OpenOnco · DIS-AITL · Actionable biomarker present
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OpenOnco · Treatment Plan
Treatment plan — Angioimmunoblastic T-Cell Lymphoma
PLAN-VAR-AITL-BIOMARK-V1 · v1 · 2026-05-13
Patient
VAR-AITL-BIOMARK · Algorithm: ALGO-AITL-1L
DiagnosisAngioimmunoblastic T-Cell Lymphoma
MOH / ICD-10C84.4
ICD-O-39705/3

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-RHOA-G17VBIO definition in KB; no ESCAT BMA entry — verify with clinician

Primary current-line option

Standard plan
★ DEFAULT
Indication
IND-AITL-1L-CHOEP
Regimen
CHOEP (cyclophosphamide + doxorubicin + vincristine + etoposide + prednisone), 6 cycles
Drugs + NSZU
  • Cyclophosphamide (DRUG-CYCLOPHOSPHAMIDE) 750 mg/m² · IV day 1 each 21-day cycle · IV ⚠ NSZU — not for this indication
  • Doxorubicin (DRUG-DOXORUBICIN) 50 mg/m² · IV day 1 each cycle · IV ⚠ NSZU — not for this indication
  • Vincristine (DRUG-VINCRISTINE) 1.4 mg/m² (cap 2 mg) · IV day 1 each cycle · IV ⚠ NSZU — not for this indication
  • Etoposide (DRUG-ETOPOSIDE) 100 mg/m² · IV days 1-3 each cycle · IV ⚠ NSZU — not for this indication
  • Prednisone (DRUG-PREDNISONE) 100 mg · PO days 1-5 each cycle · PO ⚠ NSZU — not for this indication
Supportive care
SUP-PJP-PROPHYLAXIS, SUP-ANTIEMETIC-PREMED, SUP-GCSF-NEUTROPENIA
Hard contraindications
CI-HBV-NO-PROPHYLAXIS, CI-LVEF-LOW-FOR-ANTHRACYCLINE
Reason
Primary current-line option selected by ALGO-AITL-1L at step 1.

Other current-line alternatives (1 tracks)

Same treatment line; review when biomarker, access, contraindication, or patient-context assumptions change.
Aggressive plan
Indication
IND-AITL-1L-CHP-BV
Regimen
Brentuximab vedotin + CHP (CHP-Bv), 6 cycles (CD30+ T-cell lymphomas)
Drugs + NSZU
  • Brentuximab vedotin (DRUG-BRENTUXIMAB-VEDOTIN) 1.8 mg/kg · IV day 1 each 21-day cycle × 6 · IV ⚠ NSZU — not for this indication
  • Cyclophosphamide (DRUG-CYCLOPHOSPHAMIDE) 750 mg/m² · IV day 1 each cycle · IV ⚠ NSZU — not for this indication
  • Doxorubicin (DRUG-DOXORUBICIN) 50 mg/m² · IV day 1 each cycle · IV ⚠ NSZU — not for this indication
  • Prednisone (DRUG-PREDNISONE) 100 mg · PO days 1-5 each cycle · PO ⚠ NSZU — not for this indication
Supportive care
SUP-PJP-PROPHYLAXIS, SUP-ANTIEMETIC-PREMED
Hard contraindications
CI-HBV-NO-PROPHYLAXIS, CI-LVEF-LOW-FOR-ANTHRACYCLINE, CI-BORTEZOMIB-SEVERE-NEUROPATHY
Reason
Current-line alternative presented for HCP consideration

