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Treatment plan — T-Cell Prolymphocytic Leukemia
PLAN-T-PLL-REFRACT-001-V1 · v1 · 2026-06-11
Patient
T-PLL-REFRACT-001 · Algorithm: ALGO-T-PLL-2L
DiagnosisT-Cell Prolymphocytic Leukemia
MOH / ICD-10C91.6
ICD-O-39834/3

Clinical significance of mutations (ESCAT)

Tumor-board context — the engine does not use these tiers to rank tracks
✅ Covered biomarkers (matched in KB)
BiomarkerVariantESCATEvidenceClinical significanceDrugsSources
No clinically actionable variants matched in this profile.
⚠️ Not included in plan
BiomarkerStatus
BIO-CD52-IHCBIO definition in KB; no ESCAT BMA entry — verify with clinician

Primary current-line option

Aggressive plan
★ DEFAULT
Indication
IND-T-PLL-2L-VENETOCLAX-ALEMTUZUMAB
Regimen
Venetoclax + alemtuzumab combination for r/r T-PLL (investigational)
Drugs + NSZU
  • Venetoclax (DRUG-VENETOCLAX) Ramp-up 20 → 50 → 100 → 200 → 400 mg PO daily (weekly escalation due TLS risk) · PO daily, continuous · PO ⚠ NSZU — not for this indication
  • Alemtuzumab (DRUG-ALEMTUZUMAB) 30 mg IV 3×/week (Mon/Wed/Fri); dose escalation week 1 (3 mg → 10 mg → 30 mg) · IV 3×/week × 12 weeks then re-evaluate · IV ✗ Not registered in UA
Supportive care
SUP-PJP-PROPHYLAXIS, SUP-HSV-PROPHYLAXIS, SUP-HBV-PROPHYLAXIS, SUP-CMV-MONITORING
Hard contraindications
CI-ACTIVE-INFECTION-FOR-ALEMTUZUMAB
Reason
Primary current-line option selected by ALGO-T-PLL-2L at step 1.

Pre-treatment investigations

Investigations before treatment start · critical / standard / desired · merged across tracks
IDNamePriorityCategoryWhere to orderNeeded for
TEST-BM-ASPIRATEBone Marrow AspirateCriticalhistology—all tracks
TEST-BM-TREPHINEBone Marrow TrephineCriticalhistology—all tracks
TEST-CBCComplete Blood Count with DifferentialCriticallab—all tracks
TEST-CMPComprehensive Metabolic PanelCriticallab—all tracks
TEST-FLOW-CYTOMETRYFlow CytometryCriticalhistologyCSD Lab ✓ (code TBC)all tracks
TEST-HBV-SEROLOGYHepatitis B Serology Panel (HBsAg, anti-HBc total, anti-HBs)Criticallab—all tracks
TEST-HCV-ANTIBODYHCV AntibodyCriticallab—all tracks
TEST-HIV-SEROLOGYHIV Antibody/AntigenCriticallab—all tracks
TEST-LDHLactate DehydrogenaseCriticallab—all tracks
TEST-LFTLiver Function Tests (ALT, AST, bilirubin, ALP, GGT, albumin)Criticallab—all tracks
TEST-PREGNANCYBeta-HCGCriticallab—all tracks
TEST-RENAL-FUNCTION-EGFRRenal function with eGFRCriticallab—all tracks
TEST-CMV-SEROLOGYCMV IgG/IgMStandardlab—all tracks
TEST-ECHOEchocardiographyStandardimaging—all tracks
TEST-PET-CTFDG PET/CT (whole body)Standardimaging—all tracks
TEST-URIC-ACIDSerum Uric AcidStandardlab—all tracks
TEST-NGS-LYMPHOID-PANELLymphoid NGS PanelDesiredgenomicCSD Lab ✓ (code TBC)all tracks

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track
  • Failure to achieve CR after 12 weeks alemtuzumab IV OR rapid relapse — alloSCT urgently; venetoclax + ibrutinib or pentostatin/cladribine salvage as bridge.RF-T-PLL-TRANSFORMATION-PROGRESSION

