treatment course is completed in a pediatric patient with SOS?

Do you always treat with the full 21-day treatment course, or can defibrotide be stopped if certain criteria are met sooner?

How do you choose your systemic treatment for primary mediastinal grey zone lymphomas?

Do you prefer a cHL chemotherapy backbone or PMBL chemotherapy backbone?

Should patients receive thrombophilia testing in the setting of a provoked VTE secondary to hormonal therapy/OCPs?

While thrombophilia testing is not routinely recommended prior to starting OCPs, how about after the development of a VTE?

When do you refer AYA patients with newly diagnosed severe aplastic anemia for transplant?

Would you give a trial of IST first or immediately refer for SCT if the patient has matched siblings?

Can an AYA patient with newly diagnosed AML safely sperm bank after starting cytoreduction with hydroxyurea or cytarabine?

Would you offer immunotherapy for recurrent metastatic Ewing sarcoma if the tumor is MSI high or has high TMB?

What are the current official guidelines regarding COVID-19 vaccination for patients with cancer or for hematologic conditions?

Is a patient with secondary myeloid sarcoma a candidate for hematopoietic stem cell transplant?

How would you time COVID-19 vaccination with someone on R-CHOP chemotherapy?

How do you determine when to give a second CAR-T cell infusion to a pediatric or young adult patient with relapsed/refractory ALL?

How would you approach the treatment of patients with von Willebrand disease or hemophilia A previously managed with intranasal DDAVP during the recall?

During the Stimate recall, how are we performing DDAVP challenges for newly diagnosed hemophilia A or von Willebrand disease?

For AYA patients with early-stage Hodgkin's lymphoma being treated with ABVD, how many cycles of chemotherapy do you administer, and when can radiation be avoided?

Have the RAPID or CALGB 5064 studies changed your treatment approach?

How do you counsel patients who are candidates for a clinical trial regarding their options?

Specifically, are there strategies you use to 1) empower patients to participate in decision-making and 2) reassure patients who may be skeptical?

When should a gallium-dotatate scan be incorporated into the initial evaluation of a patient with a carcinoid tumor of the appendix?

What are your thoughts on adding mycophenolate to steroids in the first line treatment of ITP based on the results of the FLIGHT trial?

Presented at ASH: FLIGHT trial

How would you treat an adolescent or young adult with newly diagnosed hepatosplenic T-cell lymphoma?

For which rituximab infusion reaction symptoms do you consider it safe to re-challenge in the office with adjusted rates and pre-medications?

Do hemoglobin S levels always correlate with SCD phenotype?

What is the lowest level you have seen with uncomplicated or complicated crises?

What is your preferred formulation of parenteral iron?

There are various formulations of intravenous iron; each with varying costs, test dose requirement, elemental dose, and number or time of infusions ne...

Do you re-test patients who test positive for COVID-19 during or prior to starting cancer treatment?

There are mixed recommendations about re-testing vs simply waiting for a quarantine period prior to resuming therapy.

How do you manage VTE in the setting of persistent severe thrombocytopenia?

Is there a preferred strategy of transfusional support versus reduced-dose anticoagulation during the duration of thrombocytopenia?

Is there any role for direct oral anticoagulants in the treatment of antiphospholipid syndrome?

What if this was "triple-negative" antiphospholipid syndrome?

Would you use a myeloablative or reduced intensity conditioning regiment for a pediatric or AYA patient who does not recover their counts after treatment for AML, but remains disease free?

Would you test for bone marrow failure syndromes before beginning the conditioning regimen?

At what level of bone marrow disease would you agree to proceed with transplant for a patient with refractory AML?

I have heard <20% MRD. What about proceeding if patient is hypoplastic after chemotherapy?

How do you approach the pharmacologic management of cancer-related fatigue?

After optimizing symptoms and reversible factors, and attempting cognitive-behavioral interventions and exercise, do you recommend pharmacologic agent...

How would you approach therapy for a young, fit patient with alveolar rhabdomyosarcoma involving the anterior nasal vault/sinuses in the absence of available clinical trials?

Presented with mass projecting into right/left anterior ethmoid complex

How would you treat a young patient with symptomatic Rosai-Dorfman disease who has recurrent, life-threatening pericardial and pleural effusions?

CT scans show omental and pelvic disease.

How would you approach treatment in an otherwise young, fit patient with transformed AML currently in remission with a plan for transplant and was found to have an invasive fungal infection not amenable to resection upon recovery from induction?

