Table Of ContentLANZKOWSKY’S MANUAL OF PEDIATRIC
HEMATOLOGY AND ONCOLOGY
SIXTH EDITION
LANZKOWSKY’S
MANUAL OF PEDIATRIC
HEMATOLOGY AND
ONCOLOGY
SIXTH EDITION
Edited by
P L , MBC B, MD, S D (H C ), FRCP, DCH, FAAP
HILIP ANZKOWSKY H C ONORIS AUSA
ChiefEmeritus,PediatricHematology-Oncology
ChairmanEmeritus,DepartmentofPediatrics
ExecutiveDirectorandChief-of-Staff(Retired)
StevenandAlexandraCohenChildren’sMedicalCenterofNewYork,NewHydePark,NewYork
VicePresident,Children’sHealthNetwork(Retired)
NorthwellHealthSystem
ProfessorofPediatrics
HofstraNorthwellSchoolofMedicine,Hempstead,NewYork
J M. L , MD, P D
EFFREY IPTON H
ChiefofHematology-OncologyandStemCellTransplantation
StevenandAlexandraCohenChildren’sMedicalCenterofNewYork,NewHydePark,NewYork
CenterHead,PatientOrientedResearch,FeinsteinInstituteforMedicalResearch,Manhasset,NewYork
ProfessorofPediatricsandMolecularMedicine
HofstraNorthwellSchoolofMedicine,Hempstead,NewYork
Professor,ElmezziGraduateSchoolofMedicine,Manhasset,NewYork
J D. F , MD
ONATHAN ISH
DirectorSurvivorsFacingForwardProgram
StevenandAlexandraCohenChildren’sMedicalCenterofNewYork,NewHydePark,NewYork
AssistantProfessorofPediatrics
HofstraNorthwellSchoolofMedicine,Hempstead,NewYork
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SANFRANCISCO(cid:129)SINGAPORE(cid:129)SYDNEY(cid:129)TOKYO
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Dedication
This book is dedicated
Toour parents,
Abeand Lily Lanzkowsky, Thelma andAl Lipton,
andVicky andLawrence Fish, who instilled inus the importance of integrity,
the rewards of industry andthe primacy of being a mensch.
To ourwives,
Rhona Lanzkowsky, Linda Lipton,and Leah Fish,
who understand that the study of medicine is a
lifelong and consumingprocess.
To our childrenand grandchildren,
our pride and joy.
And
To our patients,
students,pediatric house staff,
fellows in pediatrichematology andoncology,
and to our colleagues who have taught usso much over the years.
Today hecan discover the errorsof yesterday
andtomorrow he may obtainnewlight
onwhathe thinks himself sure of today
Moses Maimo´nides
List of Contributors
Hisham Abdel-Azim, MD, MS Division of Hematology, Teena Bhatla, MD Division of Pediatric Hematology-
Oncology and Blood & Marrow Transplantation, Oncology, NYU Langone Medical Center, New York
Children’s Hospital Los Angeles, University of UniversitySchoolofMedicine,NewYork,NY
Southern California Keck School of Medicine,
AcuteLymphoblastic Leukemia
Los Angeles, CA
Hematopoietic Stem Cell Transplantation
Lionel Blanc, PhD Departments of Molecular Medicine
and Pediatrics, Hofstra Northwell School of Medicine;
Suchitra S. Acharya, MD, MBBS, DCH Division of
Center for Oncology and Cell Biology, Laboratory of
Pediatric Hematology-Oncology and Stem Cell
Developmental Erythropoiesis, The Feinstein Institute for
Transplantation, Steven and Alexandra Cohen Children’s
MedicalResearch,Manhasset,NY
MedicalCenterofNewYork,HofstraNorthwellSchoolof
Medicine,NewHydePark,NewYork General Considerations of Hemolytic Diseases, Red Cell
Membrane, and EnzymeDefects
Disorders of Coagulation
Anurag K. Agrawal, MD Pediatric Hematology and Mary Ann Bonilla, MD Pediatric Hematology-Oncology,
Oncology, Children’s Hospital and Research Center St. Joseph’s Children’s Hospital, Paterson, NJ; Division of
Oakland,Oakland,CA Pediatric Hematology-Oncology, New York Medical
College,Valhalla,NY
Supportive Care of Patients withCancer
Disorders of White BloodCells
Robert J. Arceci, MD, PhD(†) Children’s Center for Cancer
