OpenOnco · Treatment Plan

Treatment plan — B-Lymphoblastic Leukemia/Lymphoma

PLAN-B-ALL-PH-POS-001-V1 · v1 · 2026-06-11

Patient

B-ALL-PH-POS-001 · Algorithm: ALGO-B-ALL-1L

DiagnosisB-Lymphoblastic Leukemia/Lymphoma

MOH / ICD-10C91.0

ICD-O-39836/3

Clinical significance of mutations (ESCAT)

Tumor-board context — the engine does not use these tiers to rank tracks

✅ Covered biomarkers (matched in KB)

Biomarker	Variant	ESCAT	Evidence	Clinical significance	Drugs	Sources
No clinically actionable variants matched in this profile.

⚠️ Not included in plan

Biomarker	Status
BCR-ABL1	Not in KB — ask clinician to verify

Primary current-line option

Standard plan

★ DEFAULT

Indication

IND-B-ALL-1L-PH-POS

Regimen

Hyper-CVAD + Rituximab (CD20+) — alternating courses A/B, 8 cycles total

Drugs + NSZU

Alternating block A — block A (Hyper-CVAD): cyclophosphamide + vincristine + doxorubicin + dexamethasone — cycles 1, 3, 5, 7; with rituximab for CD20+ (cycles 1-4) and IT-CNS prophylaxis

Cyclophosphamide (DRUG-CYCLOPHOSPHAMIDE) 300 mg/m² q12h × 6 doses · IV days 1-3 (Course A only) · IV ⚠ NSZU — not for this indication
Vincristine (DRUG-VINCRISTINE) 2 mg flat dose · IV days 4 + 11 (Course A only) · IV ⚠ NSZU — not for this indication
Doxorubicin (DRUG-DOXORUBICIN) 50 mg/m² · IV day 4 (Course A only) · IV ⚠ NSZU — not for this indication
Dexamethasone (DRUG-DEXAMETHASONE) 40 mg · PO/IV days 1-4 + 11-14 (Course A only) · PO ⚠ NSZU — not for this indication
Rituximab (DRUG-RITUXIMAB) 375 mg/m² · IV days 1 + 11 (cycles 1-4 для CD20+ only) · IV ⚠ NSZU — not for this indication
Methotrexate (DRUG-METHOTREXATE) 12 mg IT · IT day 2 each cycle · IT ⚠ NSZU — not for this indication
Cytarabine (DRUG-CYTARABINE) 100 mg IT · IT day 8 each cycle · IT ⚠ NSZU — not for this indication

Alternating block B — block B (MA): high-dose methotrexate + HD-cytarabine — cycles 2, 4, 6, 8; with rituximab for CD20+ (cycles 1-4) and IT-CNS prophylaxis

Methotrexate (DRUG-METHOTREXATE) 1 g/m² · IV 24h infusion day 1 (Course B only); leucovorin rescue · IV ⚠ NSZU — not for this indication
Cytarabine (DRUG-CYTARABINE) 3 g/m² q12h × 4 doses · IV days 2-3 (Course B only) · IV ⚠ NSZU — not for this indication
Rituximab (DRUG-RITUXIMAB) 375 mg/m² · IV days 1 + 11 (cycles 1-4 для CD20+ only) · IV ⚠ NSZU — not for this indication
Methotrexate (DRUG-METHOTREXATE) 12 mg IT · IT day 2 each cycle · IT ⚠ NSZU — not for this indication
Cytarabine (DRUG-CYTARABINE) 100 mg IT · IT day 8 each cycle · IT ⚠ NSZU — not for this indication

Supportive care

SUP-PJP-PROPHYLAXIS, SUP-HSV-PROPHYLAXIS, SUP-TLS-PROPHYLAXIS, SUP-GCSF-NEUTROPENIA, SUP-ANTIEMETIC-PREMED

Hard contraindications

CI-HBV-NO-PROPHYLAXIS, CI-LVEF-LOW-FOR-ANTHRACYCLINE

Reason

Primary current-line option per algorithm ALGO-B-ALL-1L: selected default was filtered; promoted first remaining current-line track

