From the Guidelines
The key components of pediatric hematology and oncology board questions include the diagnosis and management of various blood disorders and cancers, such as acute lymphoblastic leukemia (ALL), with a focus on risk assessment, supportive care, and treatment approaches based on current evidence, as outlined in the NCCN Guidelines for Pediatric ALL 1.
Basic Level Questions
For a basic level question, a 3-year-old presenting with pallor, fatigue, and petechiae, with a CBC showing hemoglobin 6.5 g/dL, platelets 15,000/μL, and WBC 2,100/μL with 30% blasts, would most likely be diagnosed with acute lymphoblastic leukemia (ALL) 1. Initial management would include:
- Supportive care with blood products, such as platelets for count <10,000/μL or bleeding, and packed RBCs for symptomatic anemia
- Tumor lysis prophylaxis with allopurinol 10 mg/kg/day (maximum 300 mg/day)
- Hyperhydration at 1.5-2 times maintenance with alkalinization to maintain urine pH >7.0
Intermediate Complexity Questions
For intermediate complexity, a 14-year-old with relapsed Hodgkin lymphoma who has received 300 mg/m² of doxorubicin would require monitoring of cardiac function with echocardiography before administering additional anthracyclines, as the lifetime cumulative dose threshold is 450 mg/m² 1. Consideration of dexrazoxane cardioprotection at a 10:1 ratio to doxorubicin for subsequent doses would also be necessary.
Advanced Complexity Questions
For advanced complexity, a 6-year-old with high-risk neuroblastoma who has completed induction therapy with rapid COJEC (cisplatin, vincristine, carboplatin, etoposide, cyclophosphamide) and shows partial response with MIBG-avid residual disease would require:
- Surgical resection
- High-dose chemotherapy with busulfan (0.8-1.2 mg/kg/dose IV q6h for 16 doses) and melphalan (140 mg/m² IV once) with autologous stem cell rescue
- Maintenance therapy with isotretinoin (160 mg/m²/day in two divided doses for 14 days of 28-day cycles for 6 months) plus immunotherapy with dinutuximab (17.5 mg/m²/day IV for 4 consecutive days during each 28-day cycle) 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Key Components of Pediatric Hematology and Oncology Board Questions
- The key components of pediatric hematology and oncology board questions include:
- The treatment of ALL typically involves four main components: remission induction, consolidation, maintenance, and central nervous system-directed therapy, and usually lasts 2 to 3 years 2
- Treatment intensity is based on risk-based stratification, with patients with more favorable disease receiving less toxic therapy and those with higher-risk disease receiving more aggressive regimens 2
- Novel treatment options, such as targeted treatment, CAR-T-cells therapy, and immunotherapy, are being developed and used in conjunction with chemotherapy to improve outcomes for pediatric ALL patients 3, 4
Complexity Levels of Board Questions
- Board questions may range from basic to complex, requiring knowledge of:
- Questions may also require analysis and application of knowledge to real-world scenarios, such as: