OpenOnco · Treatment Plan

Treatment plan — DIS-ET

PLAN-BMA-CALR_ET-V1 · v1 · 2026-05-04

Patient

BMA-CALR_ET · Algorithm: ALGO-ET-1L

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
BIO-CALR	Not in KB — ask clinician to verify

Treatment options (2 tracks)

Standard plan

★ DEFAULT

Indication

IND-ET-1L-ASA

Regimen

Hydroxyurea (PV / ET high-risk 1L cytoreduction) + baseline phlebotomy/ASA

Drugs + NSZU

Hydroxyurea (DRUG-HYDROXYUREA) Start 500-1500 mg/day PO (15-25 mg/kg/day); titrate to target · continuous PO daily; titrate by CBC q2-4wk initially, then q1-3 mo once stable · PO ✓ NSZU covered
Aspirin (DRUG-ASPIRIN) 81-100 mg PO daily (low-dose aspirin) · continuous · PO ⚠ Out-of-pocket

Reason

Engine default per algorithm ALGO-ET-1L: {'step': 3, 'outcome': False, 'branch': {'result': 'IND-ET-1L-ASA'}, 'fired_red_flags': [], 'winner_red_flag': None}

Aggressive plan

Indication

IND-ET-1L-HU

Regimen

Hydroxyurea (PV / ET high-risk 1L cytoreduction) + baseline phlebotomy/ASA

Drugs + NSZU

Hydroxyurea (DRUG-HYDROXYUREA) Start 500-1500 mg/day PO (15-25 mg/kg/day); titrate to target · continuous PO daily; titrate by CBC q2-4wk initially, then q1-3 mo once stable · PO ✓ NSZU covered
Aspirin (DRUG-ASPIRIN) 81-100 mg PO daily (low-dose aspirin) · continuous · PO ⚠ Out-of-pocket

Reason

Alternative track presented for HCP consideration

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-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-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-NGS-MYELOID-PANEL	Myeloid NGS Panel	Critical	genomic	CSD Lab ✓ (code TBC)	all tracks
TEST-PERIPHERAL-SMEAR	Peripheral Blood Smear	Critical	lab	CSD Lab ✓ (code TBC)	all tracks
TEST-PREGNANCY	Beta-HCG	Critical	lab	—	aggressive
TEST-ECHO	Echocardiography	Standard	imaging	—	desired (aggressive)
TEST-IRON-PANEL	Iron Panel	Standard	lab	—	all tracks
TEST-RETICULOCYTE	Reticulocyte Count	Standard	lab	—	all tracks
TEST-D-DIMER	D-Dimer	Desired	lab	—	all tracks

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

ET transformation to post-ET myelofibrosis (~5-10% over 15 years) or to AML / MDS (rare ~1-5%): rising LDH, new splenomegaly, leukoerythroblastic smear, increasing reticulin fibrosis on trephine, blast appearance — re-stage, switch to MF or AML algorithmRF-ET-TRANSFORMATION-PROGRESSION
PV or ET patient elderly or frail (age ≥80, ECOG ≥3, multiple comorbidities, life expectancy <5 years) — gentler cytoreduction (lower HU dose), expanded transfusion + monitoring strategyRF-PV-ET-FRAILTY-AGE
PV or ET high-risk for thrombosis: age >60 OR prior arterial / venous thrombosis OR (ET only) JAK2 V617F + CV risk factors (IPSET-thrombosis high) — triggers cytoreduction (HU 1L) in addition to baseline phlebotomy + ASARF-PV-ET-HIGH-THROMBOSIS-RISK
PV or ET patient with organ dysfunction limiting cytoreductive choice: severe renal impairment (CrCl <30 — limits HU), severe hepatic dysfunction (limits ruxolitinib), or severe cardiac dysfunction (limits anagrelide)RF-PV-ET-ORGAN-DYSFUNCTION
PV or ET patient pregnant or planning pregnancy — HU and anagrelide contraindicated; switch to interferon-α (PEG-IFN-α2a or ropeginterferon)RF-PV-ET-PREGNANCY-OR-PLANNING

CONTRA-AGGRESSIVE

Hard contraindications to escalation

What NOT to do

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

Standard plan (IND-ET-1L-ASA)

Do not skip JAK2 / CALR / MPL testing — driver-mutation status determines subtype + IPSET-thrombosis risk.
Do not prescribe ASA in extreme thrombocytosis (plt >1500K) without ruling out acquired vWD — check ristocetin cofactor activity.
Do not skip prefibrotic-PMF differential on trephine — same presentation, worse prognosis.
Do not prescribe anagrelide 1L — PT-1 trial showed lower cardiovascular profile + HU more preferable.
Do not use full-dose ASA — low-dose is standard.

Aggressive plan (IND-ET-1L-HU)

Do not prescribe HU during pregnancy / pregnancy plans — switch to IFN-α.
Do not skip monthly CBC for the first 3 months — myelosuppression-titrating.
Do not use anagrelide 1L — PT-1 trial showed HU advantage on arterial thrombosis and MF progression.
Do not prescribe in cutaneous ulceration history — risk of recurrence.
Do not combine with peg-IFN without a clear protocol.