Pre-treatment investigations

Investigations before treatment start · critical / standard / desired · merged across tracks

ID	Name	Priority	Category	Where to order	Needed for
TEST-BCR-ABL-JAK2	BCR-ABL + JAK2 + CALR + MPL	Critical	genomic	CSD Lab ✓ (code TBC)	all tracks
TEST-BM-ASPIRATE	Bone Marrow Aspirate	Critical	histology	—	all tracks
TEST-BM-TREPHINE	Bone Marrow Trephine	Critical	histology	—	all tracks
TEST-CBC	Complete Blood Count with Differential	Critical	lab	—	all tracks
TEST-CMP	Comprehensive Metabolic Panel	Critical	lab	—	all tracks
TEST-COAG-PANEL	Coagulation Panel	Critical	lab	—	all tracks
TEST-FISH-PANEL	FISH (Fluorescence In Situ Hybridization)	Critical	genomic	CSD Lab ✓ (code TBC)	all tracks
TEST-FLOW-CYTOMETRY	Flow Cytometry	Critical	histology	CSD Lab ✓ (code TBC)	all tracks
TEST-HBV-SEROLOGY	Hepatitis B Serology Panel (HBsAg, anti-HBc total, anti-HBs)	Critical	lab	—	all tracks
TEST-HCV-ANTIBODY	HCV Antibody	Critical	lab	—	all tracks
TEST-HIV-SEROLOGY	HIV Antibody/Antigen	Critical	lab	—	all tracks
TEST-KARYOTYPE	Karyotype	Critical	genomic	CSD Lab ✓ (code TBC)	all tracks
TEST-LDH	Lactate Dehydrogenase	Critical	lab	—	all tracks
TEST-LFT	Liver Function Tests (ALT, AST, bilirubin, ALP, GGT, albumin)	Critical	lab	—	all tracks
TEST-PREGNANCY	Beta-HCG	Critical	lab	—	all tracks
TEST-CSF-CYTOLOGY-FLOW	CSF cytology + flow cytometry	Standard	pathology	CSD Lab ✓ (code TBC)	all tracks
TEST-ECHO	Echocardiography	Standard	imaging	—	all tracks
TEST-PET-CT	FDG PET/CT (whole body)	Standard	imaging	—	all tracks
TEST-URIC-ACID	Serum Uric Acid	Standard	lab	—	all tracks
TEST-NGS-LYMPHOID-PANEL	Lymphoid NGS Panel	Desired	genomic	CSD Lab ✓ (code TBC)	all tracks

What NOT to do

Explicit prohibitive rules, each grounded in a regimen / supportive care / contraindication entity

Standard plan (IND-B-ALL-1L-PH-POS)

Do not start without baseline BCR::ABL1 PCR — quantitative MRD drives therapy escalation.
Do not skip CNS prophylaxis (IT MTX/cytarabine + HD-MTX intercalated) — CNS relapse is fatal.
Do not neglect T315I mutation testing — imatinib/dasatinib are useless; ponatinib needed.
Do not give vincristine intrathecally — fatal.
Do not start TKI without ECG (QTc baseline) — TKIs prolong QT.
Do not reduce TKI dose without cause — under-dosing → resistance.

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Hyper-CVAD + Rituximab (CD20+) — alternating courses A/B, 8 cycles total

21-day cycles × 8 alternating cycles (A/B/A/B/A/B/A/B); maintenance POMP × 30 months Ph-, або continuous TKI Ph+

MDT brief

Data quality

Usable with caveats. No critical default-track gap was found, but the MDT should review the listed caveats before final sign-off.

Biomarker coverage: 0/0 known (100%), 0 missing, 0 default-track gaps
Unevaluated RedFlags: RF-B-ALL-CNS-LEUKEMIA, RF-B-ALL-EMERGENCY-TLS-LEUKOSTASIS, RF-B-ALL-FRAILTY-AGE, RF-B-ALL-HIGH-RISK-BIOLOGY, RF-B-ALL-INFECTION-SCREENING, RF-B-ALL-TRANSFORMATION-PROGRESSION, RF-BALL-CD22-POS-INO-CANDIDATE

Technical MDT skill metadata (0/16 activated in this plan)

All registered virtual specialists. ✓ — activated for this case; ○ — not activated (available for other clinical scenarios).