and Blood Disorders, and Ronald A. Matricaria Institute James B. Bussel, MD Department ofPediatrics, Division of
of Molecular Medicine, Phoenix Children’s Hospital, Hematology, Weill Cornell Medical College and
Department of Child Health, College of Medicine, NewYork-PresbyterianHospital,NewYork,NY
UniversityofArizona,Phoenix,AZ
Disorders of Platelets
Histiocytosis Syndromes
William L. Carroll, MD Division of Pediatric Hematology-
Mark P. Atlas, MD Department of Pediatrics, Hofstra
Oncology, NYU Langone Medical Center, New York
Northwell School of Medicine; Steven and Alexandra
UniversitySchoolofMedicine,NewYork,NY
CohenChildren’sMedicalCenterofNewYork,NewHyde
AcuteLymphoblastic Leukemia
Park,NY
CentralNervousSystemMalignancies
Jeffrey S. Dome, MD, PhD Department of Pediatrics,
George Washington University School of Medicine;
Rochelle Bagatell, MD Department of Pediatrics, Perelman
Divisions of Hematology and Oncology, Children’s
Schoolof Medicine, University ofPennsylvania, Children’s
NationalHealthSystem,Washington,DC
HospitalofPhiladelphia,Philadelphia,PA
Renal Tumors
Neuroblastoma
Nicholas Bernthal, MD Department of Orthopaedic Elizabeth A. Van Dyne, MD Division of Pediatric
Surgery, David Geffen School of Medicine, University of Hematology-Oncology, University of California Los
California,LosAngeles,SantaMonica,CA AngelesMattel,Children’sHospital,LosAngeles,CA
Malignant BoneTumors Malignant Bone Tumors
†Deceased
xiii
xiv
LISTOFCONTRIBUTORS
Tarek M. Elghetany, MD Departments of Pathology and Mary S. Huang, MD Department of Pediatrics, Harvard
Immunology, and Pediatrics, Baylor College of Medicine, Medical School, Massachusetts General Hospital for
TexasChildren’sHospital,Houston,TX Children,Boston,MA
Myelodysplastic Syndromes and Myeloproliferative Non-Hodgkin Lymphoma
Disorders
Rachel Kessel, MD Department of Pediatrics, Hofstra
Noah Federman, MD Department of Pediatrics and Northwell School of Medicine; Division of Pediatric
Orthopaedic Surgery, David Geffen School of Medicine, Hematology-Oncology and Stem Cell Transplantation,
University of California; Division of Pediatric Steven and Alexandra Cohen Children’s Medical Center
Hematology-Oncology, University of California Los ofNewYork,NewHydePark,NY,USA
Angeles Mattel, Children’s Hospital, UCLA’s Jonsson AcuteMyeloid Leukemia
ComprehensiveCancerCenter,LosAngeles,CA
MalignantBoneTumors Julie I. Krystal, MD, MPH Department of Pediatrics,
Hofstra Northwell School of Medicine; Division of
Carolyn Fein Levy, MD Department of Pediatrics, Hofstra Pediatric Hematology-Oncology and Stem Cell
Northwell School of Medicine; Divisions of Pediatric Transplantation, Department of Pediatrics, Steven and
Hematology-Oncology and Stem Cell Transplantation, Alexandra Cohen Children’s Medical Center of New
Department of Pediatrics, Steven and Alexandra Cohen York,NewHydePark,NY
Children’s Medical CenterofNew York,NewHyde Park,
Evaluation, Investigations, and Management of Late
NY
Effectsof Childhood Cancer
Rhabdomyosarcomaand Other Soft-Tissue Sarcomas
JanetL.Kwiatkowski,MD,MSCE DivisionofHematology,
James Feusner, MD DepartmentofPediatrics,Universityof
Children’s Hospital of Philadelphia; Department of
California San Francisco Medical Center; Department of
Pediatrics,PerelmanSchoolofMedicineattheUniversityof
Oncology, Children’s Hospital and Research Center
Pennsylvania,Philadelphia,PA
Oakland,Oakland,CA
Hemoglobinopathies
Supportive Care of Patients with Cancer
Jonathan D. Fish, MD Division of Pediatric Hematology- Philip. Lanzkowsky, MBChB, MD, ScD (Honoris Causa),
