Patient
VAR-MF-SEZARY-RELAPSED · Algorithm: ALGO-MF-SEZARY-2L
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. |
| Biomarker | Status |
|---|
| BIO-CD30-IHC | BIO definition in KB; no ESCAT BMA entry — verify with clinician |
Primary current-line option
- Indication
- IND-MF-ADVANCED-2L-BEXAROTENE
- Regimen
- Bexarotene PO monotherapy for CTCL (300 mg/m² daily, continuous)
- Drugs + NSZU
- Bexarotene (DRUG-BEXAROTENE) 300 mg/m² PO once daily with meal · PO daily, continuous; reduce to 200 mg/m² if Grade ≥3 toxicity · PO ✗ Not registered in UA
- Reason
- Primary current-line option selected by ALGO-MF-SEZARY-2L at step 3.
Other current-line alternatives (1 tracks)
Same treatment line; review when biomarker, access, contraindication, or patient-context assumptions change.
- Indication
- IND-MF-MAINTENANCE-RETINOID
- Regimen
- Bexarotene low-dose maintenance for CTCL responders (75-150 mg/m² PO daily)
- Drugs + NSZU
- Bexarotene (DRUG-BEXAROTENE) 75-150 mg/m² PO once daily with meal (titrate from initial 150 down based on tolerance) · PO daily, indefinite while in response · PO ✗ Not registered in UA
- 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-FLOW-CYTOMETRY | Flow Cytometry | Critical | histology | 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-PREGNANCY | Beta-HCG | Critical | lab | — | all tracks |
| TEST-PET-CT | FDG PET/CT (whole body) | Standard | imaging | — | all tracks |
| TEST-SEZARY-COUNT | Sézary cell count | Standard | lab | CSD Lab ✓ (code TBC) | all tracks |
What NOT to do
Explicit prohibitive rules, each grounded in a regimen / supportive care / contraindication entity
Standard plan (IND-MF-ADVANCED-2L-BEXAROTENE)
- Do not start without atorvastatin/fenofibrate prophylaxis — hypertriglyceridemia majoritarily.
- Do not skip baseline + monthly fasting lipids — pancreatitis risk with TG >1000.
- Do not skip baseline + monthly TSH/T4 — central hypothyroidism in 30-50%.
- Do not combine with gemfibrozil — markedly increases bexarotene levels.
- Do not prescribe in pregnant women — Category X teratogenic; effective contraception ≥1 month before/during/after.
- Do not combine with vitamin A supplements — additive toxicity.
- Do not forget about photosensitivity — sun protection counseling.
Standard plan (IND-MF-MAINTENANCE-RETINOID)
- Do not stop abruptly — relapse risk.
- Do not neglect ongoing TG + TSH monitoring — long-term complications even at low dose.
- Do not neglect ongoing contraception counseling in women of childbearing potential.
- Do not allow supply gaps — abrupt cessation risks rapid relapse; secure international supply continuity.
- Do not combine with vitamin A supplements.
- Do not forget about skin cancer surveillance in MF pts on retinoid long-term.
Timeline
Treatment timeline — derived from regimen + monitoring schedule
Standard plan
Induction · Bexarotene PO monotherapy for CTCL (300 mg/m² daily, continuous)
28-day cycles × Continuous until progression / unacceptable toxicity; can transition to maintenance dose 75-150 mg/m²
Standard plan
Induction · Bexarotene low-dose maintenance for CTCL responders (75-150 mg/m² PO daily)
28-day cycles × Indefinite — continue while in response and tolerable
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)
Skills (recommended) — for consideration (1)
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-MF-LARGE-CELL-TRANSFORMATION, RF-MF-SEZARY-FRAILTY-AGE, RF-MF-SEZARY-INFECTION-SCREENING, RF-MF-SEZARY-LEUKEMIC, RF-MF-SEZARY-ORGAN-DYSFUNCTION
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 | Sign-offs | Domain |
|---|
| Cellular therapy specialist (CAR-T) | cellular_therapy_specialist | v0.1.0 | 2026-04-25 | 0 | cellular_therapy |
| Clinical pharmacist | clinical_pharmacist | v0.1.0 | 2026-04-25 | 0 | clinical_pharmacy |
| Hematologist / oncohematologist | hematologist | v0.1.0 | 2026-04-25 | 0 | hematology_oncology |
| Hematopathologist (lymphoma / leukemia / myeloma) | hematopathologist | v0.1.0 | 2026-04-25 | 0 | hematopathology |
| Infectious disease / hepatology | infectious_disease_hepatology | v0.1.0 | 2026-04-25 | 0 | infectious_diseases |
| Medical oncologist (solid-tumor chemotherapist) | medical_oncologist | v0.1.0 | 2026-04-25 | 0 | solid_oncology |
| Molecular geneticist / molecular oncologist | molecular_geneticist | v0.1.0 | 2026-04-25 | 0 | molecular_oncology |
| Palliative care | palliative_care | v0.1.0 | 2026-04-25 | 0 | palliative_care |
| Pathologist (general) | pathologist | v0.1.0 | 2026-04-25 | 0 | pathology |
| Primary care / family physician | primary_care | v0.1.0 | 2026-04-25 | 0 | primary_care |
| Psycho-oncologist | psychologist | v0.1.0 | 2026-04-25 | 0 | psychosocial |
| Radiation oncologist | radiation_oncologist | v0.1.0 | 2026-04-25 | 0 | radiation_oncology |
| Radiologist | radiologist | v0.1.0 | 2026-04-25 | 0 | diagnostic_imaging |
| Social worker / case manager | social_worker_case_manager | v0.1.0 | 2026-04-25 | 0 | psychosocial |
| Surgical oncologist | surgical_oncologist | v0.1.0 | 2026-04-25 | 0 | surgical_oncology |
| Transplant specialist (BMT) | transplant_specialist | v0.1.0 | 2026-04-25 | 0 | cellular_therapy |
Sources cited
- SRC-ESMO-CTCL-2024: ESMO Clinical Practice Guideline on Primary Cutaneous Lymphomas (CTCL — MF / Sézary syndrome) (2024)
- SRC-NCCN-BCELL-2025: NCCN Clinical Practice Guidelines in Oncology: B-Cell Lymphomas (v.2.2025)
Experimental options (clinical trials)
Last synced: 2026-05-13 · ctgov.
No active trials matched this scenario in ctgov.
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 Bexarotene PO monotherapy for CTCL (300 mg/m² daily, continuous) (REG-BEXAROTENE-MONO-CTCL) 1/1 component drug(s) not registered in Ukraine +1 | ✗ not registered | ✗ out-of-pocket | ₴-? — verify pathway | not recorded |
| Standard plan Bexarotene low-dose maintenance for CTCL responders (75-150 mg/m² PO daily) (REG-BEXAROTENE-MAINTENANCE-CTCL) 1/1 component drug(s) not registered in Ukraine +1 | ✗ not registered | ✗ out-of-pocket | ₴-? — verify pathway | not recorded |
Cost information is orientation. Verify with a specific pharmacy / foundation / trial site. Status updated: 2026-05-13.