OpenOnco · Treatment Plan

Treatment plan — Essential Thrombocythemia

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

Patient

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

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-2L-ANAGRELIDE

Regimen

Anagrelide — ET 2L cytoreduction (HU-intolerant / HU-resistant)

Drugs + NSZU

Anagrelide (DRUG-ANAGRELIDE) Start 0.5 mg PO BID; titrate weekly by 0.5 mg/day to platelet target <400-450 × 10⁹/L. Maximum 10 mg/day; usual maintenance 1-3 mg/day in 2-4 divided doses. · Continuous PO daily, divided 2-4 doses; titrated to platelet response · PO ⚠ Out-of-pocket

Reason

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

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	—	desired (standard)
TEST-BM-TREPHINE	Bone Marrow Trephine	Critical	histology	—	desired (standard)
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-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)	desired (standard)
TEST-PERIPHERAL-SMEAR	Peripheral Blood Smear	Critical	lab	CSD Lab ✓ (code TBC)	all tracks
TEST-PREGNANCY	Beta-HCG	Critical	lab	—	all tracks
TEST-ECHO	Echocardiography	Standard	imaging	—	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 / ET patient with positive HBV serology, latent TB, or chronic infection — primarily relevant if planning ruxolitinib (HBV reactivation; TB reactivation reported) or interferon-α (relative contraindication for active hepatitis without expert co-management)RF-PV-ET-INFECTION-SCREENING
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-2L-ANAGRELIDE)

Do not prescribe 1L — PT-1 showed inferior arterial thrombosis vs HU.
Do not escalate the dose faster than 0.5 mg/week — cumulative tachycardia + cardiomyopathy risk.
Do not start without baseline ECG + echo (LVEF) — BBW for CV-events; cardiomyopathy documented.
Do not combine with PDE3 inhibitors or other vasodilators without a cardiologist.
Do not continue with new CHF or LVEF drop ≥10% — discontinue, switch to peg-IFN-α.
Do not prescribe during pregnancy — IFN-α preferred.
Do not forget continued low-dose ASA — bleeding risk additive, but anti-thrombotic effect retained.
Do not skip the UA-funding pathway discussion — NSZU does not cover for ET, only out-of-pocket.

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Anagrelide — ET 2L cytoreduction (HU-intolerant / HU-resistant)

28-day cycles × Continuous until intolerance / progression to MF / patient preference

MDT brief

MDT talk tree (1 steps)

#	Owner	Topic	Action
1	social_worker_case_manager	Specialist review	Plan includes drugs without NSZU reimbursement — patient access pathway must be assessed.

Skills (recommended) — for consideration (1)

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 (1/16 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)
SRC-PT1-HARRISON-2005: Hydroxyurea compared with anagrelide in high-risk essential thrombocythemia (PT-1) (2005)

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
NCT04282187	Decitabine With Ruxolitinib, Fedratinib or Pacritinib for the Treatment of Accelerated/Blast Phase Myeloproliferative Neoplasms	PHASE2	RECRUITING	University of Washington	—	Small N (<50) Single country
NCT06343805	A Phase 1 Study of AJ1-11095 in Patients With Primary Myelofibrosis (PMF), Post-Polycythemia Vera Myelofibrosis (PPV-MF), or Post-Essential Thrombocythemia Myelofibrosis (PET-MF) Who Have Been Failed by a Type I JAK2 Inhibitor (JAK2i)	PHASE1	RECRUITING	Ajax Therapeutics, Inc.	—	Phase 1 only
NCT06734637	Efficacy and Safety of Peginterferon in ET and PV.	NA	RECRUITING	Zhenya Hong	—	Small N (<50) Single country
NCT07340138	Study of Pelabresib add-on to Ruxolitinib in Japanese Adult Patients With Myelofibrosis	PHASE1	RECRUITING	Novartis Pharmaceuticals	—	Phase 1 only Small N (<50) Single country
NCT06976918	Research Platform Myelofibrosis and Anemia	N/A	RECRUITING	iOMEDICO AG	—	Single country
NCT06881056	Peginterferon α-2b Injection for Aerosol Therapy in Pediatric Respiratory Syncytial Virus Pneumonia	NA	RECRUITING	West China Second University Hospital	—	Single country
NCT07590986	Identification of MPN-specific Antigens and Anti-MPN TCRs in Myeloproliferative Neoplasm	N/A	RECRUITING	Université Catholique de Louvain	—	Surrogate endpoint only Single country
NCT00935090	3'-Deoxy-3'-[18F] Fluorothymidine PET Imaging in Patients With Cancer	N/A	RECRUITING	Barbara Ann Karmanos Cancer Institute	—	Single country
NCT04645199	National Longitudinal Cohort of Hematological Diseases	N/A	RECRUITING	Institute of Hematology & Blood Diseases Hospital, China	—	Single country
NCT07527221	Safety and Tolerability of ZE74-0282 in Healthy Volunteers	PHASE1	RECRUITING	Eilean Therapeutics AU Pty Ltd	—	Phase 1 only Small N (<50) 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 Anagrelide — ET 2L cytoreduction (HU-intolerant / HU-resistant) (REG-ANAGRELIDE-ET) 1/1 component drug(s) not on NSZU formulary	✓ registered	✗ out-of-pocket	₴-? — verify pathway	not recorded
Trial · NCT04282187 Decitabine With Ruxolitinib, Fedratinib or Pacritinib for the Treatment of Accelerated/Blast Phase Myeloproliferative Neoplasms No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06343805 A Phase 1 Study of AJ1-11095 in Patients With Primary Myelofibrosis (PMF), Post-Polycythemia Vera Myelofibrosis (PPV-MF), or Post-Essential Thrombocythemia Myelofibrosis (PET-MF) Who Have Been Failed by a Type I JAK2 Inhibitor (JAK2i) 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 · NCT07340138 Study of Pelabresib add-on to Ruxolitinib in Japanese Adult Patients With Myelofibrosis No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06976918 Research Platform Myelofibrosis and Anemia No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06881056 Peginterferon α-2b Injection for Aerosol Therapy in Pediatric Respiratory Syncytial Virus Pneumonia No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07590986 Identification of MPN-specific Antigens and Anti-MPN TCRs in Myeloproliferative Neoplasm 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 · NCT04645199 National Longitudinal Cohort of Hematological Diseases No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07527221 Safety and Tolerability of ZE74-0282 in Healthy Volunteers 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-ET-RELAPSED-V1 | version: 1 | generated: 2026-06-27T09:41:01.489274+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.