FRCPath Haem Part 1 MCQs-Oncology 476

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