MDT brief

Skills (recommended) — for consideration (2)

Clinical pharmacist recommended
Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.
skill: clinical_pharmacistv0.1.0reviewed 2026-04-25STUBsign-offs: 0lead: TBD
Social worker / case manager recommended
Plan includes drugs without NSZU reimbursement — patient access pathway must be assessed.
skill: social_worker_case_managerv0.1.0reviewed 2026-04-25STUBsign-offs: 0lead: TBD

Open questions (1, 0 blocking)

OQ-LDH-CURRENT
What is the current LDH? Marker of tumor burden and transformation.
LDH is part of the prognostic indices of indolent lymphomas.
→ hematologist

Data quality

Unevaluated RedFlags: RF-ET-TRANSFORMATION-PROGRESSION, RF-PV-ET-FRAILTY-AGE, RF-PV-ET-HIGH-THROMBOSIS-RISK, RF-PV-ET-INFECTION-SCREENING, RF-PV-ET-ORGAN-DYSFUNCTION, RF-PV-ET-PREGNANCY-OR-PLANNING

Skill catalog (2/16 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-ESMO-MPN-2015: Philadelphia-negative chronic myeloproliferative neoplasms: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up (2015)
SRC-NCCN-MPN-2025: NCCN Clinical Practice Guidelines in Oncology: Myeloproliferative Neoplasms (v.X.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: 2026-05-04.

NCT	Title	Phase	Status	Sponsor	UA
NCT06770842	Ropeginterferon Alfa 2b Plus Ruxolitinib for Myelofibrosis	PHASE2	RECRUITING	The University of Hong Kong	—
NCT05123365	An Optimal Dose Finding Study of N-Acetylcysteine in Patients With Myeloproliferative Neoplasms	PHASE1 / PHASE2	RECRUITING	University of California, Irvine	—
NCT06218628	Pacritinib w/ Talazoparib in Pts w/ Myeloproliferative Neoplasms Unresponsive to JAK2 Inhibition	PHASE1	RECRUITING	Fox Chase Cancer Center	—
NCT07362225	MPN PROGRESSion Registry: Observational Study Tracking Symptoms, Treatments, and Disease Progression in People With Myeloproliferative Neoplasms (MPNs)	N/A	RECRUITING	MPN Research Foundation	—
NCT02897297	Myeloproliferative Neoplastic Diseases Observatory From Brest	N/A	RECRUITING	University Hospital, Brest	—
NCT04942080	Interest of CALR Allele Burden in Diagnosis and Follow-up of Patients With CALR Mutated Myeloproliferative Syndromes (CALRSUIVI)	NA	RECRUITING	University Hospital, Angers	—
NCT06351631	A Study to Evaluate Safety and Efficacy of Bomedemstat (MK-3543-017)	PHASE3	RECRUITING	Merck Sharp & Dohme LLC	—
NCT06976918	Registry Platform Myelofibrosis and Anemia	N/A	RECRUITING	iOMEDICO AG	—
NCT05882773	Asian Myeloproliferative Neoplasm (MPN) Registry	N/A	RECRUITING	The University of Hong Kong	—
NCT06456346	Bomedemstat vs Hydroxyurea for Essential Thrombocythemia (MK-3543-007)	PHASE3	RECRUITING	Merck Sharp & Dohme LLC	—

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 Hydroxyurea (PV / ET high-risk 1L cytoreduction) + baseline phlebotomy/ASA (REG-HU-PV-ET) 1/2 component drug(s) not on NSZU formulary	✓ registered	✗ out-of-pocket	₴-? — verify pathway	not recorded
Aggressive plan Hydroxyurea (PV / ET high-risk 1L cytoreduction) + baseline phlebotomy/ASA (REG-HU-PV-ET) 1/2 component drug(s) not on NSZU formulary	✓ registered	✗ out-of-pocket	₴-? — verify pathway	not recorded
Trial · NCT06770842 Ropeginterferon Alfa 2b Plus Ruxolitinib for Myelofibrosis No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05123365 An Optimal Dose Finding Study of N-Acetylcysteine in Patients With Myeloproliferative Neoplasms No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06218628 Pacritinib w/ Talazoparib in Pts w/ Myeloproliferative Neoplasms Unresponsive to JAK2 Inhibition No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07362225 MPN PROGRESSion Registry: Observational Study Tracking Symptoms, Treatments, and Disease Progression in People With Myeloproliferative Neoplasms (MPNs) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT02897297 Myeloproliferative Neoplastic Diseases Observatory From Brest No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04942080 Interest of CALR Allele Burden in Diagnosis and Follow-up of Patients With CALR Mutated Myeloproliferative Syndromes (CALRSUIVI) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06351631 A Study to Evaluate Safety and Efficacy of Bomedemstat (MK-3543-017) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06976918 Registry Platform Myelofibrosis and Anemia No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05882773 Asian Myeloproliferative Neoplasm (MPN) Registry No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06456346 Bomedemstat vs Hydroxyurea for Essential Thrombocythemia (MK-3543-007) 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: 2026-05-04.

plan_id: PLAN-BMA-CALR_ET-V1 | version: 1 | generated: 2026-05-04T14:13:16.583171+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.