OpenOnco · Treatment Plan

Treatment plan — Peripheral T-Cell Lymphoma, NOS

PLAN-PTCL-RELAPSED-001-V1 · v1 · 2026-06-11

Patient

PTCL-RELAPSED-001 · Algorithm: ALGO-PTCL-2L

DiagnosisPeripheral T-Cell Lymphoma, NOS

MOH / ICD-10C84.4

ICD-O-39702/3

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
BIO-CD30-IHC	Excluded (negative)

Primary current-line option

Standard plan

★ DEFAULT

Indication

IND-PTCL-2L-ROMIDEPSIN

Regimen

Romidepsin IV days 1, 8, 15 q28d — r/r PTCL incl AITL

Drugs + NSZU

Romidepsin (DRUG-ROMIDEPSIN) 14 mg/m² IV over 4 hours · Days 1, 8, 15 of each 28-day cycle, until progression or unacceptable toxicity · IV ✗ Not registered in UA

Supportive care

SUP-PJP-PROPHYLAXIS, SUP-TLS-PROPHYLAXIS, SUP-ANTIEMETIC-PREMED

Reason

Primary current-line option selected by ALGO-PTCL-2L at step 2.

Other current-line alternatives (1 tracks)

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

Standard plan

Indication

IND-PTCL-2L-PRALATREXATE

Regimen

Pralatrexate 30 mg/m² IV weekly × 6 of 7-week cycle (PROPEL schedule) — r/r PTCL

Drugs + NSZU

Pralatrexate (DRUG-PRALATREXATE) 30 mg/m² IV push over 3-5 min · Weekly × 6 of each 7-week cycle, until progression or unacceptable toxicity · IV ✗ Not registered in UA
Leucovorin (DRUG-LEUCOVORIN) 1 mg PO daily (folate) · Continuous throughout therapy + 30 days post-final dose · PO ⚠ NSZU — not for this indication

Supportive care

SUP-PJP-PROPHYLAXIS, SUP-TLS-PROPHYLAXIS, SUP-ANTIEMETIC-PREMED

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-BM-ASPIRATE	Bone Marrow Aspirate	Critical	histology	—	all tracks
TEST-CBC	Complete Blood Count with Differential	Critical	lab	—	all tracks
TEST-CD20-IHC	CD20 Immunohistochemistry	Critical	histology	CSD Lab ✓ (code TBC)	all tracks
TEST-CMP	Comprehensive Metabolic Panel	Critical	lab	—	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-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-RENAL-FUNCTION-EGFR	Renal function with eGFR	Critical	lab	—	all tracks
TEST-B2-MICROGLOBULIN	Beta-2 Microglobulin	Standard	lab	—	all tracks
TEST-LN-CORE-BIOPSY	Core LN Biopsy	Standard	histology	—	all tracks
TEST-PET-CT	FDG PET/CT (whole body)	Standard	imaging	—	all tracks

What NOT to do

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

Standard plan (IND-PTCL-2L-ROMIDEPSIN)

Do NOT skip baseline + serial QTc + correct K/Mg to upper-normal range before infusion — romidepsin has cardiac signal.
Do NOT combine with QT-prolonging drugs without strict monitoring.
Do NOT combine with warfarin without modified INR monitoring — INR rises substantially.
Do NOT prescribe with concomitant strong CYP3A inhibitor without dose reduction.
Do NOT skip TLS prophylaxis in high-burden disease.
Do NOT forget the plan to alloSCT consolidation in fit transplant-eligible responders — HDACi not curative; bridge.
Do NOT prescribe without funding pathway clarification — drug not registered in Ukraine.
Do NOT mistake intra-infusion ECG ST/T changes (typically benign) for ischemic — baseline + serial ECGs.

Standard plan (IND-PTCL-2L-PRALATREXATE)

Do NOT prescribe without MANDATORY folate 1 mg PO daily (start 10 days pre-treatment) + B12 1 mg IM q8-10 weeks throughout therapy — sharply reduces mucositis.
Do NOT skip oral cryotherapy (ice chips / cold water gargle) during infusion — additionally reduces mucositis.
Do NOT combine with TMP-SMX prolonged use (PJP prophylaxis) without strict monitoring — additive antifolate toxicity; consider alternative PJP agent.
Do NOT combine with NSAIDs — reduce pralatrexate clearance, increase toxicity.
Do NOT prescribe at CrCl <30 without dose reduction / alternative — primarily renal clearance.
Do NOT continue at Grade ≥3 mucositis preventing PO intake — hold + mitigate + reduce dose to 20 mg/m² on resume.
Do NOT forget the plan to alloSCT consolidation in fit transplant-eligible responders — pralatrexate not curative; bridge.
Do NOT prescribe without funding pathway — drug not registered in Ukraine and not EMA-approved.

