OpenOnco · Treatment Plan

Treatment plan — Classical Hodgkin Lymphoma

PLAN-VAR-CHL-RELAPSED-V1 · v1 · 2026-06-27

Patient

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

DiagnosisClassical Hodgkin Lymphoma

MOH / ICD-10C81.9

ICD-O-39650/3

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

Primary current-line option

Aggressive plan

★ DEFAULT

Indication

IND-CHL-2L-PEMBROLIZUMAB

Regimen

Pembrolizumab 200 mg IV q3w — r/r cHL post-BV (KEYNOTE-204 schedule)

Drugs + NSZU

Pembrolizumab (DRUG-PEMBROLIZUMAB) 200 mg flat dose · IV every 21 days, until progression or unacceptable toxicity (typical max 35 cycles ~2 years per KEYNOTE-204) · IV ✓ NSZU covered

Hard contraindications

CI-PEMBROLIZUMAB-AUTOIMMUNE

Reason

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

Other current-line alternatives (1 tracks)

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

Aggressive plan

Indication

IND-CHL-2L-BRENTUXIMAB-MAINTENANCE

Regimen

Brentuximab vedotin maintenance post-ASCT for high-risk cHL (AETHERA, 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-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-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-LN-CORE-BIOPSY	Core LN Biopsy	Standard	histology	—	all tracks
TEST-PET-CT	FDG PET/CT (whole body)	Standard	imaging	—	all tracks

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

Frailty profile precluding full-dose ABVD or A+AVD in classical Hodgkin lymphoma: ECOG ≥3, OR (age ≥60 with ≥2 comorbidities — elderly cHL has worse outcomes regardless of regimen), OR composite frailty (age ≥75 + Charlson ≥3 + albumin <3.5). Triggers de-escalation to AVD (omit bleomycin), VEPEMB (gem-vinorelbine-based), or BV-AVD. RF-CHL-FRAILTY-AGE
Classical Hodgkin lymphoma primary-refractory disease (positive interim PET2 with Deauville 4-5 or end-of-treatment PET-positive) OR early relapse <12 months post-ABVD/A+AVD — high-risk subset routes to salvage chemo (ICE / DHAP / BV-bendamustine) followed by autoSCT consolidation; consider BV-nivolumab combination for chemo-refractory. RF-CHL-TRANSFORMATION-PROGRESSION
Patient has NOT previously received brentuximab vedotin (BV) — eligible for BV-containing first-line and salvage regimens in CD30-expressing diseases: A+AVD in advanced cHL (ECHELON-1, Connors NEJM 2018), BV-CHP in CD30+ PTCL/ALCL (ECHELON-2, Horwitz Lancet 2019), BV monotherapy or BV-containing salvage in R/R cHL (AETHERA post-ASCT consolidation). This eligibility flag is used as an inclusion gate for BV-using algorithm branches; firing means standard BV-route is open. Co-fires with disease-specific CD30-positivity flags. RF-PRIOR-BV-NAIVE

CONTRA-AGGRESSIVE

Hard contraindications to escalation

Pembrolizumab (and other PD-1/PD-L1 inhibitors) augment T-cell responses; in patients with active autoimmunity or post-transplant immunosuppression, this can precipitate severe organ-specific flares (colitis, hepatitis, pneumonitis, transplant rejection) that may be fatal or require transplant loss. CI-PEMBROLIZUMAB-AUTOIMMUNE
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

Aggressive plan (IND-CHL-2L-PEMBROLIZUMAB)

Do NOT prescribe in active autoimmune disease (CI-PEMBROLIZUMAB-AUTOIMMUNE) — risk of severe irAE flare.
Do NOT prescribe in solid-organ transplant — risk of acute graft rejection from PD-1 blockade.
Do NOT ignore baseline thyroid function + cortisol + glucose — endocrine irAE common.
Do NOT ignore new pneumonitis-suspect symptoms (cough, dyspnea) — HRCT immediately; pneumonitis is most-feared irAE.
Do NOT discontinue for Grade 1 endocrinopathy — replacement therapy + continue treatment.
Do NOT ignore myocarditis-suspect symptoms (chest pain, dyspnea, troponin rise) — discontinue + emergent cardiology.
Do NOT forget the plan toward alloSCT consolidation in fit transplant-eligible responders — PD-1 monotherapy is not curative, durable PR + bridge to SCT.
Do NOT plan alloSCT immediately after PD-1 termination — pembrolizumab impacts on post-allo GVHD risk; ≥4 weeks washout + careful conditioning regimen selection.
Do NOT prescribe without funding pathway clarification — pembrolizumab off-label for cHL in UA.

Aggressive plan (IND-CHL-2L-BRENTUXIMAB-MAINTENANCE)

Do NOT combine with bleomycin — additive lethal pulmonary toxicity (absolute).
Do NOT prescribe in pre-existing Grade ≥2 peripheral neuropathy — risk-benefit unfavorable; surveillance only.
Do NOT start maintenance before 30 days post-ASCT — risk of poor engraftment + cytopenia.
Do NOT start maintenance after 45 days post-ASCT — best benefit when started early (AETHERA inclusion criterion).
Do NOT ignore new neuropathy — reduce dose to 1.2 mg/kg on resume; permanent discontinuation for Grade ≥3.
Do NOT continue maintenance beyond 16 cycles — protocol-defined; longer benefit not established.
Do NOT use for low-risk cHL (CR pre-ASCT + relapse >12 mo + nodal-only at relapse) — risk-benefit unfavorable.
Do NOT prescribe without funding pathway clarification — brentuximab is NOT NSZU-reimbursed for cHL maintenance.
Do NOT forget PJP prophylaxis during maintenance + ≥6 mo after last dose.

