OpenOnco · Treatment Plan

Treatment plan — Primary Myelofibrosis

PLAN-BMA-JAK2_V617F_PMF-V1 · v1 · 2026-08-17

Patient

BMA-JAK2_V617F_PMF · Algorithm: ALGO-PMF-1L

DiagnosisPrimary Myelofibrosis

MOH / ICD-10D47.4

ICD-O-39961/3; C42.1

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-JAK2	BIO definition in KB; no ESCAT BMA entry — verify with clinician

Primary current-line option

Standard plan

★ DEFAULT

Indication

IND-PMF-1L-OBSERVATION

Regimen

Ruxolitinib (PMF — symptomatic splenomegaly / constitutional symptoms)

Drugs + NSZU

Ruxolitinib (DRUG-RUXOLITINIB) Start by baseline platelet count: plt 50-100K → 5 mg BID; 100-200K → 15 mg BID; >200K → 20 mg BID. Titrate by toxicity (max 25 mg BID). · continuous PO twice daily; NEVER abrupt-stop (taper) · PO ✓ NSZU covered

Supportive care

SUP-HBV-PROPHYLAXIS, SUP-HSV-PROPHYLAXIS

Reason

Primary current-line option selected by ALGO-PMF-1L at step 4.

Other current-line alternatives (1 tracks)

Same treatment line; review when biomarker, access, contraindication, or patient-context assumptions change.

Aggressive plan

Indication

IND-PMF-1L-RUXOLITINIB

Regimen

Ruxolitinib (PMF — symptomatic splenomegaly / constitutional symptoms)

Drugs + NSZU

Ruxolitinib (DRUG-RUXOLITINIB) Start by baseline platelet count: plt 50-100K → 5 mg BID; 100-200K → 15 mg BID; >200K → 20 mg BID. Titrate by toxicity (max 25 mg BID). · continuous PO twice daily; NEVER abrupt-stop (taper) · PO ✓ NSZU covered

Supportive care

SUP-HBV-PROPHYLAXIS, SUP-HSV-PROPHYLAXIS

Reason

Current-line alternative 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-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-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-CMV-SEROLOGY	CMV IgG/IgM	Standard	lab	—	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	—	standard

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

Primary myelofibrosis with DIPSS-Plus intermediate-2 or high risk — alloHCT referral mandatory in eligible patients (only curative option); ruxolitinib for symptom + spleen control while awaiting transplant
DIPSS-Plus (Gangat 2011) extends DIPSS with platelets <100K, RBC transfusion-dependence, unfavorable karyotype. int-2 / high → median OS ~2.9 / 1.3 years without alloHCT. AlloHCT is the only curative modality but 30-50% TRM in older…
RF-DIPSS-PLUS-HIGHSRC-NCCN-MPN-2025SRC-DIPSS-PLUS-GANGAT-2011SRC-ESMO-MPN-2015
PMF with anemia as dominant clinical problem (Hb <10 g/dL OR transfusion-dependent) — momelotinib preferred over ruxolitinib (MOMENTUM trial: spleen + symptom + Hb improvement)
Direction "investigate" — surfaces JAKi-selection annotation. Momelotinib's ACVR1 inhibition lowers hepcidin → improves anemia vs ruxolitinib (which often worsens anemia). NOT registered in Ukraine — major access barrier. Alternative…
RF-PMF-ANEMIA-DOMINANTSRC-NCCN-MPN-2025SRC-COMFORT-I-VERSTOVSEK-2012
PMF progressing toward AML (blasts in PB ≥10% accelerated, ≥20% blast-phase / post-MPN AML), rapid splenic enlargement, or rising LDH — re-stage with BM, accelerate alloHCT, consider AML-style therapy if blast-phase
Post-MPN AML has dismal prognosis (~5-month median OS); ven+aza achieves modest response. Most patients with ≥10% PB blasts and fit-enough biology should be on accelerated alloHCT trajectory. STUB — requires clinical co-lead signoff.
RF-PMF-BLAST-PROGRESSIONSRC-NCCN-MPN-2025SRC-DIPSS-PLUS-GANGAT-2011
PMF patient elderly or frail (age ≥75, ECOG ≥3, or HCT-CI ≥4) — alloHCT off the table; symptom-directed therapy (ruxolitinib for splenomegaly + symptoms, momelotinib for anemia, transfusion + supportive care)
AlloHCT TRM in elderly PMF >40-50% — almost always off the table. Symptom-directed JAKi as the dominant track. STUB — requires clinical co-lead signoff.
RF-PMF-FRAILTY-AGESRC-NCCN-MPN-2025SRC-DIPSS-PLUS-GANGAT-2011
PMF intermediate-2 or high risk by DIPSS-Plus — alloHCT referral mandatory in eligible patients (only curative option); ruxolitinib for symptomatic splenomegaly + symptoms while awaiting transplant
DIPSS-Plus int-2 / high → median OS ~2.9 / 1.3 years without alloHCT. AlloHCT in fit patients improves OS but carries 30-50% TRM. Ruxolitinib bridges symptoms + spleen; does NOT eliminate clone but may extend OS in pooled COMFORT…
RF-PMF-HIGH-RISK-DIPSSSRC-NCCN-MPN-2025SRC-DIPSS-PLUS-GANGAT-2011SRC-ESMO-MPN-2015

