FRCPath Haem Part 1 EMQs-Oncology 512

For each clinical scenario, select the single most appropriate treatment from the options below. Each option may be used once, more than once, or not at all.

Option	Treatment
A	ABVD
B	AVD
C	Escalated BEACOPP
D	Brentuximab vedotin + AVD
E	ABVD followed by PET-adapted treatment (RATHL approach)
F	Salvage chemotherapy followed by autologous stem cell transplantation
G	Brentuximab vedotin monotherapy
H	Pembrolizumab or nivolumab
I	ChlVPP
J	Observation without further chemotherapy

Clinical scenarios

Question 1

A 24-year-old woman presents with newly diagnosed classical Hodgkin lymphoma, nodular sclerosis subtype, stage IIA disease. She has no bulky mediastinal disease, no extranodal involvement and no adverse prognostic features. She is otherwise fit and wishes to minimise long-term treatment toxicity.

She receives two cycles of ABVD. Interim PET-CT demonstrates complete metabolic response (Deauville score 2).

What is the most appropriate treatment strategy?

Question 2

A 32-year-old man is diagnosed with classical Hodgkin lymphoma, stage IIB, with a large mediastinal mass and elevated ESR. He has no significant comorbidities and is considered fit for intensive chemotherapy.

Following two cycles of ABVD, interim PET-CT demonstrates persistent metabolically active disease (Deauville score 5).

What is the most appropriate next treatment?

Question 3

A 29-year-old man presents with classical Hodgkin lymphoma, stage IVB, with splenic and multiple bone marrow sites of involvement. He has an ECOG performance status of 0 and normal cardiac, renal and pulmonary function.

He is commenced on ABVD. Following two cycles, interim PET-CT demonstrates complete metabolic response (Deauville score 3).

According to the PET-adapted RATHL approach, what is the most appropriate subsequent treatment?

Question 4

A 35-year-old man with stage IV classical Hodgkin lymphoma receives six cycles of ABVD. End-of-treatment PET-CT demonstrates persistent progressive disease (Deauville score 5), confirmed by repeat biopsy.

He has an ECOG performance status of 0, normal cardiac and renal function, and is considered suitable for high-dose chemotherapy and autologous stem cell transplantation.

What is the most appropriate treatment strategy?

Question 5

A 41-year-old woman with classical Hodgkin lymphoma initially achieves complete remission following first-line chemotherapy. She subsequently develops a relapse and receives salvage chemotherapy followed by autologous stem cell transplantation.

Eight months after transplantation, she develops progressive lymphadenopathy. Biopsy confirms recurrent classical Hodgkin lymphoma. She has previously received brentuximab vedotin and is unsuitable for further autologous transplantation.

Which treatment is the most appropriate option?