Oncology, Hofstra Northwell School of Medicine, Hemp- FRCP, DCH, FAAP Department of Pediatrics, Hofstra
stead, New York; Steven and Alexandra Cohen Children’s Northwell School of Medicine, Hempstead, NY; Division
MedicalCenterofNewYork,NewHydePark,NY of Pediatric Hematology-Oncology, Department of
Pediatrics, Steven and Alexandra Cohen Children’s
Evaluation, Investigations, and Management of Late
MedicalCenterofNewYork,NewHydePark,NY
Effects of Childhood Cancer
Classification and Diagnosis of Anemia in Children;
Jason L. Freedman, MD, MSCE Division of Oncology, Lymphadenopathy and Diseases of the Spleen; Anemia
Children’sHospitalofPhiladelphia,Philadelphia,PA During the Neonatal Period; Iron-Deficiency Anemia;
Management of OncologicEmergencies Megaloblastic Anemia
Debra L. Friedman, MD, MS Department of Pediatrics, Ann Leahey, MD Department of Pediatrics, Perelman
Vanderbilt University School of Medicine; Division of
School of Medicine at the University of Pennsylvania,
Pediatric Hematology-Oncology, Vanderbilt-Ingram
Children’sHospitalofPhiladelphia,Philadelphia,PA
CancerCenter,Nashville,TN
Retinoblastoma
Hodgkin Lymphoma
Jeffrey M. Lipton, MD, PhD Department of Pediatrics and
Derek R. Hanson, MD Pediatric Neuro-Oncology,
Molecular Medicine, Hofstra Northwell School of
HackensackUniversityMedicalCenter,JosephM.Sanzari Medicine, Hempstead, NY; Division of Pediatric
Children’sHospital,Hackensack,NJ
Hematology-Oncology and Stem Cell Transplantation,
CentralNervous SystemMalignancies Steven and Alexandra Cohen Children’s Medical Center
ofNewYork,NewHydePark,NY;TheFeinsteinInstitute
Inga Hofmann, MD Deparmtent of Pediatrics, Harvard forMedicalResearch,Manhasset,NY
Medical School, Dana-Farber/Boston Children’s Cancer
BoneMarrow Failure
and Blood Disorders Center; Department of
Hematopathology,BostonChildren’sHospital,Boston,MA
Naomi L.C. Luban, MD Edward J. Miller Blood Donor
Myelodysplastic Syndromes and Myeloproliferative Center; Division of Laboratory Medicine and Pathology,
Disorders Center for Cancer and Blood Disorders, Children’s
xv
LISTOFCONTRIBUTORS
National Medical Center, Sheikh Zayed Campus for Susan R. Rheingold, MD Children’s Hospital of
AdvancedChildren’sMedicine;DepartmentsofPediatrics Philadelphia; Division of Oncology, Perelman School
and Pathology, George Washington School of Medicine ofMedicineattheUniversityofPennsylvania,Philadelphia,
andHealthSciences,Washington,DC PA
BloodBanking Principles and Practices Managementof Oncologic Emergencies
Indira Sahdev, MD Department of Pediatrics, Hofstra
Catherine McGuinn, MD Department of Pediatrics,
Northwell School of Medicine; Division of Pediatric
Division of Hematology, Weill Cornell Medical College
Hematology-Oncology and Stem Cell Transplantation,
andNewYorkPresbyterianHospital,NewYork,NY
Steven and Alexandra Cohen Children’s Medical Center
Disorders of Platelets
ofNewYork,NewHydePark,NY
Hematopoietic Stem Cell Transplantation
Jill S. Menell, MD Pediatric Hematology-Oncology,
St. Joseph’s Children’s Hospital, Paterson, NJ; Division of Vijay G. Sankaran, MD, PhD Department of Pediatrics,
Pediatric Hematology-Oncology, New York Medical
Harvard Medical School, Division of Hematology-
College,Valhalla,NY
Oncology, Boston Children’s Hospital & Department of
Disorders of WhiteBlood Cells Pediatric Oncology, Dana-Farber Cancer Institute, Boston,
MA
Thomas A. Olson, MD Department of Pediatrics, Emory Diagnostic Molecular and Genomic Methodologies for
