OpenOnco · Treatment Plan

Treatment plan — Angioimmunoblastic T-Cell Lymphoma

PLAN-VAR-AITL-RELAPSED-V1 · v1 · 2026-05-13

Patient

VAR-AITL-RELAPSED · Algorithm: ALGO-AITL-2L

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)

Biomarker	Variant	ESCAT	Evidence	Clinical significance	Drugs	Sources
No clinically actionable variants matched in this profile.

⚠️ Not included in plan

Biomarker	Status
BIO-RHOA-G17V	BIO definition in KB; no ESCAT BMA entry — verify with clinician

Primary current-line option

Aggressive plan

★ DEFAULT

Indication

IND-AITL-2L-AZACITIDINE

Regimen

5-Azacitidine SC/IV 75 mg/m² days 1-7 q28d — r/r AITL (epigenetic-targeted)

Drugs + NSZU

Azacitidine (DRUG-AZACITIDINE) 75 mg/m²/day SC OR IV · Days 1-7 of each 28-day cycle (or 5-2-2 schedule); until progression or unacceptable toxicity (≥6 cycles before declaring failure) · SC ⚠ NSZU — not for this indication

Supportive care

SUP-PJP-PROPHYLAXIS, SUP-ANTIEMETIC-PREMED

Reason

Primary current-line option selected by ALGO-AITL-2L at step 3.

Other current-line alternatives (2 tracks)

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

Standard plan

Indication

IND-AITL-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

Current-line alternative presented for HCP consideration

Standard plan

Indication

IND-AITL-2L-BELINOSTAT

Regimen

Belinostat IV days 1-5 q21d (BELIEF schedule) — r/r PTCL incl AITL

Drugs + NSZU

Belinostat (DRUG-BELINOSTAT) 1000 mg/m² IV over 30 min · Days 1-5 of each 21-day cycle, until progression or unacceptable toxicity · IV ✗ Not registered in UA

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-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-PREGNANCY	Beta-HCG	Critical	lab	—	standard
TEST-B2-MICROGLOBULIN	Beta-2 Microglobulin	Standard	lab	—	all tracks
TEST-DAT-COOMBS	Direct Antiglobulin Test	Standard	lab	—	all tracks
TEST-EBER-ISH	EBER ISH	Standard	pathology	CSD Lab ✓ (code TBC)	all tracks
TEST-HAPTOGLOBIN	Haptoglobin	Standard	lab	—	aggressive
TEST-IMMUNOGLOBULINS	Quantitative Immunoglobulins	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
TEST-RETICULOCYTE	Reticulocyte Count	Standard	lab	—	all tracks
TEST-EBV-SEROLOGY	EBV Antibody Panel	Desired	lab	—	aggressive
TEST-NGS-LYMPHOID-PANEL	Lymphoid NGS Panel	Desired	genomic	CSD Lab ✓ (code TBC)	all tracks

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

AITL with autoimmune hemolytic anemia (AIHA, DAT+) and/or immune thrombocytopenia (ITP) — paraneoplastic phenomenon needing concurrent immunosuppression alongside T-cell-directed therapyRF-AITL-AUTOIMMUNE-CYTOPENIA
AITL with EBV+ B-cell expansion (large B-cells, EBER+ in microenvironment) — risk of secondary EBV-driven B-cell lymphoma (DLBCL-like) emerging during/after T-cell-directed therapyRF-AITL-EBV-DRIVEN-B-CELL

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-AITL-2L-AZACITIDINE)

Do not stop earlier than 4-6 cycles without clear progression — HMA response is slow-onset; early evaluation = false negative.
Do not forget to monitor cytopenia + delay cycle at ANC <500 / platelets <25K — hematologic toxicity is dose-limiting.
Do not ignore renal function — CrCl <60 requires 50% dose reduction.
Do not skip re-biopsy with rapid growth of CD20+ mass — secondary EBV-driven DLBCL in AITL microenvironment; separate routing.
Do not forget off-label disclosure — drug registered for MDS/AML; AITL off-label use requires MDT documentation + funding pathway clarification.
Do not skip baseline NGS for TET2/IDH2/DNMT3A — predictive enrichment + future trial routing (IDH2 inhibitor enasidenib for IDH2-mut).

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

Do not skip baseline + serial QTc + correct K/Mg to upper-normal range before infusion — romidepsin has a 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 to 10 mg/m².
Do not skip TLS prophylaxis in high-burden AITL — IL2-driven hyperactivated stage.
Do not forget re-biopsy with rapid growth of CD20+ mass — secondary EBV-driven DLBCL is common in AITL microenvironment.
Do not ignore AIHA / ITP triggers — AITL paraneoplastic; do not confuse with drug-induced cytopenia.
Do not prescribe without funding pathway — drug not registered in Ukraine.

