OpenOnco · Treatment Plan

Treatment plan — Anaplastic Large Cell Lymphoma, Systemic

PLAN-VAR-ALCL-RELAPSED-V1 · v1 · 2026-05-12

Patient

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

DiagnosisAnaplastic Large Cell Lymphoma, Systemic

MOH / ICD-10C84.6

ICD-O-39714/3

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	BIO definition in KB; no ESCAT BMA entry — verify with clinician

Primary current-line option

Standard plan

★ DEFAULT

Indication

IND-ALCL-2L-BENDAMUSTINE

Regimen

Bendamustine monotherapy 90 mg/m² days 1+2 q21d — r/r PTCL incl ALCL

Drugs + NSZU

Bendamustine (DRUG-BENDAMUSTINE) 90 mg/m² IV · Days 1 and 2 of each 21-day cycle, up to 6 cycles or until progression · IV ⚠ NSZU — not for this indication

Supportive care

SUP-PJP-PROPHYLAXIS, SUP-ANTIEMETIC-PREMED

Hard contraindications

CI-HBV-NO-PROPHYLAXIS, CI-SEVERE-CYTOPENIA-BR

Reason

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

Other current-line alternatives (3 tracks)

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

Standard plan

Indication

IND-ALCL-2L-BRENTUXIMAB-MONO

Regimen

Brentuximab vedotin monotherapy (1.8 mg/kg IV q3 weeks × up to 16 cycles) for r/r systemic ALCL

Drugs + NSZU

Brentuximab vedotin (DRUG-BRENTUXIMAB-VEDOTIN) 1.8 mg/kg (max 180 mg) · IV over 30 min every 21 days × up to 16 cycles or progression / toxicity · IV ✓ NSZU covered

Supportive care

SUP-PJP-PROPHYLAXIS

Hard contraindications

CI-BORTEZOMIB-SEVERE-NEUROPATHY

Reason

Current-line alternative presented for HCP consideration

Aggressive plan

Indication

IND-ALCL-2L-CRIZOTINIB-ALKPOS

Regimen

Crizotinib 250 mg PO BID continuous — r/r ALK+ ALCL

Drugs + NSZU

Crizotinib (DRUG-CRIZOTINIB) 250 mg PO BID · Continuous until progression or unacceptable toxicity · PO ⚠ NSZU — not for this indication

Reason

Current-line alternative presented for HCP consideration

Standard plan

Indication

IND-ALCL-MAINTENANCE-BV-POST-ASCT

Regimen

Brentuximab vedotin maintenance post-ASCT for high-risk systemic ALCL (AETHERA-style, 16 cycles)

Drugs + NSZU

Brentuximab vedotin (DRUG-BRENTUXIMAB-VEDOTIN) 1.8 mg/kg (max 180 mg) · IV every 21 days × 16 cycles, starting 30-45 days post-ASCT · IV ✓ NSZU covered

Supportive care

SUP-PJP-PROPHYLAXIS

Hard contraindications

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

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-FISH-PANEL	FISH (Fluorescence In Situ Hybridization)	Critical	genomic	CSD Lab ✓ (code TBC)	aggressive
TEST-FLOW-CYTOMETRY	Flow Cytometry	Critical	histology	CSD Lab ✓ (code TBC)	standard
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	—	standard
TEST-ECHO	Echocardiography	Standard	imaging	—	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-FIB4	FIB-4 Index (Fibrosis-4)	Calculation	clinical_assessment	—	standard

What NOT to do

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

Standard plan (IND-ALCL-2L-BENDAMUSTINE)

Do not start without HBV screening + entecavir prophylaxis if HBsAg+ or anti-HBc+ — alkylator immunosuppression risk.
Do not prescribe with severe baseline cytopenia (CI-SEVERE-CYTOPENIA-BR).
Do not use full-dose bendamustine at FIB-4 >3.25 — reduce to 70 mg/m².
Do not use full dose at CrCl 30-60 — reduce to 70 mg/m².
Do not forget PJP prophylaxis (cotrimoxazole) — continue ≥6 months after the last dose.
Do not skip the plan for alloSCT consolidation in fit transplant-eligible responders — natural history without consolidation is poor.
Do not forget off-label disclosure — drug registered for B-cell lymphomas; ALCL off-label via existing supply route.
Do not combine with brentuximab without MDT input — combination toxicity (cytopenia + infection) substantial.