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-PMF-1L-OBSERVATION)

Do not skip DIPSS-Plus / MIPSS70 risk-stratification at presentation — critical for long-term planning.
Do not prescribe ruxolitinib to asymptomatic patients — change in natural history not proven; toxicity + cost are unnecessary.
Do not skip pre-JAKi HBV / TB screening + active prophylaxis.
Do not abrupt-stop ruxolitinib — taper over 1-2 weeks.
Do not skip alloHCT discussion for intermediate-2 / high — switch to aggressive-track indication via RF.

Aggressive plan (IND-PMF-1L-RUXOLITINIB)

Do not abrupt-stop ruxolitinib — taper over 1-2 weeks; cytokine rebound may be life-threatening.
Do not skip pre-JAKi HBV / TB / HSV screening + active prophylaxis.
Do not skip alloHCT discussion for transplant-eligible — JAKi does not cure MF.
Do not use full ruxolitinib dose at plt 50-100K — start at 5 mg BID + titrate.
Do not combine with strong CYP3A4 inhibitor without dose reduction (50%).

MDT brief

Discussion 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

MDT talk tree (2 steps)

#	Owner	Topic	Action
1	hematologist	Staging / disease burden	What is the current LDH? Marker of tumor burden and transformation.
2	clinical_pharmacist	Specialist review	Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.

Skills (recommended) — for consideration (1)

Clinical pharmacist recommended
Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.

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-DIPSS-PLUS-HIGH, RF-PMF-ANEMIA-DOMINANT, RF-PMF-BLAST-PROGRESSION, RF-PMF-FRAILTY-AGE, RF-PMF-HIGH-RISK-DIPSS, RF-PMF-INFECTION-SCREENING, RF-PMF-ORGAN-DYSFUNCTION

