• Reed-Sternberg cell: The Reed-Sternberg cell is the giant, often two-nucleus cancer cell of Hodgkin lymphoma; it makes up only about 1% of the tumour, and the rest is immune cells it has recruited.
• After Hodgkin lymphoma: the late effects, and the screening that follows them: Most people treated for Hodgkin lymphoma are cured, and the long follow-up cohorts show that the treatment leaves a raised risk of heart disease, of a second cancer and of an underactive thyroid for decades.
• 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.
• Cardiotoxicity (LVEF decline, cardiomyopathy): Heart damage from cancer treatment: anthracyclines weaken the heart muscle permanently in a dose-related way, trastuzumab does so reversibly, and some kinase inhibitors raise blood pressure or disturb rhythm.
• British and American lymphoma practice: where they differ, and why: The same trials are read in both countries and reach different conclusions, because the British system asks what a treatment costs for the benefit it gives and the American one asks whether it is better at all.
• 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.
• Secondary malignancy (therapy-related cancer): A new, different cancer caused by the treatment of the first one: leukaemia after alkylating chemotherapy or PARP inhibitors, solid tumours in irradiated tissue decades later, and rarely T-cell lymphoma after CAR-T.
• Deauville score and PET-adapted therapy: A 1-to-5 scale for how brightly a lymphoma lights up on a PET scan, compared with the liver and the middle of the chest.

Biomarker results to ask for: PET-negative remission before transplant (Deauville 1 to 3; strongest predictor of cure), Time to relapse (under or over twelve months) and primary refractory status, Extranodal disease, B symptoms and prior lines (AETHERA high-risk criteria), CD30 expression (brentuximab target), 9p24.1 amplification and PD-L1 expression (PD-1 responsiveness), Circulating tumour DNA (research).

Scans and tests linked to this cancer: FDG PET, Multidisciplinary tumour boards, ctDNA monitoring in lymphoma (PhasED-seq, clonoSEQ).

