FRCPath Haem Part 1 MCQs-Oncology 477
Updated: Aug 25
A 32-year-old woman with primary mediastinal B-cell lymphoma (PMBCL) was treated with first-line chemoimmunotherapy and achieved a complete metabolic response.
She remained clinically well initially. However, 9 months after completion of first-line treatment, she develops increasing chest discomfort, cough and new left supraclavicular lymphadenopathy. PET-CT demonstrates a new intensely FDG-avid mediastinal mass with additional FDG-avid lymphadenopathy. The most metabolically active lesion is Deauville score 5.
A repeat core biopsy confirms relapsed PMBCL. There is no evidence of CNS involvement. She has good performance status and adequate cardiac, renal and hepatic function.
Which of the following is the most appropriate recommended second-line treatment according to the BSH 2026 guideline?
A. R-CHOP-21 followed by involved-site radiotherapy
B. High-dose chemotherapy followed by autologous stem-cell transplantation
C. Lisocabtagene maraleucel (liso-cel) CAR-T therapy
D. Brentuximab vedotin monotherapy
E. Observation with repeat PET-CT in 3 months
Answer: C. Lisocabtagene maraleucel (liso-cel) CAR-T therapy
Explanation
The BSH 2026 guideline specifically recommends liso-cel CAR-T as second-line treatment for PMBCL that relapses within 12 months of first-line treatment.
This is an important change in the management of early-relapsed PMBCL because conventional second-line chemotherapy has relatively poor efficacy, and many patients do not achieve sufficient chemosensitivity to proceed to autologous transplantation.
FRCPath exam pearl
PMBCL relapse ≤12 months → 2nd-line liso-cel CAR-T
For third line or subsequent treatment, the guideline recommends axi-cel or liso-cel CAR-T.