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Romidepsin IV days 1, 8, 15 q28d — r/r PTCL incl AITL

28-day cycles × Until progression or unacceptable toxicity (response-driven)

Standard plan

Induction · Pralatrexate 30 mg/m² IV weekly × 6 of 7-week cycle (PROPEL schedule) — r/r PTCL

49-day cycles × Until progression or unacceptable toxicity

MDT brief

Discussion questions (3, 2 blocking)

BLOCKING OQ-HBV-SEROLOGY
Has HBV serology (HBsAg, anti-HBc total) been done? Status must be known before starting anti-CD20 therapy.
Anti-CD20 without HBV prophylaxis in HBsAg+/anti-HBc+ patients carries significant reactivation risk (CI-HBV-NO-PROPHYLAXIS).
→ infectious_disease_hepatology
BLOCKING OQ-CD20-CONFIRMATION
Is CD20+ status confirmed by histology (IHC)? Without CD20+, rituximab/obinutuzumab are not indicated.
Anti-CD20 therapy is the backbone of most lines of treatment; absence of CD20 expression fully changes the regimen.
→ pathologist
OQ-STAGING-COMPLETE
Has complete staging been done (Lugano + PET/CT or CT)?
Prognosis and track selection depend on stage and tumor burden.
→ radiologist

MDT talk tree (4 steps)

#	Owner	Topic	Action
1	infectious_disease_hepatology	Infection / hepatic safety BLOCKING	Has HBV serology (HBsAg, anti-HBc total) been done? Status must be known before starting anti-CD20 therapy.
2	pathologist	Pathology confirmation BLOCKING	Is CD20+ status confirmed by histology (IHC)? Without CD20+, rituximab/obinutuzumab are not indicated.
3	radiologist	Staging / disease burden	Has complete staging been done (Lugano + PET/CT or CT)?
4	hematologist	Specialist review	Lymphoma diagnosis — leading specialty for treatment management.

Skills (required) — mandatory virtual specialists (1)

Hematologist / oncohematologist required
Lymphoma diagnosis — leading specialty for treatment management.

Skills (recommended) — for consideration (1)

Pathologist (general) recommended
Confirm lymphoma histology + assess transformation risk (DLBCL/Richter).
Owns: OQ-CD20-CONFIRMATION

Data quality

Incomplete for MDT sign-off. MDT sign-off is incomplete until critical clinical data gaps are resolved.

Biomarker coverage: 0/0 known (100%), 0 missing, 0 default-track gaps
Missing critical: cd20_ihc_status, hbsag blocks: RF-PTCL-NOS-INFECTION-SCREENING, anti_hbc_total blocks: RF-PTCL-NOS-INFECTION-SCREENING, lugano_stage
Missing recommended: ldh_ratio_to_uln, fib4_index, pet_ct_date
Unevaluated RedFlags: RF-PTCL-NOS-FRAILTY-AGE, RF-PTCL-NOS-INFECTION-SCREENING, RF-PTCL-NOS-ORGAN-DYSFUNCTION, RF-PTCL-NOS-TRANSFORMATION-PROGRESSION, RF-TCELL-CD30-POSITIVE

Missing data for doctor action

Priority	Clinical item	Owner	Why it matters	Next action	Blocks
CRITICAL	CD20 IHC status `cd20_ihc_status`	pathologist	Confirms CD20-directed therapy is biologically appropriate.	Verify CD20 IHC result, specimen, method, and report date.	-
CRITICAL	HBsAg `hbsag`	infectious_disease_hepatology	Identifies active HBV infection and prophylaxis need before anti-CD20 or other immunosuppressive therapy.	Order or document HBsAg before treatment start.	RF-PTCL-NOS-INFECTION-SCREENING
CRITICAL	Total anti-HBc `anti_hbc_total`	infectious_disease_hepatology	Detects prior HBV exposure and reactivation risk.	Order or document total anti-HBc and decide prophylaxis/monitoring.	RF-PTCL-NOS-INFECTION-SCREENING
CRITICAL	Lugano stage `lugano_stage`	radiologist	Defines lymphoma extent and supports tumor-burden and response-assessment decisions.	Document Lugano stage from PET/CT or contrast CT staging.	-
RECOMMENDED	LDH ratio to ULN `ldh_ratio_to_uln`	medical_oncologist	Supports prognostic scoring and aggressive-biology flags.	Enter LDH with local upper limit of normal.	-
RECOMMENDED	FIB-4 liver fibrosis index `fib4_index`	infectious_disease_hepatology	Screens hepatic fibrosis risk before hepatotoxic therapy or antiviral coordination.	Calculate FIB-4 from age, AST, ALT, and platelet count.	-
RECOMMENDED	PET/CT date `pet_ct_date`	radiologist	Shows whether baseline staging is recent enough for treatment planning and later response comparison.	Document baseline PET/CT date or explain alternative staging modality.	-