Pre-treatment investigations

Investigations before treatment start · critical / standard / desired · merged across tracks
IDNamePriorityCategoryWhere to orderNeeded for
TEST-BM-ASPIRATEBone Marrow AspirateCriticalhistologyall tracks
TEST-BM-TREPHINEBone Marrow TrephineCriticalhistologyall tracks
TEST-CBCComplete Blood Count with DifferentialCriticallaball tracks
TEST-CD20-IHCCD20 ImmunohistochemistryCriticalhistologyCSD Lab ✓ (code TBC)all tracks
TEST-CMPComprehensive Metabolic PanelCriticallaball tracks
TEST-FLOW-CYTOMETRYFlow CytometryCriticalhistologyCSD Lab ✓ (code TBC)all tracks
TEST-HBV-SEROLOGYHepatitis B Serology Panel (HBsAg, anti-HBc total, anti-HBs)Criticallaball tracks
TEST-HCV-ANTIBODYHCV AntibodyCriticallaball tracks
TEST-HIV-SEROLOGYHIV Antibody/AntigenCriticallaball tracks
TEST-LDHLactate DehydrogenaseCriticallaball tracks
TEST-LFTLiver Function Tests (ALT, AST, bilirubin, ALP, GGT, albumin)Criticallaball tracks
TEST-LN-EXCISIONAL-BIOPSYExcisional LN BiopsyCriticalhistologyall tracks
TEST-PREGNANCYBeta-HCGCriticallaball tracks
TEST-B2-MICROGLOBULINBeta-2 MicroglobulinStandardlaball tracks
TEST-DAT-COOMBSDirect Antiglobulin TestStandardlaball tracks
TEST-EBER-ISHEBER ISHStandardpathologyCSD Lab ✓ (code TBC)all tracks
TEST-ECHOEchocardiographyStandardimagingall tracks
TEST-HAPTOGLOBINHaptoglobinStandardlaball tracks
TEST-IMMUNOGLOBULINSQuantitative ImmunoglobulinsStandardlaball tracks
TEST-PET-CTFDG PET/CT (whole body)Standardimagingall tracks
TEST-RETICULOCYTEReticulocyte CountStandardlaball tracks
TEST-EBV-SEROLOGYEBV Antibody PanelDesiredlaball 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
  • T-cell lymphoma with CD30 expression ≥10% by IHC — qualifies for brentuximab vedotin-based regimen (CHP-Bv per ECHELON-2)RF-TCELL-CD30-POSITIVE

CONTRA-AGGRESSIVE

Hard contraindications to escalation
  • Active or latent HBV without antiviral prophylaxis is an absolute contraindication to starting B-cell-depleting / immunomodulatory monoclonal antibody therapy (anti-CD20, anti-CD30 ADC, anti-CD38). Severe HBV reactivation hepatitis risk including fulminant hepatic failure.CI-HBV-NO-PROPHYLAXIS
  • Pre-treatment LVEF <50% is an absolute contraindication to anthracycline-containing regimens (R-CHOP, Pola-R-CHP, ABVD, BV-AVD, etc.). Cardiotoxicity from doxorubicin is dose-cumulative and often irreversible; starting with already-impaired function risks acute decompensation.CI-LVEF-LOW-FOR-ANTHRACYCLINE
  • Severe pre-existing peripheral neuropathy is an absolute contraindication to bortezomib — therapy will likely worsen the neuropathy to a disabling and often permanent extent.CI-BORTEZOMIB-SEVERE-NEUROPATHY

What NOT to do

Explicit prohibitive rules, each grounded in a regimen / supportive care / contraindication entity
Standard plan (IND-AITL-1L-CHOEP)
  • Do not skip CD30 IHC — if ≥10%, route to CHP-Bv (ECHELON-2 evidence).
  • Do not skip EBER-ISH — AITL microenvironment has EBV+ B-cells in 80-90%; baseline + surveillance.
  • Do not skip baseline IgG + DAT — AITL-specific paraneoplastic phenomena (hypogamma + AIHA).
  • Do not skip HBV screening + entecavir prophylaxis if HBsAg+ or anti-HBc+.
  • Do not use CHOEP at age >60 — CHOP without etoposide is more tolerable.
  • Do not ignore a drop in Hb with reticulocytosis + DAT+ — this is AIHA, not chemo-toxicity; adding a prednisone-containing regimen already exists, but if refractory → rituximab/IVIG.
Aggressive plan (IND-AITL-1L-CHP-BV)
  • Do not combine brentuximab with bleomycin — lethal pulmonary toxicity.
  • Do not prescribe without CD30 IHC ≥10% confirmation — ECHELON-2 inclusion criterion.
  • Do not skip baseline LVEF ≥50% (anthracycline).
  • Do not skip HBV screening + entecavir prophylaxis.
  • Do not skip baseline EBER-ISH — surveillance for secondary EBV-driven DLBCL.
  • Do not skip baseline IgG + DAT — AITL paraneoplastic phenomena.
  • Do not ignore pre-existing neuropathy — Grade ≥2 baseline = absolute CI to brentuximab.
  • Do not use CHP-Bv if NSZU funding for brentuximab is unavailable and out-of-pocket is unrealistic — fallback CHOEP.

