FRCPath Haem Part 1 MCQs-Malignant Haem 501

A 64-year-old man presents with progressive cervical and mediastinal lymphadenopathy, weight loss and night sweats. Excisional lymph-node biopsy confirms classical Hodgkin lymphoma, with Reed–Sternberg cells expressing CD30 and CD15. PET-CT demonstrates stage IV disease with splenic and multifocal skeletal involvement.

His ECOG performance status is 1. He has a history of mild chronic obstructive pulmonary disease (COPD), with FEV1 58% predicted and DLCO 52% predicted. Renal and hepatic function are preserved. Echocardiography shows an LVEF of 60%. He has not received previous lymphoma treatment.

Following multidisciplinary team discussion, the team wishes to select a first-line regimen that avoids bleomycin-related pulmonary toxicity while providing effective treatment for advanced-stage disease.

Which of the following is the most appropriate treatment option under the NICE-recommended treatment pathway?

A. ABVD for six cycles, with bleomycin continued irrespective of pulmonary function

B. Brentuximab vedotin plus AVD (A+AVD)

C. Single-agent brentuximab vedotin until complete metabolic response

D. R-CHOP for six cycles

E. AVD alone, because CD30 expression excludes the use of brentuximab vedotin