OpenOnco · Treatment Plan

Treatment plan — Extranodal NK/T-Cell Lymphoma, Nasal Type

PLAN-VAR-NK-T-NASAL-BIOMARK-V1 · v1 · 2026-05-12

Patient

VAR-NK-T-NASAL-BIOMARK · Algorithm: ALGO-NK-T-NASAL-1L

DiagnosisExtranodal NK/T-Cell Lymphoma, Nasal Type

MOH / ICD-10C86.0

ICD-O-39719/3

Etiological driver

Etiological driver · etiologically_driven archetype

Extranodal NK/T-Cell Lymphoma, Nasal Type

EBV-driven у ~100% (EBER-ISH defining)
CD3-cytoplasmic+ / CD56+ / cytotoxic markers (TIA1, granzyme B, perforin)
Common у East Asian + Latin American populations (genetic predisposition)
P-glycoprotein expression — anthracycline resistance

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-EBV-DNA	BIO definition in KB; no ESCAT BMA entry — verify with clinician

Primary current-line option

Aggressive plan

★ DEFAULT

Indication

IND-NK-T-NASAL-1L-P-GEMOX

Regimen

P-GEMOX (pegaspargase + gemcitabine + oxaliplatin) for NK/T-cell nasal lymphoma

Drugs + NSZU

L-Asparaginase (DRUG-L-ASPARAGINASE) PEG-asparaginase 2000 IU/m² IM day 1 (preferred); OR L-asparaginase 6000 IU/m² IM days 1, 3, 5 · day 1 (PEG) or days 1, 3, 5 (L-asp) · IM ⚠ NSZU — not for this indication
Gemcitabine (DRUG-GEMCITABINE) 1000 mg/m² · IV days 1 and 8 of every 21-day cycle · IV ⚠ NSZU — not for this indication
Oxaliplatin (DRUG-OXALIPLATIN) 130 mg/m² · IV day 1 of every 21-day cycle · IV ⚠ NSZU — not for this indication

Supportive care

SUP-PJP-PROPHYLAXIS, SUP-GCSF-NEUTROPENIA, SUP-ANTIEMETIC-PREMED

Reason

Primary current-line option selected by ALGO-NK-T-NASAL-1L at step 1.

Other current-line alternatives (1 tracks)

Same treatment line; review when biomarker, access, contraindication, or patient-context assumptions change.

Standard plan

Indication

IND-NK-T-NASAL-1L-SMILE

Regimen

SMILE (Steroid + MTX + Ifosfamide + L-asparaginase + Etoposide), 2-4 cycles

Drugs + NSZU

Induction — SMILE induction 2-4 cycles — combined regimen Steroid + MTX + Ifosfamide + L-asparaginase + Etoposide for extranodal NK/T-cell lymphoma; followed by RT 50 Gy for localized stage I/II

Dexamethasone (DRUG-DEXAMETHASONE) 40 mg · PO/IV days 2-4 · PO ⚠ NSZU — not for this indication
Methotrexate (DRUG-METHOTREXATE) 2 g/m² · IV 6h infusion day 1; leucovorin rescue · IV ⚠ NSZU — not for this indication
Ifosfamide (DRUG-IFOSFAMIDE) 1.5 g/m² · IV days 2-4; mesna co-administration · IV ⚠ NSZU — not for this indication
L-Asparaginase (DRUG-L-ASPARAGINASE) 6000 IU/m² · IM days 8, 10, 12, 14, 16, 18, 20 · IM ⚠ NSZU — not for this indication
Etoposide (DRUG-ETOPOSIDE) 100 mg/m² · IV days 2-4 · IV ⚠ NSZU — not for this indication