Monitoring schedule

Monitoring schedule by treatment phase

Standard plan · MON-R-CHOP-REGIMEN

PhaseWindowTestsCheckpoints
baselineWithin 2 weeks before cycle 1TEST-CBC, TEST-CMP, TEST-LFT, TEST-LDH, TEST-B2-MICROGLOBULIN, TEST-HBV-SEROLOGY, TEST-HCV-ANTIBODY, TEST-HIV-SEROLOGY, TEST-PET-CT, TEST-LN-EXCISIONAL-BIOPSY, TEST-FLOW-CYTOMETRY, TEST-CD20-IHC, TEST-ECHO, TEST-PREGNANCY, TEST-BM-ASPIRATE, TEST-BM-TREPHINE
  • Confirm CD20+ DLBCL histology; rule out double-hit (FISH for MYC/BCL2/BCL6)
  • Confirm HBV status + entecavir prophylaxis plan if HBsAg+ or anti-HBc+
  • Baseline LVEF ≥50% before doxorubicin
  • IPI calculation documented (age, ECOG, LDH, stage, extranodal sites)
  • CNS-IPI calculation if anatomic risk sites or composite score concerning
  • Fertility preservation discussion (sperm banking / oocyte cryo) for childbearing-age
on_treatmentDay 1 of every 21-day cycleTEST-CBC, TEST-CMP, TEST-LFT
  • ANC ≥1500 + platelets ≥100K before each cycle (delay or G-CSF if not)
  • Neuropathy grade documented (CTCAE) — vincristine modification if ≥2
  • LVEF re-check after cumulative doxorubicin ~300 mg/m²
interim_response_assessmentAfter cycles 2-4 (interim PET-CT)TEST-PET-CT, TEST-LDH
  • Lugano response criteria + Deauville score
  • If Deauville 4-5 with mass progression → consider salvage or trial
end_of_treatmentAfter cycle 6 (within 6-8 weeks)TEST-PET-CT, TEST-CBC, TEST-CMP, TEST-LDH
  • Confirm CR vs PR vs SD vs PD by Lugano/Deauville
  • Begin survivorship plan: cardiac surveillance schedule, vaccination catch-up, second-cancer screening
follow_up_shortEvery 3 months × 2 years post-treatmentTEST-CBC, TEST-CMP, TEST-LFT, TEST-LDH
  • Surveillance for relapse (~40% relapse risk by 2 years overall)
  • HBV reactivation monitoring continues for 12 months post anti-CD20
follow_up_longEvery 6 months years 3-5, then annuallyTEST-CBC, TEST-LFT, TEST-ECHO
  • Late cardiomyopathy screening (LVEF) annually if cumulative dox >300
  • Annual second-malignancy screening (skin, breast, etc. age-appropriate)

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Baseline
Within 2 weeks before cycle 1
Induction · CHOEP (cyclophosphamide + doxorubicin + vincristine + etoposide + prednisone), 6 cycles
21-day cycles × 6 (consider autoSCT consolidation in fit younger)
Response assessment
After cycles 2-4 (interim PET-CT)
Follow-up
Every 3 months × 2 years post-treatment

Aggressive plan

Baseline
Within 2 weeks before cycle 1
Induction · Brentuximab vedotin + CHP (CHP-Bv), 6 cycles (CD30+ T-cell lymphomas)
21-day cycles × 6
Response assessment
After cycles 2-4 (interim PET-CT)
Follow-up
Every 3 months × 2 years post-treatment

MDT brief

Discussion questions (4, 1 blocking)

MDT talk tree (6 steps)

#OwnerTopicAction
1pathologistPathology confirmation BLOCKINGIs CD20+ status confirmed by histology (IHC)? Without CD20+, rituximab/obinutuzumab are not indicated.
2hematologistStaging / disease burden What is the current LDH? Marker of tumor burden and transformation.
3pathologistBiomarker status What is the status of CD30 expression by IHC (BIO-CD30-IHC)? It is required by track(s): IND-AITL-1L-CHP-BV. Expected value: positive.
4radiologistStaging / disease burden Has complete staging been done (Lugano + PET/CT or CT)?
5clinical_pharmacistSpecialist review Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.
6molecular_geneticistSpecialist review Indication references an actionable genomic biomarker — mutation / target / actionability interpretation needed.

