OpenOnco · Treatment Plan

Treatment plan — Multiple Myeloma

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

Patient

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

DiagnosisMultiple Myeloma

MOH / ICD-10C90.0

ICD-O-39732/3; C42.1

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

Standard plan

★ DEFAULT

Indication

IND-MM-2L-DKD

Regimen

Daratumumab + Carfilzomib + Dexamethasone (DKd / D-Kd / Isa-Kd analog), 28-day cycles

Drugs + NSZU

Daratumumab (DRUG-DARATUMUMAB) 16 mg/kg IV (or 1800 mg SC fixed dose) · Weekly cycles 1-2 (days 1, 8, 15, 22), q2-weekly cycles 3-6, q4-weekly cycle 7+ · IV ⚠ NSZU — not for this indication
Carfilzomib (DRUG-CARFILZOMIB) 20 mg/m² day 1 cycle 1, then 56 mg/m² (or weekly 70 mg/m² alternative — KdW) · IV days 1, 2, 8, 9, 15, 16 of each 28-day cycle · IV ⚠ NSZU — not for this indication
Dexamethasone (DRUG-DEXAMETHASONE) 40 mg (20 mg if age >75 or frail) · PO days 1, 8, 15, 22 of each 28-day cycle · PO ✓ NSZU covered

Supportive care

SUP-HSV-PROPHYLAXIS, SUP-PJP-PROPHYLAXIS, SUP-MM-VTE-PROPHYLAXIS, SUP-MM-BONE-PROTECTION

Hard contraindications

CI-HBV-NO-PROPHYLAXIS

Reason

Primary current-line option selected by ALGO-MM-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-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-FREE-LIGHT-CHAINS	Serum Free Light Chains	Critical	lab	—	all tracks
TEST-HBV-SEROLOGY	Hepatitis B Serology Panel (HBsAg, anti-HBc total, anti-HBs)	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-SPEP-UPEP	SPEP / UPEP with IFE	Critical	lab	—	all tracks
TEST-WHOLE-BODY-MRI	Whole-Body MRI	Critical	imaging	—	desired (standard)
TEST-B2-MICROGLOBULIN	Beta-2 Microglobulin	Standard	lab	—	all tracks
TEST-DAT-COOMBS	Direct Antiglobulin Test	Standard	lab	—	all tracks
TEST-ECHO	Echocardiography	Standard	imaging	—	all tracks
TEST-IMMUNOGLOBULINS	Quantitative Immunoglobulins	Standard	lab	—	all tracks

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

Multiple myeloma with malignant epidural spinal cord compression: new motor deficit, sensory level, severe back pain with vertebral plasmacytoma / lytic lesion + canal invasion — MM is a leading hematologic cause of MESCCRF-MM-CORD-COMPRESSION
Multiple myeloma high-risk cytogenetics: any of t(4;14), t(14;16), t(14;20), del(17p)/TP53 loss, gain or amplification of 1q21 by interphase FISH on CD138-enriched plasma cellsRF-MM-HIGH-RISK-CYTOGENETICS
Multiple myeloma with hypercalcemia (corrected serum calcium ≥11 mg/dL or symptomatic): part of CRAB criteria; emergency when ≥14 mg/dL or symptomatic (altered mentation, AKI, arrhythmia)RF-MM-HYPERCALCEMIA
Multiple myeloma with hyperviscosity syndrome — uncommon but classic in IgA-MM (M-spike >5 g/dL, polymerization tendency) or biclonal gammopathy: blurred vision, retinal hemorrhage, mucosal bleeding, neurologic symptomsRF-MM-HYPERVISCOSITY
Multiple myeloma with significant renal dysfunction: CrCl <60 mL/min or serum creatinine >177 µmol/L (>2 mg/dL) attributable to myeloma kidneyRF-MM-RENAL-DYSFUNCTION

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-MM-2L-DKD)

Do not prescribe without baseline ECG + ECHO + controlled hypertension — carfilzomib has 5-7% rate of cardiac AE.
Do not skip baseline DAT/Coombs + red-cell phenotyping BEFORE first dara — anti-CD38 interferes with crossmatch for months.
Do not start without HBV screening + entecavir prophylaxis in HBsAg+ or anti-HBc+.
Do not skip IV hydration (250-500 mL pre/post) for the first carfilzomib — TLS + AKI risk highest cycle 1.
Do not confirm plan without verified funding pathway — neither daratumumab nor carfilzomib are reimbursed by NSZU.
Do not use with baseline LVEF <40% — carfilzomib cardiotoxicity may become irreversible.
Do not escalate carfilzomib to full dose without cycle-1 step-up (20 mg/m² days 1-2) — risk of infusion reaction + cardiac event.