CONTRA-AGGRESSIVE

Hard contraindications to escalation
  • Alemtuzumab causes profound, prolonged CD4+ T-cell depletion (median recovery 9-12 months). Active uncontrolled infection at baseline becomes life-threatening once cellular immunity collapses. HIV-positive status is itself an absolute contraindication — alemtuzumab on top of HIV immunosuppression has unacceptable infectious mortality. CI-ACTIVE-INFECTION-FOR-ALEMTUZUMAB

What NOT to do

Explicit prohibitive rules, each grounded in a regimen / supportive care / contraindication entity
Aggressive plan (IND-T-PLL-2L-VENETOCLAX-ALEMTUZUMAB)
  • Do NOT give venetoclax without TLS prophylaxis + ramp-up — high tumor burden T-PLL = HIGH TLS risk.
  • Do NOT combine with strong CYP3A4 inhibitors (azoles) without dose reduction venetoclax 75%.
  • Do NOT skip CMV monitoring weekly — alemtuzumab pan-lymphopenia → universal CMV reactivation risk.
  • Do NOT skip PJP + HSV prophylaxis ≥6 months after last alemtuzumab dose.
  • Do NOT skimp on donor search — alloSCT — the only curative path.
  • Do NOT give with active infection (especially CMV, HBV).
  • Do NOT use outside clinical trial or tertiary center — investigational regimen.

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Aggressive plan

Induction · Venetoclax + alemtuzumab combination for r/r T-PLL (investigational)
7-day cycles × 12 weeks combined induction; alloSCT consolidation in CR fit; venetoclax continuation if no transplant

MDT brief

Discussion questions (2, 1 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
  • 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)

#OwnerTopicAction
1infectious_disease_hepatologyInfection / hepatic safety BLOCKINGHas HBV serology (HBsAg, anti-HBc total) been done? Status must be known before starting anti-CD20 therapy.
2hematologistStaging / disease burden What is the current LDH? Marker of tumor burden and transformation.
3clinical_pharmacistSpecialist 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: 1/1 known (100%), 0 missing, 0 default-track gaps
  • Unevaluated RedFlags: RF-T-PLL-HIGH-RISK-BIOLOGY, RF-T-PLL-INFECTION-SCREENING, RF-T-PLL-ORGAN-DYSFUNCTION, RF-T-PLL-TRANSFORMATION-PROGRESSION
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).
Specialistskill_idVersionLast reviewedSign-offsDomain
Cellular therapy specialist (CAR-T)cellular_therapy_specialistv0.1.02026-04-250cellular_therapy
Clinical pharmacistclinical_pharmacistv0.1.02026-04-250clinical_pharmacy
Hematologist / oncohematologisthematologistv0.1.02026-04-250hematology_oncology
Hematopathologist (lymphoma / leukemia / myeloma)hematopathologistv0.1.02026-04-250hematopathology
Infectious disease / hepatologyinfectious_disease_hepatologyv0.1.02026-04-250infectious_diseases
Medical oncologist (solid-tumor chemotherapist)medical_oncologistv0.1.02026-04-250solid_oncology
Molecular geneticist / molecular oncologistmolecular_geneticistv0.1.02026-04-250molecular_oncology
Palliative carepalliative_carev0.1.02026-04-250palliative_care
Pathologist (general)pathologistv0.1.02026-04-250pathology
Primary care / family physicianprimary_carev0.1.02026-04-250primary_care
Psycho-oncologistpsychologistv0.1.02026-04-250psychosocial
Radiation oncologistradiation_oncologistv0.1.02026-04-250radiation_oncology
Radiologistradiologistv0.1.02026-04-250diagnostic_imaging
Social worker / case managersocial_worker_case_managerv0.1.02026-04-250psychosocial
Surgical oncologistsurgical_oncologistv0.1.02026-04-250surgical_oncology
Transplant specialist (BMT)transplant_specialistv0.1.02026-04-250cellular_therapy

Sources cited

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).
OptionUA registrationNSZUCost orientationAccess pathway
Aggressive plan
Venetoclax + alemtuzumab combination for r/r T-PLL (investigational) (REG-VENETOCLAX-ALEMTUZUMAB-TPLL)
1/2 component drug(s) not registered in Ukraine +1
✗ not registered✗ out-of-pocket₴-? — verify pathwaynot recorded

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

plan_id: PLAN-T-PLL-REFRACT-001-V1 | version: 1 | generated: 2026-06-11T11:52:06.117785+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.