OpenOnco · Treatment Plan

Treatment plan — Adult T-Cell Leukemia/Lymphoma

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

Patient

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

DiagnosisAdult T-Cell Leukemia/Lymphoma

MOH / ICD-10C91.5

ICD-O-39827/3

Etiological driver

Etiological driver · etiologically_driven archetype

Adult T-Cell Leukemia/Lymphoma

HTLV-1 (Human T-cell Lymphotropic Virus 1) — defining etiology, 100%
CD3+ CD4+ CD25+ CCR4+ FoxP3+ — Treg-like phenotype
TCR αβ rearrangement з clonal HTLV-1 integration
Endemic у Japan, Caribbean, Latin America, Sub-Saharan Africa

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-HTLV-1	BIO definition in KB; no ESCAT BMA entry — verify with clinician

Primary current-line option

Standard plan

★ DEFAULT

Indication

IND-ATLL-2L-MOGAMULIZUMAB

Regimen

Mogamulizumab monotherapy (1.0 mg/kg IV weekly × 5, then q2 weeks)

Drugs + NSZU

Mogamulizumab (DRUG-MOGAMULIZUMAB) 1.0 mg/kg · IV over ≥1h weekly × 5 (induction); then every 2 weeks until progression or toxicity · IV ✗ Not registered in UA

Reason

Primary current-line option selected by ALGO-ATLL-2L at step 1.

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-CECT-CAP	CECT chest/abdomen/pelvis	Critical	imaging	—	all tracks
TEST-CMP	Comprehensive Metabolic Panel	Critical	lab	—	all tracks
TEST-FLOW-CYTOMETRY	Flow Cytometry	Critical	histology	CSD Lab ✓ (code TBC)	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	—	all tracks
TEST-ECHO	Echocardiography	Standard	imaging	—	all tracks
TEST-HTLV1-SEROLOGY	HTLV-1/2 antibody screen + confirmatory	Standard	lab	—	all tracks
TEST-PET-CT	FDG PET/CT (whole body)	Standard	imaging	—	all tracks
TEST-NGS-LYMPHOID-PANEL	Lymphoid NGS Panel	Desired	genomic	CSD Lab ✓ (code TBC)	desired (standard)

What NOT to do

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

Standard plan (IND-ATLL-2L-MOGAMULIZUMAB)

Do NOT give mogamulizumab within 50 days before planned alloSCT — fatal GVHD risk per FDA black box.
Do NOT ignore skin reactions (drug rash up to 25%) — biopsy to distinguish drug rash vs cutaneous progression.
Do NOT skip hypercalcemia management — ATLL-specific paraneoplastic; bisphosphonates + hydration mandatory.
Do NOT give without CCR4 confirmation IHC — confirmatory step required for funding.
Do NOT neglect parallel donor search — alloSCT is the only curative option for aggressive ATLL.
Do NOT use in patients with prior severe drug reactions — anaphylactoid risk.
Do NOT forget about opportunistic infections — CCR4-targeted therapy reduces Treg, increases autoimmune-like AE risk.

Monitoring schedule

Monitoring schedule by treatment phase

Standard plan · MON-MF-SYSTEMIC

Phase	Window	Tests	Checkpoints
baseline	Within 2 weeks before first dose	TEST-CBC, TEST-CMP, TEST-LFT, TEST-LDH, TEST-SEZARY-COUNT, TEST-TCR-CLONALITY, TEST-FLOW-CYTOMETRY, TEST-CD20-IHC, TEST-HBV-SEROLOGY, TEST-HCV-ANTIBODY, TEST-HIV-SEROLOGY, TEST-PET-CT	Confirm TNMB stage; document T/N/M/B + IA-IVB stage Skin photograph baseline (mSWAT score) for response tracking If allo-SCT planned downstream — defer mogamulizumab (severe GVHD risk per FDA black box) Dermatology partnership for AE management (mogamulizumab rash ~25%)
induction	Weekly × 5 doses (mogamulizumab) OR every 3 weeks (BV-mono)	TEST-CBC, TEST-CMP	Infusion reactions (especially mogamulizumab first dose) Skin AE grading (CTCAE) — interrupt if severe rash; differentiate drug rash from disease progression
maintenance	Every 2 weeks (mogamulizumab) OR every 3 weeks (BV-mono) until progression / toxicity	TEST-CBC, TEST-CMP, TEST-LFT	mSWAT skin response every 2-3 months Sézary count repeat at 3 months (mogamulizumab — blood compartment response) Neuropathy grading on BV-mono
response_assessment	After 12-16 weeks of therapy	TEST-PET-CT, TEST-SEZARY-COUNT	Global response per ISCL/EORTC consensus (skin + nodes + viscera + blood) Continue if responding; switch line if stable/progressive
follow_up	Every 3 months × 2 years post-treatment, then every 6 months	TEST-CBC, TEST-LFT, TEST-LDH, TEST-SEZARY-COUNT	Surveillance for relapse + LCT Skin cancer screening (CTCL + treatment increases risk)

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Baseline

Within 2 weeks before first dose

Induction · Mogamulizumab monotherapy (1.0 mg/kg IV weekly × 5, then q2 weeks)

14-day cycles × 5 weekly induction + maintenance until progression / toxicity

Response assessment

After 12-16 weeks of therapy

Maintenance

Every 2 weeks (mogamulizumab) OR every 3 weeks (BV-mono) until progression / toxicity

Follow-up

Every 3 months × 2 years post-treatment, then every 6 months

MDT brief

Discussion questions (2, 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

MDT talk tree (3 steps)

#	Owner	Topic	Action
1	pathologist	Pathology confirmation BLOCKING	Is CD20+ status confirmed by histology (IHC)? Without CD20+, rituximab/obinutuzumab are not indicated.
2	radiologist	Staging / disease burden	Has complete staging been done (Lugano + PET/CT or CT)?
3	hematologist	Specialist review	Lymphoma diagnosis — leading specialty for treatment management.