Specialist	skill_id	Version	Last reviewed	Domain
Cellular therapy specialist (CAR-T)	`cellular_therapy_specialist`	v0.1.0	2026-04-25	cellular_therapy
Clinical pharmacist	`clinical_pharmacist`	v0.1.0	2026-04-25	clinical_pharmacy
Hematologist / oncohematologist	`hematologist`	v0.1.0	2026-04-25	hematology_oncology
Hematopathologist (lymphoma / leukemia / myeloma)	`hematopathologist`	v0.1.0	2026-04-25	hematopathology
Infectious disease / hepatology	`infectious_disease_hepatology`	v0.1.0	2026-04-25	infectious_diseases
Medical oncologist (solid-tumor chemotherapist)	`medical_oncologist`	v0.1.0	2026-04-25	solid_oncology
Molecular geneticist / molecular oncologist	`molecular_geneticist`	v0.1.0	2026-04-25	molecular_oncology
Palliative care	`palliative_care`	v0.1.0	2026-04-25	palliative_care
Pathologist (general)	`pathologist`	v0.1.0	2026-04-25	pathology
Primary care / family physician	`primary_care`	v0.1.0	2026-04-25	primary_care
Psycho-oncologist	`psychologist`	v0.1.0	2026-04-25	psychosocial
Radiation oncologist	`radiation_oncologist`	v0.1.0	2026-04-25	radiation_oncology
Radiologist	`radiologist`	v0.1.0	2026-04-25	diagnostic_imaging
Social worker / case manager	`social_worker_case_manager`	v0.1.0	2026-04-25	psychosocial
Surgical oncologist	`surgical_oncologist`	v0.1.0	2026-04-25	surgical_oncology
Transplant specialist (BMT)	`transplant_specialist`	v0.1.0	2026-04-25	cellular_therapy

Sources cited

SRC-NCCN-BCELL-2025: NCCN Clinical Practice Guidelines in Oncology: B-Cell Lymphomas (v.2.2025)

Experimental options (clinical trials)

Third plan track — open-enrollment trials from ClinicalTrials.gov. Render-time metadata; engine selection is not affected by this block (CHARTER §8.3). Last synced: 2026-06-11.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT06967610	Phase II Study of Combined Pirtobrutinib, Venetoclax and Obinutuzumab (PVO) Time-limited Treatment for Patients With Recurrent Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL).	PHASE2	RECRUITING	M.D. Anderson Cancer Center	—	Small N (<50) Single country
NCT01087333	Collection of Human Samples to Study Hairy Cell and Other Leukemias, and to Develop Recombinant Immunotoxins for Cancer Treatment	N/A	RECRUITING	National Cancer Institute (NCI)	—	Single country
NCT07509151	Surovatamig as Consolidation Therapy in Participants With Chronic Lymphocytic Leukaemia or Small Lymphocytic Lymphoma With Unmutated Immunoglobulin Heavy Chain Variable (IGHV)	PHASE3	RECRUITING	AstraZeneca	—	Surrogate endpoint only
NCT05887167	Feasibility and Safety of Collecting and Combining Autologous Hematopoietic Stem Cells With Chimeric Antigen Receptor (CAR) T-Cell Therapy in Subjects With Relapsed/Refractory Hematological Malignancies	PHASE1	RECRUITING	Joshua Sasine, MD, PhD	—	Phase 1 only Small N (<50) Single country
NCT07221500	A Study of NX-5948 in Adults With CLL/SLL Previously Treated With a Bruton's Tyrosine Kinase Inhibitor and a B-cell Lymphoma-2 Inhibitor (DAYBreak CLL-201)	PHASE2	RECRUITING	Nurix Therapeutics, Inc.	—	Surrogate endpoint only
NCT06735495	CD19 & CD22 Bispecific CAR T Cells in the Treatment of Relapsed/Refractory B Cell Hematologic Tumors	PHASE1 / PHASE2	RECRUITING	Union Hospital, Tongji Medical College, Huazhong University of Science and Technology	—	Surrogate endpoint only Single country
NCT01371630	Inotuzumab Ozogamicin and Combination Chemotherapy in Treating Patients With Acute Lymphoblastic Leukemia	PHASE1 / PHASE2	RECRUITING	M.D. Anderson Cancer Center	—	Surrogate endpoint only Single country
NCT02727803	Personalized NK Cell Therapy in CBT	PHASE2	RECRUITING	M.D. Anderson Cancer Center	—	Surrogate endpoint only Single country
NCT06876662	A Study of (LY3527727) Pirtobrutinib in Participants With Previously Treated Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma or Non-Hodgkin Lymphoma	PHASE4	RECRUITING	Eli Lilly and Company	—	—
NCT06777979	CD19-CD22-Bispecific Chimeric Antigen Receptor (CAR) T Cell Therapy for Pediatric Patients With Acute Lymphoblastic Leukemia	PHASE1	RECRUITING	St. Jude Children's Research Hospital	—	Phase 1 only Small N (<50) Single country