University School of Medicine; Pediatric Hematology- the Hematologist/Oncologist
Oncology, Aflac Cancer and Blood Disorders Center,
Children’sHealthcareofAtlanta,Atlanta,GA Susmita N. Sarangi, MD, MBBS Division of Pediatric
Hematology-Oncology, Steven and Alexandra Cohen
Germ Cell Tumors; Hepatic Tumors
Children’s Medical Center of New York, New Hyde
Park, NY
Julie R. Park, MD Department of Pediatrics, University of
Disorders of Coagulation
Washington School of Medicine; Department of
Hematology-Oncology Education, Division of Pediatric
Tsewang Tashi, MD Division of Hematology and
Hematology-Oncology, Seattle Children’s Hospital,
Hematologic Malignacies, University of Utah School of
Seattle,Washington,DC
Medicine,SaltLakeCity,UT
Neuroblastoma
Polycythemia
Josef T. Prchal, MD Division of Hematology and
DavidT.Teachey,MD DepartmentofPediatrics,Perelman
Hematologic Malignancies, Department of Internal
School of Medicine at the University of Pennsylvania,
Medicine at the University of Utah; Huntsman Cancer
Children’sHospitalofPhiladelphia,Philadelphia,PA
Hospital, Myeloproliferative Disorders Clinic, Salt
Lake City, Utah; First Faculty of Medicine, Charles Lymphoproliferative and Myeloproliferative Disorders
University,Prague,CzechRepublic
Meg Tippy, PsyD Mental Health and Psychosocial
Polycythemia
Services, Division of Pediatric Hematology-Oncology and
Stem Cell Transplantation, Department of Pediatrics,
Louis B. Rapkin, MD Department of Pediatrics, Emory Steven and Alexandra Cohen Children’s Medical Center
University School of Medicine; Pediatric Hematology-
ofNewYork,NewHydePark,NY
Oncology, Aflac Cancer and Blood Disorders Center,
Psychosocial Aspects of Cancer for Children and Their
Children’sHealthcareofAtlanta,Atlanta,GA
Families
Hepatic Tumors
Adrianna Vlachos, MD Department of Pediatrics, Hofstra
Arlene Redner, MD Department of Pediatrics, Hofstra
Northwell School of Medicine; Division of Pediatric
Northwell School of Medicine; Department of Oncology,
Hematology-Oncology and Stem Cell Transplantation,
Steven and Alexandra Cohen Children’s Medical Center
Steven and Alexandra Cohen Children’s Medical Center
ofNewYork,NewHydePark,NY,USA
ofNewYork,NewHydePark,NY
Acute Myeloid Leukemia
BoneMarrow Failure
xvi
LISTOFCONTRIBUTORS
Anne B. Warwick, MD, MPH Department of Pediatrics, Lawrence C. Wolfe, MD Department of Pediatrics, Hofstra
F. Edward He´bert School of Medicine, Uniformed Northwell School of Medicine; Division of Pediatric
ServicesUniversityoftheHealthSciences,Bethesda,MD Hematology-Oncology and Stem Cell Transplantation,
Steven and Alexandra Cohen Children’s Medical Center
Renal Tumors
ofNewYork,NewHydePark,NY
HowardWeinstein,MD DepartmentofPediatrics,Harvard Hematologic Manifestations of Systemic Illness; General
Medical School; Division of Pediatric Hematology and ConsiderationsofHemolyticDiseases,RedCellMembrane,
Oncology, Massachusetts General Hospital for Children, andEnzymeDefects;ExtracorpuscularHemolyticAnemia
Boston,MA
Non-Hodgkin Lymphoma Edward C.C. Wong, MD Department of Transfusion
Medicine,DivisionofLaboratoryMedicine,CenterforCancer
Leonard H. Wexler, MD Department of Pediatrics, and Blood Disorders, Children’s National Medical Center
Sheikh Zayed Campus for Advanced Children’s Medicine;
MemorialSloan-KetteringCancerCenter,NewYork,NY
DepartmentofPediatricsandPathology,GeorgeWashington
Rhabdomyosarcomaand Other Soft-Tissue Sarcomas
SchoolofMedicineandHealthSciences,Washington,DC
BloodBanking Principles and Practices
About the Editors
xvii
DRPHILIPLANZKOWSKY