Supportive care

SUP-PJP-PROPHYLAXIS, SUP-GCSF-NEUTROPENIA, SUP-ANTIEMETIC-PREMED

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-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-HCV-ANTIBODY	HCV Antibody	Critical	lab	—	all tracks
TEST-HIV-SEROLOGY	HIV Antibody/Antigen	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-LN-EXCISIONAL-BIOPSY	Excisional LN Biopsy	Critical	histology	—	all tracks
TEST-PREGNANCY	Beta-HCG	Critical	lab	—	all tracks
TEST-RENAL-FUNCTION-EGFR	Renal function with eGFR	Critical	lab	—	aggressive
TEST-EBV-VIRAL-LOAD	EBV DNA quantitative PCR	Standard	lab	—	all tracks
TEST-ECHO	Echocardiography	Standard	imaging	—	all tracks
TEST-MRI-BRAIN-CONTRAST	MRI brain with contrast	Standard	imaging	—	all tracks
TEST-PET-CT	FDG PET/CT (whole body)	Standard	imaging	—	all tracks

What NOT to do

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

Aggressive plan (IND-NK-T-NASAL-1L-P-GEMOX)

Do not skip antithrombin III monitoring with asparaginase — thrombosis.
Do not give asparaginase if pancreatitis history — fatal pancreatitis.
Do not skip hypersensitivity test before the first dose of asparaginase.
Do not skip EBV viral load — correlates with disease activity + relapse early detection.
Do not give full-dose oxaliplatin at CrCl <30 — dose reduce 50% or switch to alternative.
Do not combine asparaginase with warfarin without INR monitoring — coagulopathy.
Do not administer vincristine (if in subsequent regimen) intrathecally — fatal.

Standard plan (IND-NK-T-NASAL-1L-SMILE)

Do not give CHOP — anecdotally ineffective (P-gp-mediated resistance).
Do not skip mesna with ifosfamide — hemorrhagic cystitis.
Do not skip antithrombin III monitoring with asparaginase — thrombosis risk elevated.
Do not administer vincristine (if in subsequent regimen) intrathecally.
Do not give asparaginase if pancreatitis history — fatal pancreatitis.
Do not skip EBV viral load — correlates with disease activity + relapse early detection.

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Aggressive plan

Induction · P-GEMOX (pegaspargase + gemcitabine + oxaliplatin) for NK/T-cell nasal lymphoma

21-day cycles × 4-6 cycles induction; concurrent RT 50 Gy for localized stage I/II

Standard plan

Induction · SMILE (Steroid + MTX + Ifosfamide + L-asparaginase + Etoposide), 2-4 cycles

28-day cycles × 2-4 cycles induction; followed by RT 50 Gy для localized stage I/II

MDT brief

Discussion questions (3, 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
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 (4 steps)

#	Owner	Topic	Action
1	pathologist	Pathology confirmation BLOCKING	Is CD20+ status confirmed by histology (IHC)? Without CD20+, rituximab/obinutuzumab are not indicated.
2	hematologist	Staging / disease burden	What is the current LDH? Marker of tumor burden and transformation.
3	radiologist	Staging / disease burden	Has complete staging been done (Lugano + PET/CT or CT)?
4	clinical_pharmacist	Specialist review	Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.

Skills (required) — mandatory virtual specialists (1)

Hematologist / oncohematologist required
Lymphoma diagnosis — leading specialty for treatment management.
Owns: OQ-LDH-CURRENT

Skills (recommended) — for consideration (2)

Clinical pharmacist recommended
Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.
Pathologist (general) recommended
Confirm lymphoma histology + assess transformation risk (DLBCL/Richter).
Owns: OQ-CD20-CONFIRMATION

Data quality

Incomplete for MDT sign-off. MDT sign-off is incomplete until critical clinical data gaps are resolved.

