{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T21:24:07Z","timestamp":1783113847559,"version":"3.54.6"},"reference-count":37,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp;amp; Cancer"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sirolimus is a mainstay medical therapy for vascular anomalies (VAs). However, there is limited guidance on managing sirolimus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>We sought to characterize the practice patterns of clinicians who prescribe sirolimus to identify best practices or areas of disagreement warranting future investigation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods\/Procedures<\/jats:title>\n                    <jats:p>We conducted standardized interviews with 92 US clinicians who prescribe sirolimus to patients with VAs. We performed descriptive statistics of clinicians\u2019 responses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We found wide variation in sirolimus practices. Clinicians reported numerous dosing strategies. The upper end of target goal troughs ranged from 6 to 15\u00a0ng\/mL, with some clinicians targeting as low as 4\u20136\u00a0ng\/mL and others as high as 10\u201315\u00a0ng\/mL. Clinicians were split on whether they always, sometimes, or never administered\n                      <jats:italic>pneumocystis<\/jats:italic>\n                      prophylaxis. They were similarly divided on how they administered live\u2010attenuated vaccines, with some forgoing vaccination indefinitely, some administering with specific measures, and others administering without precautionary measures. Fever management also varied. While many encouraged primary care evaluation, nearly 20% mandated emergency department visits. A sizeable minority obtained blood cultures and administered empiric antibiotics to all patients with fevers. Lastly, peri\u2010procedural management of sirolimus varied. Half of the clinicians held sirolimus for major procedures, and 14% held sirolimus for all procedures, including sclerotherapy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite more than 15\u00a0years of data on the efficacy of sirolimus, we identified wide variation in how clinicians prescribe and manage sirolimus for patients with VAs. Future work is needed to generate data and develop evidence\u2010based guidelines for the management of sirolimus to ensure safe and appropriate care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/1545-5017.70330","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T12:47:08Z","timestamp":1776257228000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Treatment of Vascular Anomalies With Sirolimus: Characterizing Practice Patterns of US Specialist Clinicians"],"prefix":"10.1002","volume":"73","author":[{"given":"Bryan A.","family":"Sisk","sequence":"first","affiliation":[{"name":"Division of Hematology\/Oncology, Department of Pediatrics Washington University School of Medicine  St. Louis Missouri USA"},{"name":"Bioethics Research Center, Department of Medicine Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Milam","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, Department of Pediatrics Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Bereitschaft","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, Department of Pediatrics Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Kerr","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, Department of Pediatrics Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theo","family":"Marghitu","sequence":"additional","affiliation":[{"name":"Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Harmoney","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, Department of Pediatrics University of New Mexico  Albuquerque New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Heym","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology Cook Children's Hospital  Fort Worth Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tishi","family":"Shah","sequence":"additional","affiliation":[{"name":"Pediatric Hematology\u2013Oncology, Dana\u2010Farber\/Boston Children's Cancer and Blood Disorders Center Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Autumn","family":"Atkinson","sequence":"additional","affiliation":[{"name":"Division of Community and General Pediatrics, Department of Pediatrics University of Texas Health Science Center at Houston  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L. 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