OpenOnco · Treatment Plan

Treatment plan — Essential Thrombocythemia

PLAN-VAR-ET-BIOMARK-V1 · v1 · 2026-05-12

Patient

VAR-ET-BIOMARK · Algorithm: ALGO-ET-1L

DiagnosisEssential Thrombocythemia

MOH / ICD-10D47.3

ICD-O-39962/3; C42.1

Clinical significance of mutations (ESCAT)

Tumor-board context — the engine does not use these tiers to rank tracks

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

Primary current-line option

Standard plan

★ DEFAULT

Indication

IND-ET-1L-ASA

Regimen

Hydroxyurea (PV / ET high-risk 1L cytoreduction) + baseline phlebotomy/ASA

Drugs + NSZU

Hydroxyurea (DRUG-HYDROXYUREA) Start 500-1500 mg/day PO (15-25 mg/kg/day); titrate to target · continuous PO daily; titrate by CBC q2-4wk initially, then q1-3 mo once stable · PO ✓ NSZU covered
Aspirin (DRUG-ASPIRIN) 81-100 mg PO daily (low-dose aspirin) · continuous · PO ⚠ Out-of-pocket

Reason

Primary current-line option selected by ALGO-ET-1L 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-ET-1L-HU

Regimen

Hydroxyurea (PV / ET high-risk 1L cytoreduction) + baseline phlebotomy/ASA

Drugs + NSZU

Hydroxyurea (DRUG-HYDROXYUREA) Start 500-1500 mg/day PO (15-25 mg/kg/day); titrate to target · continuous PO daily; titrate by CBC q2-4wk initially, then q1-3 mo once stable · PO ✓ NSZU covered
Aspirin (DRUG-ASPIRIN) 81-100 mg PO daily (low-dose aspirin) · continuous · PO ⚠ Out-of-pocket

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-BCR-ABL-JAK2	BCR-ABL + JAK2 + CALR + MPL	Critical	genomic	CSD Lab ✓ (code TBC)	all tracks
TEST-BM-ASPIRATE	Bone Marrow Aspirate	Critical	histology	—	all tracks
TEST-BM-TREPHINE	Bone Marrow Trephine	Critical	histology	—	all tracks
TEST-CBC	Complete Blood Count with Differential	Critical	lab	—	all tracks
TEST-CMP	Comprehensive Metabolic Panel	Critical	lab	—	all tracks
TEST-COAG-PANEL	Coagulation 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-KARYOTYPE	Karyotype	Critical	genomic	CSD Lab ✓ (code TBC)	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-NGS-MYELOID-PANEL	Myeloid NGS Panel	Critical	genomic	CSD Lab ✓ (code TBC)	all tracks
TEST-PERIPHERAL-SMEAR	Peripheral Blood Smear	Critical	lab	CSD Lab ✓ (code TBC)	all tracks
TEST-PREGNANCY	Beta-HCG	Critical	lab	—	aggressive
TEST-ECHO	Echocardiography	Standard	imaging	—	desired (aggressive)
TEST-IRON-PANEL	Iron Panel	Standard	lab	—	all tracks
TEST-RETICULOCYTE	Reticulocyte Count	Standard	lab	—	all tracks
TEST-D-DIMER	D-Dimer	Desired	lab	—	all tracks

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

ET transformation to post-ET myelofibrosis (~5-10% over 15 years) or to AML / MDS (rare ~1-5%): rising LDH, new splenomegaly, leukoerythroblastic smear, increasing reticulin fibrosis on trephine, blast appearance — re-stage, switch to MF or AML algorithmRF-ET-TRANSFORMATION-PROGRESSION
PV or ET patient elderly or frail (age ≥80, ECOG ≥3, multiple comorbidities, life expectancy <5 years) — gentler cytoreduction (lower HU dose), expanded transfusion + monitoring strategyRF-PV-ET-FRAILTY-AGE
PV or ET high-risk for thrombosis: age >60 OR prior arterial / venous thrombosis OR (ET only) JAK2 V617F + CV risk factors (IPSET-thrombosis high) — triggers cytoreduction (HU 1L) in addition to baseline phlebotomy + ASARF-PV-ET-HIGH-THROMBOSIS-RISK
PV or ET patient with organ dysfunction limiting cytoreductive choice: severe renal impairment (CrCl <30 — limits HU), severe hepatic dysfunction (limits ruxolitinib), or severe cardiac dysfunction (limits anagrelide)RF-PV-ET-ORGAN-DYSFUNCTION
PV or ET patient pregnant or planning pregnancy — HU and anagrelide contraindicated; switch to interferon-α (PEG-IFN-α2a or ropeginterferon)RF-PV-ET-PREGNANCY-OR-PLANNING

CONTRA-AGGRESSIVE

Hard contraindications to escalation

What NOT to do

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

Standard plan (IND-ET-1L-ASA)

Do not skip JAK2 / CALR / MPL testing — driver-mutation status determines subtype + IPSET-thrombosis risk.
Do not prescribe ASA in extreme thrombocytosis (plt >1500K) without ruling out acquired vWD — check ristocetin cofactor activity.
Do not skip prefibrotic-PMF differential on trephine — same presentation, worse prognosis.
Do not prescribe anagrelide 1L — PT-1 trial showed lower cardiovascular profile + HU more preferable.
Do not use full-dose ASA — low-dose is standard.

Aggressive plan (IND-ET-1L-HU)

Do not prescribe HU during pregnancy / pregnancy plans — switch to IFN-α.
Do not skip monthly CBC for the first 3 months — myelosuppression-titrating.
Do not use anagrelide 1L — PT-1 trial showed HU advantage on arterial thrombosis and MF progression.
Do not prescribe in cutaneous ulceration history — risk of recurrence.
Do not combine with peg-IFN without a clear protocol.