Skills (required) — mandatory virtual specialists (1)

Hematologist / oncohematologist required
Lymphoma diagnosis — leading specialty for treatment management.

Skills (recommended) — for consideration (1)

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-ATLL-HIGH-RISK-BIOLOGY, RF-ATLL-HYPERCALCEMIA, RF-ATLL-INFECTION-SCREENING, RF-ATLL-ORGAN-DYSFUNCTION, RF-ATLL-SHIMOYAMA-INDOLENT, RF-ATLL-TRANSFORMATION-PROGRESSION

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 (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	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
NCT05995028	Universal 4SCAR7U Targeting CD7-positive Malignancies	PHASE1	RECRUITING	Shenzhen Geno-Immune Medical Institute	—	Phase 1 only Small N (<50) Single country
NCT01137825	Registry of Older Patients With Cancer	N/A	RECRUITING	UNC Lineberger Comprehensive Cancer Center	—	Single country
NCT05442515	CD19/CD22 Bicistronic Chimeric Antigen Receptor (CAR) T Cells in Children and Young Adults With Recurrent or Refractory CD19/CD22-expressing B Cell Malignancies	PHASE1 / PHASE2	RECRUITING	National Cancer Institute (NCI)	—	Single country
NCT04195633	Donor Stem Cell Transplant With Treosulfan, Fludarabine, and Total-Body Irradiation for the Treatment of Hematological Malignancies	PHASE2	RECRUITING	Fred Hutchinson Cancer Center	—	Single country
NCT07224100	Dose-Adjusted EPOCH With or Without Rituximab Plus Ponatinib for the Treatment of Newly-Diagnosed Philadelphia Chromosome Positive Acute Lymphoblastic Leukemia/Lymphoma	PHASE2	RECRUITING	University of Washington	—	Small N (<50) Single country
NCT06220487	A Single-arm, Open-label Study of Olverembatinib, CD3/CD19 Bispecific T-cell Engager, and Chidamide in Patients With Newly Diagnosed Ph+ALL	PHASE2	RECRUITING	Nanfang Hospital, Southern Medical University	—	Single country
NCT06909474	Clinical Trial of CD5-targeted CAR-NK Therapy for Relapse/Refractory T-Cell Hematologic Malignancies	PHASE1	RECRUITING	Chongqing Precision Biotech Co., Ltd	—	Phase 1 only Small N (<50) Single country
NCT06080191	Allogeneic Second-generation CD19-CAR T Cells for Pediatric Relapsed/Refractory B-ALL	PHASE1	RECRUITING	Bambino Gesù Hospital and Research Institute	—	Phase 1 only Small N (<50) Single country
NCT07256210	Feasibility and Safety of Donor-derived NK-cell Infusions for Leukemia Relapse Prophylaxis After Hematopoietic Stem Cell Transplantation	PHASE2	RECRUITING	Federal Research Institute of Pediatric Hematology, Oncology and Immunology	—	Small N (<50) Single country
NCT01087333	Collection of Human Samples to Study Hairy Cell and Other Leukemias, and to Develop Recombinant Immunotoxins for Cancer Treatment	N/A	RECRUITING	National Cancer Institute (NCI)	—	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 Mogamulizumab monotherapy (1.0 mg/kg IV weekly × 5, then q2 weeks) (REG-MOGAMULIZUMAB) 1/1 component drug(s) not registered in Ukraine +1	✗ not registered	✗ out-of-pocket	₴-? — verify pathway	not recorded
Trial · NCT05995028 Universal 4SCAR7U Targeting CD7-positive Malignancies 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 · NCT05442515 CD19/CD22 Bicistronic Chimeric Antigen Receptor (CAR) T Cells in Children and Young Adults With Recurrent or Refractory CD19/CD22-expressing B Cell Malignancies No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04195633 Donor Stem Cell Transplant With Treosulfan, Fludarabine, and Total-Body Irradiation for the Treatment of Hematological Malignancies No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07224100 Dose-Adjusted EPOCH With or Without Rituximab Plus Ponatinib for the Treatment of Newly-Diagnosed Philadelphia Chromosome Positive Acute Lymphoblastic Leukemia/Lymphoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06220487 A Single-arm, Open-label Study of Olverembatinib, CD3/CD19 Bispecific T-cell Engager, and Chidamide in Patients With Newly Diagnosed Ph+ALL No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06909474 Clinical Trial of CD5-targeted CAR-NK Therapy for Relapse/Refractory T-Cell Hematologic Malignancies No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06080191 Allogeneic Second-generation CD19-CAR T Cells for Pediatric Relapsed/Refractory B-ALL No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07256210 Feasibility and Safety of Donor-derived NK-cell Infusions for Leukemia Relapse Prophylaxis After Hematopoietic Stem Cell Transplantation No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT01087333 Collection of Human Samples to Study Hairy Cell and Other Leukemias, and to Develop Recombinant Immunotoxins for Cancer Treatment 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-ATLL-RELAPSED-V1 | version: 1 | generated: 2026-05-13T10:01:51.687682+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.