Biomarker coverage: 1/1 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-NK-T-NASAL-HIGH-RISK-BIOLOGY, RF-NK-T-NASAL-INFECTION-SCREENING, RF-NK-T-NASAL-ORGAN-DYSFUNCTION, RF-NK-T-NASAL-TRANSFORMATION-PROGRESSION

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 (3/16 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-LYMPHOMA-2025: Lymphomas: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up (2025)
SRC-NCCN-BCELL-2025: NCCN Clinical Practice Guidelines in Oncology: B-Cell Lymphomas (v.2.2025)

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
NCT06069830	PET and EBV DNA-directed Therapy for Localized Nasal Extranodal NK/T Cell Lymphoma	NA	RECRUITING	Ruijin Hospital	—	Surrogate endpoint only Single country
NCT04288726	Allogeneic CD30.CAR-EBVSTs in Patients With Relapsed or Refractory CD30-Positive Lymphomas	PHASE1	RECRUITING	Baylor College of Medicine	—	Phase 1 only Small N (<50) Single country
NCT01137825	Registry of Older Patients With Cancer	N/A	RECRUITING	UNC Lineberger Comprehensive Cancer Center	—	Single country
NCT00935090	3'-Deoxy-3'-[18F] Fluorothymidine PET Imaging in Patients With Cancer	N/A	RECRUITING	Barbara Ann Karmanos Cancer Institute	—	Single country
NCT06583083	Sintilimab With P-GEMOX Versus the P-GEMOX in the Teatment of Advanced-stage Extranodal Natural Killer/T Cell Lymphoma	PHASE2	RECRUITING	Sun Yat-sen University	—	Surrogate endpoint only Single country
NCT05477264	Concurrent Tislelizumab and Radiotherapy in Newly Diagnosed Extranodal NK/T-cell Lymphoma, Nasal Type	PHASE2	RECRUITING	Won Seog Kim	—	Small N (<50) Surrogate endpoint only Single country
NCT05978141	A Registry for People With T-cell Lymphoma	N/A	RECRUITING	Memorial Sloan Kettering Cancer Center	—	Single country
NCT01137643	Tissue, Blood, and Body Fluid Sample Collection From Patients With Hematologic Cancer	N/A	RECRUITING	UNC Lineberger Comprehensive Cancer Center	—	Surrogate endpoint only Single country
NCT05475925	A Study of DR-01 in Subjects With Large Granular Lymphocytic Leukemia or Cytotoxic Lymphomas	PHASE1 / PHASE2	RECRUITING	Dren Bio	—	Surrogate endpoint only
NCT04365036	A Multicenter, Phase 3, Randomized Trial of Sequencial Chemoradiotherapy with or Without Toripalimab (PD-1 Antibody) in Newly Diagnosed Early-Stage Extranodal Natural Killer/T Cell Lymphoma, Nasal Type (ENKTL)	PHASE3	RECRUITING	Sun Yat-sen University	—	Surrogate endpoint only 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 P-GEMOX (pegaspargase + gemcitabine + oxaliplatin) for NK/T-cell nasal lymphoma (REG-P-GEMOX-NK-T)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Standard plan SMILE (Steroid + MTX + Ifosfamide + L-asparaginase + Etoposide), 2-4 cycles (REG-SMILE)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Trial · NCT06069830 PET and EBV DNA-directed Therapy for Localized Nasal Extranodal NK/T Cell Lymphoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04288726 Allogeneic CD30.CAR-EBVSTs in Patients With Relapsed or Refractory CD30-Positive Lymphomas No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT01137825 Registry of Older Patients With Cancer 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 · NCT06583083 Sintilimab With P-GEMOX Versus the P-GEMOX in the Teatment of Advanced-stage Extranodal Natural Killer/T Cell Lymphoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05477264 Concurrent Tislelizumab and Radiotherapy in Newly Diagnosed Extranodal NK/T-cell Lymphoma, Nasal Type No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05978141 A Registry for People With T-cell Lymphoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT01137643 Tissue, Blood, and Body Fluid Sample Collection From Patients With Hematologic Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05475925 A Study of DR-01 in Subjects With Large Granular Lymphocytic Leukemia or Cytotoxic Lymphomas No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04365036 A Multicenter, Phase 3, Randomized Trial of Sequencial Chemoradiotherapy with or Without Toripalimab (PD-1 Antibody) in Newly Diagnosed Early-Stage Extranodal Natural Killer/T Cell Lymphoma, Nasal Type (ENKTL) 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-NK-T-NASAL-BIOMARK-V1 | version: 1 | generated: 2026-05-12T18:41:26.561359+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.