MDT brief

Discussion questions (1, 0 blocking)

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 (3 steps)

#	Owner	Topic	Action
1	hematologist	Staging / disease burden	What is the current LDH? Marker of tumor burden and transformation.
2	clinical_pharmacist	Specialist review	Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.
3	social_worker_case_manager	Specialist review	Plan includes drugs without NSZU reimbursement — patient access pathway must be assessed.

Skills (recommended) — for consideration (2)

Clinical pharmacist recommended
Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.
Social worker / case manager recommended
Plan includes drugs without NSZU reimbursement — patient access pathway must be assessed.

Data quality

Usable with caveats. No critical default-track gap was found, but the MDT should review the listed caveats before final sign-off.

Biomarker coverage: 0/0 known (100%), 0 missing, 0 default-track gaps
Unevaluated RedFlags: RF-ET-HU-RESISTANT-INTOLERANT, RF-ET-TRANSFORMATION-PROGRESSION, RF-PV-ET-FRAILTY-AGE, RF-PV-ET-HIGH-THROMBOSIS-RISK, RF-PV-ET-INFECTION-SCREENING, RF-PV-ET-ORGAN-DYSFUNCTION, RF-PV-ET-PREGNANCY-OR-PLANNING

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-MPN-2015: Philadelphia-negative chronic myeloproliferative neoplasms: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up (2015)
SRC-NCCN-MPN-2025: NCCN Clinical Practice Guidelines in Oncology: Myeloproliferative Neoplasms (v.X.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
NCT05320198	Study of DISC-0974 (RALLY-MF) in Participants With Myelofibrosis or Myelodysplastic Syndrome and Anemia	PHASE1 / PHASE2	RECRUITING	Disc Medicine, Inc	—	—
NCT06063486	Curcumin to Improve Inflammation and Symptoms in Patients With Clonal Cytopenia of Undetermined Significance, Low Risk Myelodysplastic Syndrome, and Myeloproliferative Neoplasms	PHASE2	RECRUITING	University of Southern California	—	Small N (<50) Single country
NCT06541249	MethoTRExATE in MyelOpRolifErative Neoplasms (TREATMORE) Trial	PHASE2	RECRUITING	Icahn School of Medicine at Mount Sinai	—	Surrogate endpoint only Single country
NCT04942080	Interest of CALR Allele Burden in Diagnosis and Follow-up of Patients With CALR Mutated Myeloproliferative Syndromes (CALRSUIVI)	NA	RECRUITING	University Hospital, Angers	—	Single country
NCT05835466	Reparixin in Patients With Myelofibrosis Myeloproliferative Neoplasms Research Consortium (MPN-RC 120)	PHASE2	RECRUITING	Icahn School of Medicine at Mount Sinai	—	Small N (<50) Single country
NCT05025488	Mutant CALR-peptide Based Vaccine in Patients With Mutated CALR Myeloproliferative Neoplasm	PHASE1	RECRUITING	Marina Kremyanskaya	—	Phase 1 only Small N (<50) Single country
NCT06361641	Functional and Phenotypic Characterization of Monocytes in Myeloproliferative Syndromes	NA	RECRUITING	University Hospital, Angers	—	Single country
NCT06734637	Efficacy and Safety of Peginterferon in ET and PV.	NA	RECRUITING	Zhenya Hong	—	Small N (<50) Single country
NCT05031897	Two Step Haplo With Radiation Conditioning	PHASE2	RECRUITING	Thomas Jefferson University	—	Single country
NCT07203768	A ELN-Multicenter Study on Phenotypic Evolution and Clinical Outcomes	N/A	RECRUITING	FROM- Fondazione per la Ricerca Ospedale di Bergamo- ETS	—	—

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 Hydroxyurea (PV / ET high-risk 1L cytoreduction) + baseline phlebotomy/ASA (REG-HU-PV-ET) 1/2 component drug(s) not on NSZU formulary	✓ registered	✗ out-of-pocket	₴-? — verify pathway	not recorded
Aggressive plan Hydroxyurea (PV / ET high-risk 1L cytoreduction) + baseline phlebotomy/ASA (REG-HU-PV-ET) 1/2 component drug(s) not on NSZU formulary	✓ registered	✗ out-of-pocket	₴-? — verify pathway	not recorded
Trial · NCT05320198 Study of DISC-0974 (RALLY-MF) in Participants With Myelofibrosis or Myelodysplastic Syndrome and Anemia No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06063486 Curcumin to Improve Inflammation and Symptoms in Patients With Clonal Cytopenia of Undetermined Significance, Low Risk Myelodysplastic Syndrome, and Myeloproliferative Neoplasms No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06541249 MethoTRExATE in MyelOpRolifErative Neoplasms (TREATMORE) Trial No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04942080 Interest of CALR Allele Burden in Diagnosis and Follow-up of Patients With CALR Mutated Myeloproliferative Syndromes (CALRSUIVI) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05835466 Reparixin in Patients With Myelofibrosis Myeloproliferative Neoplasms Research Consortium (MPN-RC 120) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05025488 Mutant CALR-peptide Based Vaccine in Patients With Mutated CALR Myeloproliferative Neoplasm No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06361641 Functional and Phenotypic Characterization of Monocytes in Myeloproliferative Syndromes No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06734637 Efficacy and Safety of Peginterferon in ET and PV. No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05031897 Two Step Haplo With Radiation Conditioning No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07203768 A ELN-Multicenter Study on Phenotypic Evolution and Clinical Outcomes 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-ET-BIOMARK-V1 | version: 1 | generated: 2026-05-12T18:41:26.363369+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.