Technical MDT skill metadata (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-LYMPHOMA-2025: Lymphomas: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up (2025)
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
NCT05770037	DETERMINE Trial Treatment Arm 01: Alectinib in Adult, Paediatric and Teenage/Young Adult Patients With ALK Positive Cancers	PHASE2 / PHASE3	RECRUITING	Cancer Research UK	—	Small N (<50) Surrogate endpoint only Single country
NCT07162012	Safety and Efficacy of Anti-EBV Autologous TCR-T Cell Injection in Relapsed/Refractory EBV-Positive Lymphoma	EARLY_PHASE1	RECRUITING	Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine	—	Small N (<50) Single country
NCT06630091	A Phase II, Single-center, Single-arm Study Evaluating the Safety and Efficacy of Golidocitinib in the Management of Newly Diagnosed Peripheral T Cell Lymphoma Patients (GOLDEN Study) and Correlative Study	PHASE2	RECRUITING	M.D. Anderson Cancer Center	—	Small N (<50) Single country
NCT07093710	Golidocitinib Combined With Mitoxantrone Hydrochloride Liposome or Chidamide in the Treatment of Relapsed or Refractory Peripheral T-cell Lymphoma	PHASE1 / PHASE2	RECRUITING	Sun Yat-sen University	—	Surrogate endpoint only Single country
NCT04747236	Randomized Phase IIB Trial of Oral Azacytidine Plus Romidepsin Versus Investigator's Choice in PTCL	PHASE2	RECRUITING	University of Virginia	—	Surrogate endpoint only Single country
NCT04512534	Sintilimab Combined With Chidamide in Treating Peripheral T Cell Lymphoma	PHASE2	RECRUITING	Fudan University	—	Surrogate endpoint only Single country
NCT07389616	A Clinical Trial of Cidabenamine Plus Azacitidine to Prevent Post-Transplant Progression in High-Risk Peripheral T-Cell Lymphoma	PHASE2 / PHASE3	RECRUITING	Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine	—	Small N (<50) Single country
NCT04922567	Efficacy and Safety of Lenalidomide Plus CHOP vs CHOP in Patients With Untreated Peripheral T-Cell Lymphoma	PHASE2	RECRUITING	Second Affiliated Hospital, School of Medicine, Zhejiang University	—	Surrogate endpoint only Single country
NCT05313243	Pembrolizumab and Brentuximab Vedotin in Subjects With Relapsed/Refractory T-cell Lymphoma	PHASE2	RECRUITING	Yale University	—	Small N (<50) Surrogate endpoint only Single country
NCT05978141	A Registry for People With T-cell Lymphoma	N/A	RECRUITING	Memorial Sloan Kettering Cancer Center	—	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 Romidepsin IV days 1, 8, 15 q28d — r/r PTCL incl AITL (REG-ROMIDEPSIN-PTCL) 1/1 component drug(s) not registered in Ukraine +1	✗ not registered	✗ out-of-pocket	₴-? — verify pathway	not recorded
Standard plan Pralatrexate 30 mg/m² IV weekly × 6 of 7-week cycle (PROPEL schedule) — r/r PTCL (REG-PRALATREXATE-PTCL) 1/2 component drug(s) not registered in Ukraine +1	✗ not registered	✗ out-of-pocket	₴-? — verify pathway	not recorded
Trial · NCT05770037 DETERMINE Trial Treatment Arm 01: Alectinib in Adult, Paediatric and Teenage/Young Adult Patients With ALK Positive Cancers No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07162012 Safety and Efficacy of Anti-EBV Autologous TCR-T Cell Injection in Relapsed/Refractory EBV-Positive Lymphoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06630091 A Phase II, Single-center, Single-arm Study Evaluating the Safety and Efficacy of Golidocitinib in the Management of Newly Diagnosed Peripheral T Cell Lymphoma Patients (GOLDEN Study) and Correlative Study No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07093710 Golidocitinib Combined With Mitoxantrone Hydrochloride Liposome or Chidamide in the Treatment of Relapsed or Refractory Peripheral T-cell Lymphoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04747236 Randomized Phase IIB Trial of Oral Azacytidine Plus Romidepsin Versus Investigator's Choice in PTCL No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04512534 Sintilimab Combined With Chidamide in Treating Peripheral T Cell Lymphoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07389616 A Clinical Trial of Cidabenamine Plus Azacitidine to Prevent Post-Transplant Progression in High-Risk Peripheral T-Cell Lymphoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04922567 Efficacy and Safety of Lenalidomide Plus CHOP vs CHOP in Patients With Untreated Peripheral T-Cell Lymphoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05313243 Pembrolizumab and Brentuximab Vedotin in Subjects With Relapsed/Refractory T-cell Lymphoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05978141 A Registry for People With T-cell Lymphoma 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-PTCL-RELAPSED-001-V1 | version: 1 | generated: 2026-06-11T11:52:06.098753+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.