FRCPath Haem Part 1 MCQ-Lymphoma 431

A 60-year-old man with a 3-year history of Waldenström macroglobulinaemia (WM) presents with progressive unsteadiness, diplopia, and cognitive decline over 6 weeks. He is currently on second-line therapy with bendamustine-rituximab for systemic relapse.

Examination reveals:

• Right 6th cranial nerve palsy

Investigations:

• Hb: 102 g/L

• IgM: mildly elevated from baseline

• MRI brain and spine: diffuse leptomeningeal enhancement

• CSF analysis:

  • Lymphocytosis

  • Clonal B-cells on flow cytometry

  
  

He has normal renal function and no significant comorbidities. His performance status is ECOG 1.

What is the most appropriate treatment in this patient?

A. High-dose intravenous methotrexate-based regimen

B. Intrathecal methotrexate alone

C. Ibrutinib monotherapy

D. Whole brain radiotherapy

E. Autologous stem cell transplantation

F. Intrathecal Cytarabine

G. IV High Dose Methotrexate