OpenOnco · Treatment Plan

Treatment plan — Myelodysplastic Syndromes — Lower Risk

PLAN-VAR-MDS-LR-RELAPSED-V1 · v1 · 2026-06-27

Patient

VAR-MDS-LR-RELAPSED · Algorithm: ALGO-MDS-LR-2L

DiagnosisMyelodysplastic Syndromes — Lower Risk

MOH / ICD-10D46.9

ICD-O-39989/3; 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

Aggressive plan

★ DEFAULT

Indication

IND-MDS-LR-2L-IMETELSTAT

Regimen

Imetelstat (Rytelo) for transfusion-dependent LR-MDS post-ESA failure

Drugs + NSZU

Imetelstat (DRUG-IMETELSTAT) 7.1 mg/kg IV (2-hour infusion) every 4 weeks · Continuous q4wk until loss of transfusion independence / unacceptable toxicity / disease progression · IV ✗ Not registered in UA

Reason

Primary current-line option selected by ALGO-MDS-LR-2L at step 4.

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-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-FISH-PANEL	FISH (Fluorescence In Situ Hybridization)	Critical	genomic	CSD Lab ✓ (code TBC)	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-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-B12-FOLATE	B12 + Folate	Standard	lab	—	all tracks
TEST-IRON-PANEL	Iron Panel	Standard	lab	—	all tracks
TEST-RETICULOCYTE	Reticulocyte Count	Standard	lab	—	all tracks

What NOT to do

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

Aggressive plan (IND-MDS-LR-2L-IMETELSTAT)

Do not prescribe without verified ESA failure — IMerge inclusion criteria specifically post-ESA refractory/relapsed.
Do not ignore baseline + serial CBC + LFT — Grade ≥3 cytopenia + hepatotoxicity are documented.
Do not continue full dose with Grade 4 thrombocytopenia / neutropenia — mandatory reduction + G-CSF support.
Do not start in HBV-positive without antiviral prophylaxis — immunomodulation + cytopenia.
Do not forget premedication (antihistamine + acetaminophen) for the first 2 cycles — infusion reactions.
Do not confirm plan without funding pathway — drug not registered in Ukraine.
Do not use in del(5q) patients as 1L after ESA — lenalidomide remains preferred for del(5q).

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Aggressive plan

Induction · Imetelstat (Rytelo) for transfusion-dependent LR-MDS post-ESA failure

28-day cycles × Continue until loss of TI / unacceptable toxicity / progression; median treatment duration in IMerge ~33 weeks

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 (2 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.

Skills (recommended) — for consideration (1)

Clinical pharmacist recommended
Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.

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-IPSS-M-HIGH, RF-MDS-DEL-5Q-ISOLATED, RF-MDS-FRAILTY-AGE, RF-MDS-HIGH-RISK-IPSS, RF-MDS-INFECTION-SCREENING, RF-MDS-ORGAN-DYSFUNCTION, RF-MDS-TP53-MUTATION, RF-MDS-TRANSFORMATION-PROGRESSION, RF-OCC-BENZENE-MALIGNANCY-PREVENTION

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-MDS-2021: Myelodysplastic syndromes: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up (2021)
SRC-IMERGE-PLATZBECKER-2024: Imetelstat in patients with lower-risk myelodysplastic syndromes who have relapsed or are refractory to erythropoiesis-stimulating agents (IMerge) (2024)
SRC-IPSS-M-BERNARD-2022: Molecular International Prognostic Scoring System for Myelodysplastic Syndromes (2022)
SRC-NCCN-AML-2025: NCCN Clinical Practice Guidelines in Oncology: Acute Myeloid Leukemia (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: 2026-06-27.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT06304103	A Study of Efficacy and Safety of AND017 in Patients With Myelodysplastic Syndrome	PHASE2	RECRUITING	Kind Pharmaceuticals LLC	—	Single country
NCT07579429	Research On Nicotinamide Riboside Supplement Support in MDS (ROSS Trial)	PHASE2	RECRUITING	University of Colorado, Denver	—	Small N (<50) Single country
NCT05925504	The Tapering Dose of Luspatercept in Patients With Lower-risk Myelodysplastic Syndromes	PHASE2	RECRUITING	Institute of Hematology & Blood Diseases Hospital, China	—	Small N (<50) Single country
NCT07096297	Luspatercept + Darbepoetin in MDS	PHASE2	RECRUITING	Yale University	—	Single country
NCT05308264	Study of R289 in Patients With Lower-risk Myelodysplastic Syndromes (LR MDS)	PHASE1 / PHASE2	RECRUITING	Rigel Pharmaceuticals	—	Single country
NCT05384691	Efficacy of Luspatercept in ESA-naive LR-MDS Patients With or Without Ring Sideroblasts Who do Not Require Transfusions	PHASE2	RECRUITING	University of Leipzig	—	Single country
NCT06614595	Transfusion in Lower Risk MDS Patients: Predictors of Adequacy of Transfusion and Quality of Life in Lower Risk MDS	N/A	RECRUITING	Fundación para la Investigación Biosanitaria del Principado de Asturias	—	Small N (<50) Single country
NCT06566742	A Phase 2 Study Evaluating Olutasidenib in Patients With IDH1-mutated Clonal Cytopenia of Undetermined Significance and Lower-risk Myelodysplastic/Syndromes/Chronic Myelomonocytic Leukemia.	PHASE2	RECRUITING	M.D. Anderson Cancer Center	—	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
Aggressive plan Imetelstat (Rytelo) for transfusion-dependent LR-MDS post-ESA failure (REG-IMETELSTAT-MDS-LR) 1/1 component drug(s) not registered in Ukraine +1	✗ not registered	✗ out-of-pocket	₴-? — verify pathway	not recorded
Trial · NCT06304103 A Study of Efficacy and Safety of AND017 in Patients With Myelodysplastic Syndrome No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07579429 Research On Nicotinamide Riboside Supplement Support in MDS (ROSS Trial) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05925504 The Tapering Dose of Luspatercept in Patients With Lower-risk Myelodysplastic Syndromes No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07096297 Luspatercept + Darbepoetin in MDS No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05308264 Study of R289 in Patients With Lower-risk Myelodysplastic Syndromes (LR MDS) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05384691 Efficacy of Luspatercept in ESA-naive LR-MDS Patients With or Without Ring Sideroblasts Who do Not Require Transfusions No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06614595 Transfusion in Lower Risk MDS Patients: Predictors of Adequacy of Transfusion and Quality of Life in Lower Risk MDS No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06566742 A Phase 2 Study Evaluating Olutasidenib in Patients With IDH1-mutated Clonal Cytopenia of Undetermined Significance and Lower-risk Myelodysplastic/Syndromes/Chronic Myelomonocytic Leukemia. 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-MDS-LR-RELAPSED-V1 | version: 1 | generated: 2026-06-27T09:41:01.843516+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.