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Aggressive plan

Induction · Pembrolizumab 200 mg IV q3w — r/r cHL post-BV (KEYNOTE-204 schedule)

21-day cycles × Until progression or unacceptable toxicity (typically ≤2 years / 35 cycles)

Aggressive plan

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

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

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-ACTIVE-AUTOIMMUNE-DISEASE-ICI-RISK, RF-CHL-ADVANCED-STAGE, RF-CHL-FRAILTY-AGE, RF-CHL-INFECTION-SCREENING, RF-CHL-ORGAN-DYSFUNCTION, RF-CHL-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 (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: 2026-06-27.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT07275216	Pembrolizumab in Combination With Chemotherapy for the Treatment of Frail Hodgkin Lymphoma Patients Ineligible for Standard Treatment	PHASE2	RECRUITING	City of Hope Medical Center	—	Small N (<50) Single country
NCT06848569	Sintilimab Plus AVD in Pediatric Low/Moderate Risk Hodgkin Lymphoma: A Phase II Study	PHASE2	RECRUITING	Sun Yat-sen University	—	Single country
NCT05934084	Lifestyles Implemented-Survivorship Care Plan In Lymphoma Survivors	NA	RECRUITING	Fondazione Italiana Linfomi - ETS	—	Single country
NCT04510636	Study of Pembrolizumab With Bendamustine in Hodgkin Lymphoma	PHASE2	RECRUITING	University Health Network, Toronto	—	Small N (<50) Surrogate endpoint only Single country
NCT05955105	A Study of ILB2109 and Toripalimab in Patients With Advanced Solid Malignancies	PHASE1 / PHASE2	RECRUITING	Innolake Biopharm	—	Surrogate endpoint only Single country
NCT06393361	Chidamide Decitabine Plus Anti-PD-1 Antibody for Patients With R/R cHL Who Are Transplant-ineligible or Refused Transplant.	PHASE2	RECRUITING	Chinese PLA General Hospital	—	Surrogate endpoint only Single country
NCT06745076	Personalized Reduction of Chemotherapy Intensity Through ctDNA Evaluation for the Treatment of Patients With Advanced Hodgkin Lymphoma	PHASE2	RECRUITING	University of Washington	—	Surrogate endpoint only Single country
NCT05362773	A Study of MGD024 in Patients With Relapsed or Refractory Hematologic Malignancies	PHASE1	RECRUITING	MacroGenics	—	Phase 1 only Single country
NCT04638790	First Line Chemotherapy for Classical Hodgkin Lymphoma in Russia (HL-Russia-1)	PHASE3	RECRUITING	State Budgetary Healthcare Institution, National Medical Surgical Center N.A. N.I. Pirogov, Ministry of Health of Russia	—	Surrogate endpoint only
NCT04378647	BREntuximab Vedotin in SEcond LIne Therapy BEfore Transplant	PHASE2	RECRUITING	Grupo Español de Linfomas y Transplante Autólogo de Médula Ósea	—	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 Pembrolizumab 200 mg IV q3w — r/r cHL post-BV (KEYNOTE-204 schedule) (REG-PEMBROLIZUMAB-CHL)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Aggressive plan Brentuximab vedotin maintenance post-ASCT for high-risk cHL (AETHERA, 16 cycles) (REG-BRENTUXIMAB-MAINTENANCE-CHL)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Trial · NCT07275216 Pembrolizumab in Combination With Chemotherapy for the Treatment of Frail Hodgkin Lymphoma Patients Ineligible for Standard Treatment No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06848569 Sintilimab Plus AVD in Pediatric Low/Moderate Risk Hodgkin Lymphoma: A Phase II Study No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05934084 Lifestyles Implemented-Survivorship Care Plan In Lymphoma Survivors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04510636 Study of Pembrolizumab With Bendamustine in Hodgkin Lymphoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05955105 A Study of ILB2109 and Toripalimab in Patients With Advanced Solid Malignancies No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06393361 Chidamide Decitabine Plus Anti-PD-1 Antibody for Patients With R/R cHL Who Are Transplant-ineligible or Refused Transplant. No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06745076 Personalized Reduction of Chemotherapy Intensity Through ctDNA Evaluation for the Treatment of Patients With Advanced Hodgkin Lymphoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05362773 A Study of MGD024 in Patients With Relapsed or Refractory Hematologic Malignancies No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04638790 First Line Chemotherapy for Classical Hodgkin Lymphoma in Russia (HL-Russia-1) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04378647 BREntuximab Vedotin in SEcond LIne Therapy BEfore Transplant 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: 2026-06-27.

plan_id: PLAN-VAR-CHL-RELAPSED-V1 | version: 1 | generated: 2026-06-27T09:41:01.259967+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.