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

• Salvage before transplant: Platinum-based chemotherapy (ICE, DHAP, GVD) increasingly combined with brentuximab vedotin or pembrolizumab, or brentuximab vedotin with nivolumab, to reach PET-negative remission. (Brentuximab vedotin, Nivolumab, Pembrolizumab, Gemcitabine, FDG PET, Deauville five-point scale)
• Consolidation: High-dose chemotherapy with autologous stem cell transplantation for chemosensitive relapse; brentuximab vedotin maintenance for a year in high-risk patients (AETHERA). (Autologous stem cell transplant (high-dose therapy), Brentuximab vedotin, AETHERA)
• Failure of PD-1 antibodies and brentuximab: Allogeneic transplantation for fit patients; bendamustine, gemcitabine or everolimus; CD30 CAR T cells and bispecific antibodies in trials. (Allogeneic stem cell transplantation, Gemcitabine, Everolimus, Phase 2 Study Evaluating Autologous CD30.CAR-T Cells in Patients With Relapsed/Refractory Hodgkin Lymphoma (CHARIOT), CD30 CAR-T for multiply relapsed Hodgkin lymphoma)
• Transplant-ineligible patients: PD-1 antibody with or without brentuximab vedotin as ongoing therapy; palliative radiotherapy for symptomatic sites. (Nivolumab, Brentuximab vedotin, IMRT / IGRT (modern external beam))
• After brentuximab vedotin and PD-1 blockade have both failed: This is a small group and there is no standard. Options, roughly in the order they are usually considered: re-treatment with a PD-1 antibody after a chemotherapy-induced response, because chemotherapy can restore sensitivity; an allogeneic transplant with reduced-intensity conditioning in a fit younger patient, which is the only treatment with curative potential; anti-CD30 CAR-T, which has produced responses in phase 1 and 2 studies and is not approved; gemcitabine-based or single-agent chemotherapy for control; involved-site radiotherapy for a symptomatic site, which is highly effective in a radiosensitive disease; and a clinical trial, which at this point is often the best available treatment. The conversation about aim belongs here explicitly. Palliative radiotherapy and low-intensity chemotherapy can give good quality of life for a long time in Hodgkin lymphoma, and early involvement of a palliative care team alongside oncology is recommended rather than deferred. (Brentuximab vedotin, Nivolumab, Pembrolizumab, Gemcitabine, Bendamustine, Allogeneic stem cell transplantation, CAR-T cell therapy, Palliative radiotherapy, Early integrated palliative care, Anti-CD30 CAR-T Cell Therapy in Relapsed and Refractory Hodgkin Lymphoma)
• Relapse after transplant: Pembrolizumab (KEYNOTE-204) or nivolumab (CheckMate 205); brentuximab vedotin if not previously given; PD-1 antibodies in China include penpulimab and others. (Pembrolizumab, KEYNOTE-204, Nivolumab, CheckMate 205, Brentuximab vedotin, Penpulimab, Immune checkpoint inhibitors)
• First relapse of classical Hodgkin lymphoma: salvage to a negative PET, then autologous transplant: The aim of salvage treatment is not a response but a negative PET, because the proportion of patients cured by the transplant that follows depends more on the depth of the remission before it than on which salvage regimen produced it. Salvage regimens in use: brentuximab vedotin with bendamustine; brentuximab vedotin with nivolumab, which produces high complete response rates without chemotherapy; ICE or IGEV or DHAP or ESHAP. There is no randomised trial ranking them, and the choice is made on toxicity, on stem cell mobilisation and on what the patient has already had. Two to three cycles, then a PET; if it is negative, proceed to BEAM conditioning and autologous transplant; if it is positive, change salvage rather than proceeding. Consolidation after transplant with brentuximab vedotin is standard for patients at high risk of relapse, on the strength of AETHERA, which randomised 329 such patients to brentuximab vedotin or placebo and gave median progression-free survival of 42.9 against 24.1 months (hazard ratio 0.57). High risk means primary refractory disease, relapse within twelve months, or extranodal disease at relapse. Patients who received brentuximab vedotin in first-line treatment are a group in whom this is less clear. (AETHERA, Brentuximab vedotin, Nivolumab, Bendamustine, Ifosfamide, Carboplatin, Etoposide, Cisplatin, Cytarabine, Carmustine, Melphalan (including hepatic delivery system), Autologous stem cell transplant (high-dose therapy), FDG PET, Deauville score and PET-adapted therapy, Stem cell transplant in lymphoma: what it is still for, AETHERA: brentuximab vedotin consolidation after autologous stem cell transplantation in Hodgkin lymphoma at risk of relapse)
• Relapse after autologous transplant, or where transplant is not possible: PD-1 blockade: Classical Hodgkin lymphoma has amplification of chromosome 9p24.1, which drives expression of PD-L1 and PD-L2, and it is the disease in which PD-1 blockade works best of all. Nivolumab. CheckMate 205 treated 243 patients after autologous transplant failure and reported an objective response of 69 per cent, with responses lasting in many. It is also active after both autologous transplant and brentuximab vedotin have failed. Pembrolizumab. KEYNOTE-204 randomised 304 patients with relapsed or refractory classical Hodgkin lymphoma to pembrolizumab or brentuximab vedotin and gave median progression-free survival of 13.2 against 8.3 months (hazard ratio 0.65), which established PD-1 blockade as preferred over brentuximab vedotin at this point for patients who have had one or the other. Combinations of brentuximab vedotin with nivolumab are used as a bridge to transplant and in later lines. Where a response is achieved in a fit younger patient who has already had an autologous transplant, an allogeneic transplant with reduced-intensity conditioning is considered, although PD-1 blockade before allogeneic transplant increases the risk of severe graft-versus-host disease and the timing has to be planned with the transplant team. (CheckMate 205, KEYNOTE-204, Nivolumab, Pembrolizumab, Brentuximab vedotin, Allogeneic stem cell transplantation, CheckMate 205: nivolumab for relapsed or refractory classical Hodgkin lymphoma after autologous transplant failure, extended follow-up, KEYNOTE-204: pembrolizumab versus brentuximab vedotin in relapsed or refractory classical Hodgkin lymphoma)

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