• Transplant or CAR-T at second line in diffuse large B-cell lymphoma: If a large B-cell lymphoma comes back within a year of first treatment, two trials found that engineered T cells worked better than salvage chemotherapy followed by a transplant of the person's own stem cells, and a third trial of a different T-cell product found no difference.
• The Hodgkin microenvironment: when the cancer cell is the minority: In Hodgkin lymphoma most of the swollen lymph node is not cancer.
• The CAR-T pathway in lymphoma: referral, apheresis, bridging and the waiting: CAR-T is not a prescription but a manufacturing process.
• Treatment at the local hospital or at a cell-therapy centre far from home: Most lymphoma chemotherapy is given at the nearest hospital, but engineered T-cell treatment is only given at a small number of approved centres, and it requires living near that centre for about a month with another adult present.
• Late effects of Hodgkin lymphoma treatment, and the follow-up that answers them: Hodgkin lymphoma is usually cured, and the problems that follow arrive twenty and thirty years later: heart disease, an underactive thyroid, and second cancers, especially breast cancer in women irradiated to the chest when young.
• Deauville five-point scale: A 1-to-5 score for how bright a lymphoma looks on PET compared with the liver; 1-3 is considered a complete metabolic response.
• Fertility before lymphoma treatment: what to ask for, and when: Several lymphoma treatments can end fertility, and the chance to preserve it exists only before the first dose.
• The surveillance schedule, and the evidence that routine scans do not find relapse first: Most people expect regular scans after lymphoma treatment and are unsettled when they are not offered.
• Fertility preservation before lymphoma treatment: a decision with a deadline in days: Most of the ways of preserving fertility have to happen before the first dose of chemotherapy, and two of them take about a fortnight.
• ICANS (neurotoxicity): ICANS is confusion, speech difficulty, and rarely seizures after CAR-T or bispecific therapy.

Biomarker results to ask for: CD20, CD23, MAL and weak or partial CD30 expression, 9p24.1 gain or amplification (PD-L1, PD-L2, JAK2), CIITA rearrangement and loss of MHC class II, End-of-treatment FDG PET (Deauville score) to decide on radiotherapy, Circulating tumour DNA for response monitoring (under study).

Scans and tests linked to this cancer: Cytogenetics and FISH, FDG PET, Histopathology & immunohistochemistry, Multidisciplinary tumour boards, PET-adapted (response-adapted) therapy, ctDNA monitoring in lymphoma (PhasED-seq, clonoSEQ).

Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.

• First line: Dose-adjusted EPOCH-R for six cycles without radiotherapy, or R-CHOP for six cycles with PET-guided consolidation radiotherapy; end-of-treatment PET decides whether radiotherapy is needed (IELSG37). (Rituximab, Doxorubicin, Cyclophosphamide, Etoposide, Vincristine, Prednisone, R-CHOP (lymphoma chemoimmunotherapy), FDG PET, PET-adapted (response-adapted) therapy, IELSG37)
• Residual PET-positive disease after immunochemotherapy: Biopsy where feasible; involved-site radiotherapy to the mediastinum (30 to 36 Gy) for persistent uptake; salvage therapy for proven refractory disease. (IMRT / IGRT (modern external beam), Proton therapy, FDG PET, Deauville five-point scale)
• Primary mediastinal B-cell lymphoma: which first-line regimen, and why radiotherapy is now usually avoided: A disease of young adults, more often women, presenting with a bulky mass between the lungs that can compress the superior vena cava. It is biologically closer to Hodgkin lymphoma than to diffuse large B-cell lymphoma, which is why PD-1 blockade works in it. Dose-adjusted EPOCH-R for six cycles is the regimen most used in the United States, on the strength of a National Cancer Institute series in which five-year event-free survival was 93 per cent and overall survival 97 per cent, with radiotherapy avoided in 96 per cent of patients. R-CHOP with consolidation radiotherapy is the alternative used in much of Europe. There has never been a randomised comparison of the two. What has been settled is the radiotherapy. IELSG37 randomised patients with a negative end-of-treatment PET to mediastinal radiotherapy or observation: 30-month progression-free survival was 96.2 per cent with observation against 98.5 per cent with radiotherapy, non-inferior, and overall survival was 99 per cent in both arms. Since the patients are young and the field sits over the heart and breasts, avoiding it matters for the next forty years. Radiotherapy is still given where the end-of-treatment PET is positive. (Dose-adjusted EPOCH-rituximab therapy in primary mediastinal B-cell lymphoma, IELSG37: omission of radiotherapy in primary mediastinal B-cell lymphoma after a negative PET scan, R-CHOP (lymphoma chemoimmunotherapy), Rituximab, Etoposide, Doxorubicin, Cyclophosphamide, Vincristine, Prednisone, FDG PET, Deauville score and PET-adapted therapy, Radiotherapy in lymphoma: involved-site fields, 24 Gy, 4 Gy and total skin electron therapy, Late effects of Hodgkin lymphoma treatment, and the follow-up that answers them, Fertility before lymphoma treatment: what to ask for, and when)
• Relapsed or refractory: Salvage chemotherapy then autologous stem cell transplant if chemosensitive; pembrolizumab (KEYNOTE-170) or nivolumab plus brentuximab vedotin; CD19 CAR-T (axicabtagene ciloleucel, lisocabtagene maraleucel) after two lines or as second line for early relapse. (Autologous stem cell transplant (high-dose therapy), Pembrolizumab, KEYNOTE-170, Nivolumab, Brentuximab vedotin, Axicabtagene ciloleucel, Lisocabtagene maraleucel, CAR-T cell therapy)
• Primary mediastinal B-cell lymphoma that relapses or does not respond: Relapse is uncommon and almost always early, within the first year. CD19 CAR-T is the treatment of choice and primary mediastinal disease was included in the pivotal ZUMA-1 and TRANSCEND populations. Where CAR-T is not available or has failed, pembrolizumab has an established role: KEYNOTE-170 treated 53 patients whose disease had relapsed after autologous transplant or who could not have one after two or more lines, and reported an objective response of 45 per cent and complete response of 13 per cent, which led to accelerated approval in the United States on 13 June 2018, converted to traditional approval on 14 October 2020. Nivolumab with brentuximab vedotin is the other checkpoint-based option. Salvage chemotherapy with autologous transplant is used where the disease is still chemosensitive and CAR-T is not accessible. Mediastinal radiotherapy is added to a residual localised site. (KEYNOTE-170, Pembrolizumab, Nivolumab, Brentuximab vedotin, Axicabtagene ciloleucel, Lisocabtagene maraleucel, CAR-T cell therapy, Autologous stem cell transplant (high-dose therapy), The CAR-T pathway in lymphoma: referral, apheresis, bridging and the waiting, Radiotherapy in lymphoma: involved-site fields, 24 Gy, 4 Gy and total skin electron therapy)

From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.