Would you consider “bridging” therapy with something like an HMA?

How would you approach langerhans cell histiocytosis involving a single bone site after resection?

During induction therapy for acute leukemia, when do you decide to discontinue the antimicrobial prophylaxis?

Is it at neutrophil recovery, at documentation of CR on bone marrow biopsy, or is there a different point in time?

What are the options of induction treatment of young AML patients who are on CRRT, continuous renal replacement therapy ?

For pre-menopausal female patients who present with acute leukemia in need of urgent anti-neoplastic therapy, what is your preferred approach in effort to preserve fertility?

Does acute leukemia sub-type affect your decision?

How do you choose first or second-line systemic therapy for fibrolamellar hepatocellular carcinoma?

What are there most evidence-based options?

How do you approach the decision of whether and when to initiate therapy in patients who remain COVID-19 positive >2 weeks after infection but are asymptomatic from the virus?

E.g. a patient with progression of their primary cancer but still is testing COVID19+ over a month after infection?

5 Answers available

When during ALL induction therapy are you checking for MRD?

Should we be utilizing prophylactic G-CSF in our patients with intermediate risk of febrile neutropenia due to the COVID-19 pandemic?

Are you placing more weight on patient risk factors such as age >65 or co-morbidities?

When will theMednet release an app for the iPhone?

Would you hold rituximab for newly diagnosed B-cell lymphoma if the patient is COVID-19 positive?

What if the patient has a history of confirmed COVID-19 but has since recovered?

What treatment would you offer a young pregnant woman with a symptomatic midline low grade glioma?

Discussion of treatment options for midline low-grade glioma causing life-altering symptoms in a pregnant patient to avoid teratogenicity.

How do you determine whether to treat a young adult with stage IA Hodgkin Lymphoma with the adult or pediatric treatment paradigm?

At what age would you treat an early stage hodgkins lymphoma patient with ABVD + RT (adult treatment) vs OEPA x 2 or AV-PC x 3 (pediatric paradigm)?&n...

Do you offer fertility preservation to patients prior to CAR-T therapy?

Do you limit it to post-pubertal patients? Do you offer it only if they will proceed with bone marrow transplantation after CAR-T?

How do you treat a patient with a history of clinical stage IIb cN2, mixed germ cell embryonal carcinoma treated with BEP and RPLND five years ago, who now has signet ring cell adenocarcinoma with abdominal carcinomatosis with an unknown primary?

GI work up negative. NGS cancer type and isochromosome 12p ordered and pending. Pathology at RPLND was negative for cancer.

How do you decide the right time to transition to hospice?

Obviously, patient and caregiver preferences are paramount. But, what factors do you consider? Does expanded hospice (e.g., Medicare Care Choices) inf...

What chemotherapy would you recommend for a patient with Ewing Sarcoma who has relapsed after being initially treated with vincristine/doxorubicin/ifosfamide?

Are you altering your use of immune checkpoint inhibitors given the risk of immune-related pneumonitis and the COVID-19 outbreak?

How should you manage a COVID-19 infected/suspected patient who is receiving chemotherapy and cannot interrupt or delay their cancer treatment?

In light of promising results of hydroxychloroquine in COVID-19, should we consider using it prophylactically in cancer patients, especially if immunocompromised?

Acknowledging that there is no time for good trials yet in this setting

How should you manage a coronavirus infected/suspected patient who is receiving radiotherapy and cannot interrupt or delay their cancer treatment?

How would you approach a patient who is receiving chemoRT but has confirmed COVID-19 with minor symptoms, as breaking treatment for 2 weeks quarantine...

7 Answers available

Should I wear gloves during a routine physical exam on an asymptomatic patient with no risk factors for COVID-19?

How does the management of nasopharyngeal cancer in kids/young adults differ from adult patients?

-The data on induction for adult H&N ca has been mixed (excluded NPX) but recent data suggest a benefit for adult NPX. -Given that this is standa...

What is the standard of care (if any) for pediatric desmoplastic round cell tumor?

Is there a role for immunotherapy outside of trial setting?

When would you consider testicular RT prior to TBI for BMT?

What dose do you recommend?

Should I treat a patient who doesn't know she has cancer?

My patient’s family has asked that I don’t tell her that she has metastatic cancer because it will devastate her. I am planning on palliat...