Standard plan (IND-ALCL-2L-BRENTUXIMAB-MONO)

Do not combine with bleomycin — additive lethal pulmonary toxicity (absolute).
Do not prescribe with pre-existing Grade ≥2 peripheral neuropathy — Grade ≥2 = absolute CI.
Do not skip baseline CD30 IHC verification — ALCL universally CD30+ but mandatory documentation for funding.
Do not ignore hepatitis screening + entecavir prophylaxis if HBsAg+ or anti-HBc+.
Do not forget PJP prophylaxis throughout cycles + ≥6 months after the last dose.
Do not stop at Grade 1-2 neuropathy — reduce dose to 1.2 mg/kg + continue; permanent discontinuation for Grade ≥3.
Do not prescribe without funding pathway clarification — brentuximab is NOT NSZU-reimbursed for r/r ALCL.
Do not skip the plan for alloSCT consolidation in fit transplant-eligible responders — natural history without consolidation is poor.

Aggressive plan (IND-ALCL-2L-CRIZOTINIB-ALKPOS)

Do not prescribe without verified ALK rearrangement (IHC + FISH) — drug effective only in ALK+ subset (~70% systemic ALCL).
Do not ignore baseline + serial QTc + visual examinations — visual disturbances (60%), QTc prolongation, bradycardia.
Do not combine with QT-prolonging drugs without strict monitoring.
Do not prescribe with concomitant strong CYP3A inhibitor without dose reduction.
Do not ignore pneumonitis warning — cough/fever/dyspnea = HRCT immediately + permanent discontinuation if confirmed.
Do not skip the plan for alloSCT consolidation in fit transplant-eligible responders — TKI monotherapy is not curative.
Do not forget off-label disclosure — drug registered for ALK+ NSCLC; ALCL off-label use requires MDT documentation.
Do not stop at mild visual disturbances (~60% common, transient) — counseling + dose reduction for persistent.

Standard plan (IND-ALCL-MAINTENANCE-BV-POST-ASCT)

Do not continue maintenance at Grade ≥2 neuropathy — permanent discontinuation.
Do not combine with bleomycin — lethal pulmonary toxicity (absolute).
Do not start earlier than 30 days post-ASCT — engraftment safety.
Do not skip baseline ECG / LVEF if anthracycline-rich pre-ASCT.
Do not ignore HBV-prophylaxis if HBsAg+ or anti-HBc+.
Do not skip PJP prophylaxis throughout maintenance + ≥6 months after.
Do not substitute for pre-ASCT salvage — poor pre-ASCT response is not corrected by maintenance.

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Bendamustine monotherapy 90 mg/m² days 1+2 q21d — r/r PTCL incl ALCL

21-day cycles × Up to 6 (longer if sustained response + tolerability)

Standard plan

Induction · Brentuximab vedotin monotherapy (1.8 mg/kg IV q3 weeks × up to 16 cycles) for r/r systemic ALCL

21-day cycles × Up to 16 (longer if sustained CR + toxicity acceptable)

Aggressive plan

Induction · Crizotinib 250 mg PO BID continuous — r/r ALK+ ALCL

28-day cycles × Continuous

Standard plan

Induction · Brentuximab vedotin maintenance post-ASCT for high-risk systemic ALCL (AETHERA-style, 16 cycles)

21-day cycles × 16 cycles (~12 months) starting 30-45 days post-ASCT

MDT brief

Discussion questions (4, 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
OQ-BIOMARKER-ALK-REARRANGEMENT
What is the status of ALK rearrangement (most commonly NPM1-ALK t(2;5)) (BIO-ALK-REARRANGEMENT)? It is required by track(s): IND-ALCL-2L-CRIZOTINIB-ALKPOS. Expected value: positive (NPM1-ALK most common; other ALK partners also responsive).
A treatment-track biomarker requirement is missing from the patient profile; the MDT should verify the test result, method, specimen, and date before relying on this option.
→ molecular_geneticist