Standard plan (IND-AITL-2L-BELINOSTAT)

Do not skip baseline + serial QTc — belinostat has a cardiac signal; correct K/Mg before the first infusion.
Do not combine with QT-prolonging drugs (azoles, certain antiemetics) without strict monitoring.
Do not prescribe in severe hepatic impairment — UGT1A1-dependent metabolism.
Do not skip TLS monitoring in high-burden AITL (IL2-driven hyperactivated state) — allopurinol + hydration cycle 1.
Do not forget re-biopsy on appearance of a rapidly growing CD20+ B-cell mass — secondary EBV-driven DLBCL is common in AITL microenvironment.
Do not prescribe without funding pathway clarification — drug not registered in Ukraine.
Do not ignore AIHA / ITP triggers — AITL paraneoplastic phenomena (RF-AITL-AUTOIMMUNE-CYTOPENIA); do not confuse with drug-induced cytopenia.

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Aggressive plan

Induction · 5-Azacitidine SC/IV 75 mg/m² days 1-7 q28d — r/r AITL (epigenetic-targeted)

28-day cycles × Until progression (≥6 cycles before declaring failure — slow onset response)

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 · Belinostat IV days 1-5 q21d (BELIEF schedule) — r/r PTCL incl AITL

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

MDT brief

Discussion questions (3, 1 blocking)

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
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 (4 steps)

#	Owner	Topic	Action
1	pathologist	Pathology confirmation BLOCKING	Is CD20+ status confirmed by histology (IHC)? Without CD20+, rituximab/obinutuzumab are not indicated.
2	hematologist	Staging / disease burden	What is the current LDH? Marker of tumor burden and transformation.
3	radiologist	Staging / disease burden	Has complete staging been done (Lugano + PET/CT or CT)?
4	clinical_pharmacist	Specialist review	Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.

Skills (required) — mandatory virtual specialists (1)

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

Skills (recommended) — for consideration (2)

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

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	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 (3/16 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: 2026-05-13.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT01137825	Registry of Older Patients With Cancer	N/A	RECRUITING	UNC Lineberger Comprehensive Cancer Center	—	Single country
NCT06393738	A Study of ARV-393 in Relapsed/Refractory Non-Hodgkin Lymphoma.	PHASE1	RECRUITING	Arvinas Inc.	—	Phase 1 only
NCT06756308	A Study of Enasidenib in People With T-Cell Lymphoma	PHASE2	RECRUITING	Memorial Sloan Kettering Cancer Center	—	Small N (<50) Surrogate endpoint only Single country
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	PHASE3	RECRUITING	Eastern Cooperative Oncology Group	—	Surrogate endpoint only Single country
NCT01137643	Tissue, Blood, and Body Fluid Sample Collection From Patients With Hematologic Cancer	N/A	RECRUITING	UNC Lineberger Comprehensive Cancer Center	—	Surrogate endpoint only Single country
NCT07058103	Tislelizumab , Cyclophosphamide, Mitoxantrone Liposomes, Chidamide, and Prednisone in the Treatment of R/R AITL	PHASE2	RECRUITING	The Affiliated Hospital of Xuzhou Medical University	—	Small N (<50) Surrogate endpoint only Single country
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	PHASE3	RECRUITING	Corvus Pharmaceuticals, Inc.	—	Surrogate endpoint only
NCT04234048	Phase 1 Trial of ST-001 nanoFenretinide in Relapsed/Refractory T-cell Non-Hodgkin Lymphoma	PHASE1	RECRUITING	SciTech Development, Inc.	—	Phase 1 only Small N (<50) Single country
NCT00935090	3'-Deoxy-3'-[18F] Fluorothymidine PET Imaging in Patients With Cancer	N/A	RECRUITING	Barbara Ann Karmanos Cancer Institute	—	Single country
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)	PHASE1	RECRUITING	National 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).

Option	UA registration	NSZU	Cost orientation	Access pathway
Aggressive plan 5-Azacitidine SC/IV 75 mg/m² days 1-7 q28d — r/r AITL (epigenetic-targeted) (REG-AZACITIDINE-AITL)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
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 Belinostat IV days 1-5 q21d (BELIEF schedule) — r/r PTCL incl AITL (REG-BELINOSTAT-PTCL) 1/1 component drug(s) not registered in Ukraine +1	✗ not registered	✗ out-of-pocket	₴-? — verify pathway	not recorded
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.

plan_id: PLAN-VAR-AITL-RELAPSED-V1 | version: 1 | generated: 2026-05-13T10:01:51.593742+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.