Treatment plan — Polycythemia Vera

OpenOnco · PV · HU-resistant (Ruxolitinib 2L)

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OpenOnco · Treatment Plan

Treatment plan — Polycythemia Vera

PLAN-PV-2L-RUX-001-V1 · v1 · 2026-06-11

Patient

PV-2L-RUX-001 · Algorithm: ALGO-PV-2L

DiagnosisPolycythemia Vera

MOH / ICD-10D45

ICD-O-39950/3; C42.1

Clinical significance of mutations (ESCAT)

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

Biomarker	Variant	ESCAT	Evidence	Clinical significance	Drugs	Sources
BIO-JAK2	V617F (exon 14, JH2 pseudokinase domain — present in ~95% of polycythemia vera)	IA	Molecular evidence option SRC-CIVIC: Level B (Supports, Negative) Trial or research option SRC-CIVIC: Level D (Supports, Sensitivity/Response)	JAK2 V617F is the defining driver of polycythemia vera (~95%) and a WHO 2022 / ICC 2022 major diagnostic criterion (per SRC-NCCN-MPN-2025, SRC-ESMO-MPN-2015). Treatment is risk-stratified, not variant-genotype directed: low-risk PV → phlebotomy + low-dose aspirin; high-risk PV (age ≥60 or prior thrombosis) → cytoreduction with hydroxyurea or interferon-alpha (ropeginterferon-alfa-2b, PROUD-PV / CONTINUATION-PV Gisslinger 2020 — superior molecular response and event-free survival at 5y vs hydroxyurea); ruxolitinib (RESPONSE Vannucchi 2015 — 21% CHR + spleen response vs 1% best available therapy) for hydroxyurea- intolerant or -resistant disease.	phlebotomy + low-dose aspirin (low-risk PV per SRC-NCCN-MPN-2025) hydroxyurea (high-risk 1L cytoreduction per SRC-NCCN-MPN-2025, SRC-ESMO-MPN-2015) ropeginterferon alfa-2b (high-risk; preferred for younger patients per SRC-PROUD-PV-GISSLINGER-2020) ruxolitinib (post-hydroxyurea resistance/intolerance per SRC-RESPONSE-VANNUCCHI-2015)	SRC-NCCN-MPN-2025 SRC-ESMO-MPN-2015 SRC-RESPONSE-VANNUCCHI-2015 SRC-PROUD-PV-GISSLINGER-2020

Primary current-line option

Aggressive plan

★ DEFAULT

Indication

IND-PV-2L-RUXOLITINIB

Regimen

Ruxolitinib (PV — HU-resistant / intolerant)

Drugs + NSZU

Ruxolitinib (DRUG-RUXOLITINIB) 10 mg PO BID — start; titrate to Hct <45% + WBC + plt control (max 25 mg BID) · continuous PO twice daily; do NOT abrupt-stop (cytokine rebound) · PO ✓ NSZU covered
Aspirin (DRUG-ASPIRIN) 81-100 mg PO daily · continuous · PO ⚠ Out-of-pocket

Supportive care

SUP-HBV-PROPHYLAXIS, SUP-HSV-PROPHYLAXIS

Reason

Primary current-line option selected by ALGO-PV-2L at step 4.

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	—	desired (aggressive)
TEST-BM-TREPHINE	Bone Marrow Trephine	Critical	histology	—	desired (aggressive)
TEST-CBC	Complete Blood Count with Differential	Critical	lab	—	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-IRON-PANEL	Iron Panel	Standard	lab	—	all tracks
TEST-RETICULOCYTE	Reticulocyte Count	Standard	lab	—	all tracks

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

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 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 resistant or intolerant to hydroxyurea per ELN criteria: persistent need for phlebotomy on HU 2 g/day, persistent symptoms, splenomegaly progression, cytopenias at minimum effective HU dose, or HU-related cutaneous ulcers — switch to ruxolitinib (RESPONSE)RF-PV-HU-RESISTANCE-INTOLERANCE