MDT talk tree (5 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	molecular_geneticist	Biomarker status	What is the status of ALK rearrangement (most commonly NPM1-ALK t(2;5)) (BIO-ALK-REARRANGEMENT)? It is required by track(s): IND-ALCL-2L-CRIZOTINIB-ALKPOS. Expected value: positive (NPM1-ALK most common; other ALK partners also responsive).
4	radiologist	Staging / disease burden	Has complete staging been done (Lugano + PET/CT or CT)?
5	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 (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.
Owns: OQ-BIOMARKER-ALK-REARRANGEMENT
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: 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-ALCL-FRAILTY-AGE, RF-ALCL-INFECTION-SCREENING, RF-ALCL-ORGAN-DYSFUNCTION, RF-ALCL-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.	-

Missing biomarker	Label	MDT owner	Default track	Required by	Next action
`BIO-ALK-REARRANGEMENT`	ALK rearrangement (most commonly NPM1-ALK t(2;5))	molecular_geneticist	no	IND-ALCL-2L-CRIZOTINIB-ALKPOS	Verify result, method, specimen, and report date before sign-off. Expected/constraint: positive (NPM1-ALK most common; other ALK partners also responsive)

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).

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-ECHELON-2-HORWITZ-2019: Brentuximab vedotin with chemotherapy for CD30-positive peripheral T-cell lymphoma (ECHELON-2): a global, double-blind, randomised, phase 3 trial (2019)
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: 2026-05-12.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT01793168	Rare Disease Patient Registry & Natural History Study - Coordination of Rare Diseases at Sanford	N/A	RECRUITING	Sanford Health	—	—
NCT03017820	A Vaccine (VSV-hIFNβ-NIS) With or Without Cyclophosphamide and Combinations of Ipilimumab, Nivolumab, and Cemiplimab in Treating Relapsed or Refractory Multiple Myeloma, Acute Myeloid Leukemia or Lymphoma	PHASE1	RECRUITING	Mayo Clinic	—	Phase 1 only Single country
NCT01137825	Registry of Older Patients With Cancer	N/A	RECRUITING	UNC Lineberger Comprehensive Cancer Center	—	Single country
NCT00935090	3'-Deoxy-3'-[18F] Fluorothymidine PET Imaging in Patients With Cancer	N/A	RECRUITING	Barbara Ann Karmanos Cancer Institute	—	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
NCT06508463	Intravenous Vesicular Stomatitis Virus in Patients With Peripheral T-cell Lymphoma	PHASE1	RECRUITING	Mayo Clinic	—	Phase 1 only Small N (<50) Single country
NCT05978141	A Registry for People With T-cell Lymphoma	N/A	RECRUITING	Memorial Sloan Kettering Cancer Center	—	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

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 Bendamustine monotherapy 90 mg/m² days 1+2 q21d — r/r PTCL incl ALCL (REG-BENDAMUSTINE-PTCL)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Standard plan Brentuximab vedotin monotherapy (1.8 mg/kg IV q3 weeks × up to 16 cycles) for r/r systemic ALCL (REG-BV-MONO-SYSTEMIC-ALCL)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Aggressive plan Crizotinib 250 mg PO BID continuous — r/r ALK+ ALCL (REG-CRIZOTINIB-ALCL)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Standard plan Brentuximab vedotin maintenance post-ASCT for high-risk systemic ALCL (AETHERA-style, 16 cycles) (REG-BRENTUXIMAB-MAINTENANCE-ALCL)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Trial · NCT01793168 Rare Disease Patient Registry & Natural History Study - Coordination of Rare Diseases at Sanford No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT03017820 A Vaccine (VSV-hIFNβ-NIS) With or Without Cyclophosphamide and Combinations of Ipilimumab, Nivolumab, and Cemiplimab in Treating Relapsed or Refractory Multiple Myeloma, Acute Myeloid Leukemia or Lymphoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT01137825 Registry of Older Patients With Cancer 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 · 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 · NCT06508463 Intravenous Vesicular Stomatitis Virus in Patients With Peripheral 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
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

Cost information is orientation. Verify with a specific pharmacy / foundation / trial site. Status updated: 2026-05-12.

plan_id: PLAN-VAR-ALCL-RELAPSED-V1 | version: 1 | generated: 2026-05-12T18:41:26.193749+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.