Skills (required) — mandatory virtual specialists (1)

  • Hematologist / oncohematologist required
    Lymphoma diagnosis — leading specialty for treatment management.
    Owns: OQ-LDH-CURRENT

Skills (recommended) — for consideration (3)

  • Clinical pharmacist recommended
    Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.
  • Molecular geneticist / molecular oncologist recommended
    Indication references an actionable genomic biomarker — mutation / target / actionability interpretation needed.
  • Pathologist (general) recommended
    Confirm lymphoma histology + assess transformation risk (DLBCL/Richter).
    Owns: OQ-CD20-CONFIRMATION, OQ-BIOMARKER-CD30-IHC

Data quality

Incomplete for MDT sign-off. MDT sign-off is incomplete until critical clinical data gaps are resolved.
  • Biomarker coverage: 1/2 known (50%), 1 missing, 0 default-track gaps
  • Missing critical: cd20_ihc_status, lugano_stage
  • Missing recommended: ldh_ratio_to_uln, fib4_index, pet_ct_date
  • Unevaluated RedFlags: RF-AITL-AUTOIMMUNE-CYTOPENIA, RF-AITL-EBV-DRIVEN-B-CELL, RF-AITL-FRAILTY-AGE, RF-AITL-HYPOGAMMA, RF-AITL-ORGAN-DYSFUNCTION, RF-AITL-ROMIDEPSIN-INELIGIBLE, RF-AITL-TRANSFORMATION-PROGRESSION, RF-TCELL-CD30-POSITIVE

Missing data for doctor action

PriorityClinical itemOwnerWhy it mattersNext actionBlocks
CRITICALCD20 IHC status
cd20_ihc_status
pathologistConfirms CD20-directed therapy is biologically appropriate.Verify CD20 IHC result, specimen, method, and report date.-
CRITICALLugano stage
lugano_stage
radiologistDefines lymphoma extent and supports tumor-burden and response-assessment decisions.Document Lugano stage from PET/CT or contrast CT staging.-
RECOMMENDEDLDH ratio to ULN
ldh_ratio_to_uln
medical_oncologistSupports prognostic scoring and aggressive-biology flags.Enter LDH with local upper limit of normal.-
RECOMMENDEDFIB-4 liver fibrosis index
fib4_index
infectious_disease_hepatologyScreens hepatic fibrosis risk before hepatotoxic therapy or antiviral coordination.Calculate FIB-4 from age, AST, ALT, and platelet count.-
RECOMMENDEDPET/CT date
pet_ct_date
radiologistShows whether baseline staging is recent enough for treatment planning and later response comparison.Document baseline PET/CT date or explain alternative staging modality.-
Missing biomarkerLabelMDT ownerDefault trackRequired byNext action
BIO-CD30-IHCCD30 expression by IHCpathologistnoIND-AITL-1L-CHP-BVVerify result, method, specimen, and report date before sign-off. Expected/constraint: positive
Technical MDT skill metadata (4/16 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)