CONTRA-AGGRESSIVE

Hard contraindications to escalation

—

What NOT to do

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

Aggressive plan (IND-PV-2L-RUXOLITINIB)

Do NOT prescribe without verified HU resistance/intolerance per ELN — slot 2L specific.
Do NOT discontinue abrupt — taper ≥1-2 weeks; cytokine rebound + spleen flare can be life-threatening.
Do NOT initiate without HBV / HCV / HIV / TB screening — JAKi may reactivate latent infection.
Do NOT combine with strong CYP3A4-inhibitor (fluconazole, clarithromycin) without dose reduction ~50%.
Do NOT ignore zoster prophylaxis in HSV-positive — reactivation documented.
Do NOT forget aspirin 81-100 mg PO daily for thrombosis prevention (continued from PV pathway).
Do NOT confirm plan without funding pathway — drug not reimbursed for PV in Ukraine.

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 (3 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.
3	social_worker_case_manager	Specialist review	Plan includes drugs without NSZU reimbursement — patient access pathway must be assessed.

Skills (recommended) — for consideration (2)

Clinical pharmacist recommended
Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.
Social worker / case manager recommended
Plan includes drugs without NSZU reimbursement — patient access pathway must be assessed.

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-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, RF-PV-HU-RESISTANCE-INTOLERANCE

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	Sign-offs	Domain
Cellular therapy specialist (CAR-T)	`cellular_therapy_specialist`	v0.1.0	2026-04-25	0	cellular_therapy
Clinical pharmacist	`clinical_pharmacist`	v0.1.0	2026-04-25	0	clinical_pharmacy
Hematologist / oncohematologist	`hematologist`	v0.1.0	2026-04-25	0	hematology_oncology
Hematopathologist (lymphoma / leukemia / myeloma)	`hematopathologist`	v0.1.0	2026-04-25	0	hematopathology
Infectious disease / hepatology	`infectious_disease_hepatology`	v0.1.0	2026-04-25	0	infectious_diseases
Medical oncologist (solid-tumor chemotherapist)	`medical_oncologist`	v0.1.0	2026-04-25	0	solid_oncology
Molecular geneticist / molecular oncologist	`molecular_geneticist`	v0.1.0	2026-04-25	0	molecular_oncology
Palliative care	`palliative_care`	v0.1.0	2026-04-25	0	palliative_care
Pathologist (general)	`pathologist`	v0.1.0	2026-04-25	0	pathology
Primary care / family physician	`primary_care`	v0.1.0	2026-04-25	0	primary_care
Psycho-oncologist	`psychologist`	v0.1.0	2026-04-25	0	psychosocial
Radiation oncologist	`radiation_oncologist`	v0.1.0	2026-04-25	0	radiation_oncology
Radiologist	`radiologist`	v0.1.0	2026-04-25	0	diagnostic_imaging
Social worker / case manager	`social_worker_case_manager`	v0.1.0	2026-04-25	0	psychosocial
Surgical oncologist	`surgical_oncologist`	v0.1.0	2026-04-25	0	surgical_oncology
Transplant specialist (BMT)	`transplant_specialist`	v0.1.0	2026-04-25	0	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)
SRC-RESPONSE-VANNUCCHI-2015: Ruxolitinib versus standard therapy for the treatment of polycythemia vera (2015)

Experimental options (clinical trials)

Last synced: 2026-06-11 · ctgov.

No active trials matched this scenario in ctgov.

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
Aggressive plan Ruxolitinib (PV — HU-resistant / intolerant) (REG-RUX-PV) 1/2 component drug(s) not on NSZU formulary	✓ registered	✗ out-of-pocket	₴-? — verify pathway	not recorded

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

plan_id: PLAN-PV-2L-RUX-001-V1 | version: 1 | generated: 2026-06-11T11:52:06.186060+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.