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Daratumumab + Carfilzomib + Dexamethasone (DKd / D-Kd / Isa-Kd analog), 28-day cycles

28-day cycles × Until progression or unacceptable toxicity

MDT brief

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-ISS-1, RF-ISS-3, RF-MM-BCMA-EXPRESSION-POS, RF-MM-CD38-EXPRESSION-DARA-CANDIDATE, RF-MM-CORD-COMPRESSION, RF-MM-FRAILTY-AGE, RF-MM-HIGH-RISK-CYTOGENETICS, RF-MM-HYPERCALCEMIA, RF-MM-HYPERVISCOSITY, RF-MM-INFECTION-SCREENING, RF-MM-RENAL-DYSFUNCTION, RF-MM-T11-14-ACTIONABLE, RF-MM-TRANSFORMATION-PROGRESSION, RF-R-ISS-3-HIGH-RISK

Technical MDT skill metadata (0/16 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-MM-2023: ESMO Clinical Practice Guideline on Multiple Myeloma (2023)
SRC-NCCN-MM-2025: NCCN Clinical Practice Guidelines in Oncology: Multiple Myeloma (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
NCT07444268	How [14C]-DSP-5336 is Absorbed, Broken Down, and Removed From the Body After a Single Oral Dose in Patients With Advanced Blood Cancers	PHASE1	RECRUITING	Sumitomo Pharma America, Inc.	—	Phase 1 only Small N (<50) Single country
NCT05528887	Study of CAR-T Cell Therapy in the Treatment of Relapsed/Refractory Hematological Malignancies	PHASE1	RECRUITING	The Affiliated People's Hospital of Ningbo University	—	Phase 1 only Small N (<50) Single country
NCT06539832	Intestinal Flora and Immunity in Monoclonal Gammopathy Patients	N/A	RECRUITING	Zhujiang Hospital	—	Single country
NCT06103838	18F-Fluciclovine PET/CT in Multiple Myeloma	PHASE2	RECRUITING	National Cancer Institute (NCI)	—	Single country
NCT06297226	Study of Arlocabtagene Autoleucel (BMS-986393) a GPRC5D-directed CAR T Cell Therapy in Adult Participants With Relapsed or Refractory Multiple Myeloma	PHASE2	RECRUITING	Juno Therapeutics, Inc., a Bristol-Myers Squibb Company	—	Surrogate endpoint only
NCT07202065	Role of Antibiotic Therapy or Immunoglobulin On iNfections in hAematoLogy Dosing Immunoglobulin (Dose Ig)	PHASE2 / PHASE3	RECRUITING	Monash University	—	Single country
NCT06799026	A Phase 1 Study of Vaccination With Dendritic Cell (DC)/Multiple Myeloma (MM) Fusions in Combination With Elranatamab in Relapsed or Refractory Multiple Myeloma	PHASE1	RECRUITING	David Avigan	—	Phase 1 only Small N (<50) Single country
NCT07205523	High-Altitude Hematology Observation-Stem Cell Transplantation (HALO-SCT)	N/A	RECRUITING	Yigeng Cao,MD,PhD	—	Single country
NCT06505369	Bispecific T-cell Redirectors as Part of First Line Treatment in Transplant Eligible Multiple Myeloma Patients	PHASE2	RECRUITING	North Estonia Medical Centre	—	—
NCT06910124	Linvoseltamab in Addition to Lenalidomide (L2) During Maintenance Therapy of NDMM to Deepen Responses or Redrive MRD Negativity After Relapse	PHASE2	RECRUITING	Dickran Kazandjian, MD	—	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 Daratumumab + Carfilzomib + Dexamethasone (DKd / D-Kd / Isa-Kd analog), 28-day cycles (REG-DKD)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Trial · NCT07444268 How [14C]-DSP-5336 is Absorbed, Broken Down, and Removed From the Body After a Single Oral Dose in Patients With Advanced Blood Cancers No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05528887 Study of CAR-T Cell Therapy in the Treatment of Relapsed/Refractory Hematological Malignancies No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06539832 Intestinal Flora and Immunity in Monoclonal Gammopathy Patients No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06103838 18F-Fluciclovine PET/CT in Multiple Myeloma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06297226 Study of Arlocabtagene Autoleucel (BMS-986393) a GPRC5D-directed CAR T Cell Therapy in Adult Participants With Relapsed or Refractory Multiple Myeloma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07202065 Role of Antibiotic Therapy or Immunoglobulin On iNfections in hAematoLogy Dosing Immunoglobulin (Dose Ig) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06799026 A Phase 1 Study of Vaccination With Dendritic Cell (DC)/Multiple Myeloma (MM) Fusions in Combination With Elranatamab in Relapsed or Refractory Multiple Myeloma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07205523 High-Altitude Hematology Observation-Stem Cell Transplantation (HALO-SCT) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06505369 Bispecific T-cell Redirectors as Part of First Line Treatment in Transplant Eligible Multiple Myeloma Patients No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06910124 Linvoseltamab in Addition to Lenalidomide (L2) During Maintenance Therapy of NDMM to Deepen Responses or Redrive MRD Negativity After Relapse 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-MM-RELAPSED-V1 | version: 1 | generated: 2026-06-27T09:41:01.901823+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.