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: 2026-05-13.
NCTTitlePhaseStatusSponsorUASignalsEligibility (excerpt)
NCT01137825Registry of Older Patients With CancerN/ARECRUITINGUNC Lineberger Comprehensive Cancer CenterSingle country
NCT06393738A Study of ARV-393 in Relapsed/Refractory Non-Hodgkin Lymphoma.PHASE1RECRUITINGArvinas Inc.Phase 1 only
NCT06756308A Study of Enasidenib in People With T-Cell LymphomaPHASE2RECRUITINGMemorial Sloan Kettering Cancer CenterSmall N (<50) Surrogate endpoint only Single country
NCT06724237Testing Whether High Dose Chemotherapy and Infusion of the Patients' Own Stem Cells Improves Survival in Patients With Peripheral T-cell Lymphoma Who Achieved a Complete Response at the End of the Initial ChemotherapyPHASE3RECRUITINGEastern Cooperative Oncology GroupSurrogate endpoint only Single country
NCT01137643Tissue, Blood, and Body Fluid Sample Collection From Patients With Hematologic CancerN/ARECRUITINGUNC Lineberger Comprehensive Cancer CenterSurrogate endpoint only Single country
NCT07058103Tislelizumab , Cyclophosphamide, Mitoxantrone Liposomes, Chidamide, and Prednisone in the Treatment of R/R AITLPHASE2RECRUITINGThe Affiliated Hospital of Xuzhou Medical UniversitySmall N (<50) Surrogate endpoint only Single country
NCT06561048Soquelitinib vs Standard of Care in Participants With Relapsed/Refractory Peripheral T-cell Lymphoma Not Otherwise Specified, Follicular Helper T-cell Lymphomas, or Systemic Anaplastic Large-cell LymphomaPHASE3RECRUITINGCorvus Pharmaceuticals, Inc.Surrogate endpoint only
NCT04234048Phase 1 Trial of ST-001 nanoFenretinide in Relapsed/Refractory T-cell Non-Hodgkin LymphomaPHASE1RECRUITINGSciTech Development, Inc.Phase 1 only Small N (<50) Single country
NCT009350903'-Deoxy-3'-[18F] Fluorothymidine PET Imaging in Patients With CancerN/ARECRUITINGBarbara Ann Karmanos Cancer InstituteSingle country
NCT07055477A Phase I Trial Anti-CC Chemokine Receptor 4 Chimeric Antigen Receptor T Cells (CCR4 CAR T Cells) for CCR4 Expressing T-cell Malignancies Including Peripheral T-cell Non-Hodgkin Lymphoma (PTCL) and Cutaneous T-cell Non-Hodgkin Lymphoma (CTCL)PHASE1RECRUITINGNational Cancer Institute (NCI)Phase 1 only 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).
OptionUA registrationNSZUCost orientationAccess pathway
Standard plan
CHOEP (cyclophosphamide + doxorubicin + vincristine + etoposide + prednisone), 6 cycles (REG-CHOEP)
✓ registered✓ covered₴-? — verify pathwayNSZU formulary
Aggressive plan
Brentuximab vedotin + CHP (CHP-Bv), 6 cycles (CD30+ T-cell lymphomas) (REG-CHP-BV)
✓ registered✓ covered₴-? — verify pathwayNSZU formulary
Trial · NCT01137825
Registry of Older Patients With Cancer
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT06393738
A Study of ARV-393 in Relapsed/Refractory Non-Hodgkin Lymphoma.
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT06756308
A Study of Enasidenib in People With T-Cell Lymphoma
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT06724237
Testing Whether High Dose Chemotherapy and Infusion of the Patients' Own Stem Cells Improves Survival in Patients With Peripheral T-cell Lymphoma Who Achieved a Complete Response at the End of the Initial Chemotherapy
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT01137643
Tissue, Blood, and Body Fluid Sample Collection From Patients With Hematologic Cancer
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT07058103
Tislelizumab , Cyclophosphamide, Mitoxantrone Liposomes, Chidamide, and Prednisone in the Treatment of R/R AITL
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT06561048
Soquelitinib vs Standard of Care in Participants With Relapsed/Refractory Peripheral T-cell Lymphoma Not Otherwise Specified, Follicular Helper T-cell Lymphomas, or Systemic Anaplastic Large-cell Lymphoma
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT04234048
Phase 1 Trial of ST-001 nanoFenretinide in Relapsed/Refractory T-cell Non-Hodgkin Lymphoma
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT00935090
3'-Deoxy-3'-[18F] Fluorothymidine PET Imaging in Patients With Cancer
No UA site listed — international referral required
— unknown— unknown
self-pay: ₴0/course
Trial sponsor
Trial · NCT07055477
A Phase I Trial Anti-CC Chemokine Receptor 4 Chimeric Antigen Receptor T Cells (CCR4 CAR T Cells) for CCR4 Expressing T-cell Malignancies Including Peripheral T-cell Non-Hodgkin Lymphoma (PTCL) and Cutaneous T-cell Non-Hodgkin Lymphoma (CTCL)
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: 2026-05-13.