Verify recruitment status directly with the trial site. ctgov data can lag behind current UA-site status.

Option availability in Ukraine

Per-track UA registration · NSZU · cost · access pathway. Render-time metadata; engine selection does not depend on these fields (CHARTER §8.3).

Option	UA registration	NSZU	Cost orientation	Access pathway
Standard plan Hyper-CVAD + Rituximab (CD20+) — alternating courses A/B, 8 cycles total (REG-HYPER-CVAD-R)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Trial · NCT06967610 Phase II Study of Combined Pirtobrutinib, Venetoclax and Obinutuzumab (PVO) Time-limited Treatment for Patients With Recurrent Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL). No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT01087333 Collection of Human Samples to Study Hairy Cell and Other Leukemias, and to Develop Recombinant Immunotoxins for Cancer Treatment No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07509151 Surovatamig as Consolidation Therapy in Participants With Chronic Lymphocytic Leukaemia or Small Lymphocytic Lymphoma With Unmutated Immunoglobulin Heavy Chain Variable (IGHV) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05887167 Feasibility and Safety of Collecting and Combining Autologous Hematopoietic Stem Cells With Chimeric Antigen Receptor (CAR) T-Cell Therapy in Subjects With Relapsed/Refractory Hematological Malignancies No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07221500 A Study of NX-5948 in Adults With CLL/SLL Previously Treated With a Bruton's Tyrosine Kinase Inhibitor and a B-cell Lymphoma-2 Inhibitor (DAYBreak CLL-201) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06735495 CD19 & CD22 Bispecific CAR T Cells in the Treatment of Relapsed/Refractory B Cell Hematologic Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT01371630 Inotuzumab Ozogamicin and Combination Chemotherapy in Treating Patients With Acute Lymphoblastic Leukemia No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT02727803 Personalized NK Cell Therapy in CBT No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06876662 A Study of (LY3527727) Pirtobrutinib in Participants With Previously Treated Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma or Non-Hodgkin Lymphoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06777979 CD19-CD22-Bispecific Chimeric Antigen Receptor (CAR) T Cell Therapy for Pediatric Patients With Acute Lymphoblastic Leukemia No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor

Cost information is orientation. Verify with a specific pharmacy / foundation / trial site. Status updated: 2026-06-11.

plan_id: PLAN-B-ALL-PH-POS-001-V1 | version: 1 | generated: 2026-06-11T11:52:06.206958+00:00

Per FDA non-device CDS positioning (CHARTER §15): Outpatient oncology treatment planning to support tumor-board discussion. Not a medical device; not for autonomous clinical decision-making.

Per FDA non-device CDS positioning (CHARTER §15): Both treatment options below are presented for review. The engine's selection of a 'recommended' default does not constitute a clinical decision. Final treatment selection requires HCP judgment incorporating information not available to the system.

This document is an informational resource supporting tumor-board discussion (per CHARTER §11). It is not a system that makes clinical decisions. Every recommendation must be verified by the treating physician.