Technical MDT skill metadata (1/16 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-COMFORT-I-VERSTOVSEK-2012: A double-blind, placebo-controlled trial of ruxolitinib for myelofibrosis (2012)
SRC-DIPSS-PLUS-GANGAT-2011: DIPSS plus: a refined Dynamic International Prognostic Scoring System for primary myelofibrosis that incorporates prognostic information from karyotype, platelet count, and transfusion status (2011)
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: 2026-08-17.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT06541249	MethoTRExATE in MyelOpRolifErative Neoplasms (TREATMORE) Trial	PHASE2	RECRUITING	Icahn School of Medicine at Mount Sinai	—	Surrogate endpoint only Single country
NCT04771572	Study of Oral Administration of LP-118 in Patients With Relapsed or Refractory CLL, SLL, MDS, MDS/MPN, AML, CMML-2, MPN-BP, ALL, MF, NHL, RT, MM or T-PLL.	PHASE1	RECRUITING	Newave Pharmaceutical Inc	—	Phase 1 only Single country
NCT03964506	Hyperbaric Oxygen Therapy and Allogeneic Peripheral Blood Stem Cell (PBSC) Transplant	EARLY_PHASE1	RECRUITING	Omar Aljitawi	—	Small N (<50) Single country
NCT07357727	A Phase 3 Study of Pelabresib (DAK539) and Ruxolitinib in Myelofibrosis (MF)	PHASE3	RECRUITING	Novartis Pharmaceuticals	—	—
NCT06859424	A Platform Protocol to Investigate Post-Transplant Cyclophosphamide-Based Graft-Versus-Host Disease Prophylaxis in Patients With Hematologic Malignancies Undergoing Mismatched Unrelated Donor Peripheral Blood Stem Cell Transplantation	PHASE2	RECRUITING	Center for International Blood and Marrow Transplant Research	—	Surrogate endpoint only Single country
NCT06605586	Tasquinimod in Patients with Myelofibrosis Refractory to or Intolerant for JAK2 Inhibition	PHASE1 / PHASE2	RECRUITING	Stichting Hemato-Oncologie voor Volwassenen Nederland	—	Small N (<50)
NCT05320198	Study of DISC-0974 (RALLY-MF) in Participants With Myelofibrosis or Myelodysplastic Syndrome and Anemia	PHASE1 / PHASE2	RECRUITING	Disc Medicine, Inc	—	—
NCT05440838	Identification of Factors Associated With Treatment Response in Patients With Polycythemia Vera, Essential Thrombocythemia, and Pre-myelofibrosis.	N/A	RECRUITING	University Hospital, Angers	—	Single country
NCT05280509	Study of TL-895 Combined With Ruxolitinib in JAKi Treatment-Naïve MF Subjects and Subjects With MF Who Have a Suboptimal Response to Ruxolitinib	PHASE1 / PHASE2	RECRUITING	Telios Pharma, Inc.	—	—
NCT07441694	Study of INCA036978 in Participants With Myeloproliferative Neoplasms	PHASE1	RECRUITING	Incyte Corporation	—	Phase 1 only

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 Ruxolitinib (PMF — symptomatic splenomegaly / constitutional symptoms) (REG-RUX-PMF)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Aggressive plan Ruxolitinib (PMF — symptomatic splenomegaly / constitutional symptoms) (REG-RUX-PMF)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Trial · NCT06541249 MethoTRExATE in MyelOpRolifErative Neoplasms (TREATMORE) Trial No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04771572 Study of Oral Administration of LP-118 in Patients With Relapsed or Refractory CLL, SLL, MDS, MDS/MPN, AML, CMML-2, MPN-BP, ALL, MF, NHL, RT, MM or T-PLL. No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT03964506 Hyperbaric Oxygen Therapy and Allogeneic Peripheral Blood Stem Cell (PBSC) Transplant No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07357727 A Phase 3 Study of Pelabresib (DAK539) and Ruxolitinib in Myelofibrosis (MF) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06859424 A Platform Protocol to Investigate Post-Transplant Cyclophosphamide-Based Graft-Versus-Host Disease Prophylaxis in Patients With Hematologic Malignancies Undergoing Mismatched Unrelated Donor Peripheral Blood Stem Cell Transplantation No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06605586 Tasquinimod in Patients with Myelofibrosis Refractory to or Intolerant for JAK2 Inhibition No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05320198 Study of DISC-0974 (RALLY-MF) in Participants With Myelofibrosis or Myelodysplastic Syndrome and Anemia No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05440838 Identification of Factors Associated With Treatment Response in Patients With Polycythemia Vera, Essential Thrombocythemia, and Pre-myelofibrosis. No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05280509 Study of TL-895 Combined With Ruxolitinib in JAKi Treatment-Naïve MF Subjects and Subjects With MF Who Have a Suboptimal Response to Ruxolitinib No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07441694 Study of INCA036978 in Participants With Myeloproliferative Neoplasms 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: 2026-08-17.

plan_id: PLAN-BMA-JAK2_V617F_PMF-V1 | version: 1 | generated: 2026-08-17T08:06:31.856275+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.