OpenOnco · Treatment Plan

Treatment plan — Primary Myelofibrosis

PLAN-VAR-PMF-RELAPSED-V1 · v1 · 2026-05-13

Patient

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

DiagnosisPrimary Myelofibrosis

MOH / ICD-10D47.4

ICD-O-39961/3; 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-PMF-2L-FEDRATINIB

Regimen

Fedratinib (Inrebic) for ruxolitinib-resistant / intolerant PMF

Drugs + NSZU

Fedratinib (DRUG-FEDRATINIB) 400 mg PO once daily with food · Continuous; cycles of 28 days; until progression / unacceptable toxicity · PO ⚠ Out-of-pocket

Supportive care

SUP-HBV-PROPHYLAXIS

Reason

Primary current-line option selected by ALGO-PMF-2L at step 5.

Other current-line alternatives (1 tracks)

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

Aggressive plan

Indication

IND-PMF-MOMELOTINIB-ANEMIA

Regimen

Momelotinib (Ojjaara) for MF with anemia

Drugs + NSZU

Momelotinib (DRUG-MOMELOTINIB) 200 mg PO once daily (with or without food) · Continuous; cycles of 28 days; until progression / unacceptable toxicity · PO ✗ Not registered in UA

Supportive care

SUP-HBV-PROPHYLAXIS

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-BCR-ABL-JAK2	BCR-ABL + JAK2 + CALR + MPL	Critical	genomic	CSD Lab ✓ (code TBC)	all tracks
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-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-NGS-MYELOID-PANEL	Myeloid NGS Panel	Critical	genomic	CSD Lab ✓ (code TBC)	all tracks
TEST-PERIPHERAL-SMEAR	Peripheral Blood Smear	Critical	lab	CSD Lab ✓ (code TBC)	all tracks
TEST-IRON-PANEL	Iron Panel	Standard	lab	—	all tracks
TEST-RETICULOCYTE	Reticulocyte Count	Standard	lab	—	all tracks

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

PMF with anemia as dominant clinical problem (Hb <10 g/dL OR transfusion-dependent) — momelotinib preferred over ruxolitinib (MOMENTUM trial: spleen + symptom + Hb improvement)RF-PMF-ANEMIA-DOMINANT
PMF patient elderly or frail (age ≥75, ECOG ≥3, or HCT-CI ≥4) — alloHCT off the table; symptom-directed therapy (ruxolitinib for splenomegaly + symptoms, momelotinib for anemia, transfusion + supportive care)RF-PMF-FRAILTY-AGE
PMF patient with organ dysfunction limiting JAK-inhibitor or alloHCT eligibility: severe thrombocytopenia (plt <50K — affects ruxolitinib dose; pacritinib option), severe hepatic dysfunction, or significant cardiac/pulmonary comorbidityRF-PMF-ORGAN-DYSFUNCTION

CONTRA-AGGRESSIVE

Hard contraindications to escalation

What NOT to do

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

Aggressive plan (IND-PMF-2L-FEDRATINIB)

Do NOT initiate without baseline thiamine measurement + correction of deficiency — boxed warning, fatal cases documented.
Do NOT skip prophylactic thiamine 100 mg PO daily throughout therapy.
Do NOT ignore GI symptoms — take with food + active loperamide management; severe diarrhea causes dehydration.
Do NOT combine with strong CYP3A4-inhibitor without dose reduction to 200 mg.
Do NOT continue with Wernicke symptoms (confusion, ataxia, ophthalmoplegia) — discontinue + IV thiamine.
Do NOT forget alloHCT-pathway for transplant-eligible — fedratinib is not curative.
Do NOT confirm plan without funding pathway — drug not registered in Ukraine.

Aggressive plan (IND-PMF-MOMELOTINIB-ANEMIA)

Do NOT prescribe without HBV / HCV / HIV / TB screening — JAKi reactivation risk.
Do NOT combine with ruxolitinib — choose one JAKi.
Do NOT ignore baseline + serial LFT — hepatotoxicity in MOMENTUM.
Do NOT continue without response — assessment at 24 weeks; switch if no symptom + anemia improvement.
Do NOT forget alloHCT-pathway for transplant-eligible — momelotinib is not curative.
Do NOT combine with OATP1B1/1B3 substrates (rosuvastatin) without caution.
Do NOT confirm plan without funding pathway — drug not registered in Ukraine.

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Aggressive plan

Induction · Fedratinib (Inrebic) for ruxolitinib-resistant / intolerant PMF

28-day cycles × Continuous until progression / unacceptable toxicity

Aggressive plan

Induction · Momelotinib (Ojjaara) for MF with anemia

28-day cycles × Continuous until progression / unacceptable toxicity

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 (3 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.
3	social_worker_case_manager	Specialist review	Plan includes drugs without NSZU reimbursement — patient access pathway must be assessed.

Skills (recommended) — for consideration (2)

Clinical pharmacist recommended
Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.
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-DIPSS-PLUS-HIGH, RF-PMF-ANEMIA-DOMINANT, RF-PMF-BLAST-PROGRESSION, RF-PMF-FRAILTY-AGE, RF-PMF-HIGH-RISK-DIPSS, RF-PMF-INFECTION-SCREENING, RF-PMF-ORGAN-DYSFUNCTION

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	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-DIPSS-PLUS-GANGAT-2011: DIPSS plus: a refined Dynamic International Prognostic Scoring System for primary myelofibrosis that incorporates prognostic information from karyotype, platelet count, and transfusion status (2011)
SRC-ESMO-MPN-2015: Philadelphia-negative chronic myeloproliferative neoplasms: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up (2015)
SRC-JAKARTA2-HARRISON-2017: Janus kinase inhibition with fedratinib in patients with myelofibrosis previously treated with ruxolitinib (JAKARTA-2) (2017)
SRC-MOMENTUM-VERSTOVSEK-2023: Momelotinib versus danazol in symptomatic patients with anaemia and myelofibrosis (MOMENTUM): results from an international, double-blind, randomised, controlled, phase 3 study (2023)
SRC-NCCN-MPN-2025: NCCN Clinical Practice Guidelines in Oncology: Myeloproliferative Neoplasms (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: 2026-05-13.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT01137825	Registry of Older Patients With Cancer	N/A	RECRUITING	UNC Lineberger Comprehensive Cancer Center	—	Single country
NCT06834282	CER-1236 in Patients With Acute Myeloid Leukemia (AML), Myelodysplastic Syndrome (MDS), and Myelofibrosis (MF)	PHASE1	RECRUITING	CERo Therapeutics Holdings, Inc.	—	Phase 1 only Small N (<50) Surrogate endpoint only Single country
NCT03964506	Hyperbaric Oxygen Therapy and Allogeneic Peripheral Blood Stem Cell (PBSC) Transplant	EARLY_PHASE1	RECRUITING	Omar Aljitawi	—	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
NCT06770842	Ropeginterferon Alfa 2b Plus Ruxolitinib for Myelofibrosis	PHASE2	RECRUITING	The University of Hong Kong	—	Small N (<50) Single country
NCT06887803	A Study of Roginolisib in Combination With Ruxolitinib in Patients With Myelofibrosis (MF) Who Are Unresponsive to JAK Inhibitors	PHASE1 / PHASE2	RECRUITING	iOnctura	—	Small N (<50)
NCT06378437	A Study of GLB-001 in Patients With Myeloid Malignancies	PHASE1	RECRUITING	Hangzhou GluBio Pharmaceutical Co., Ltd.	—	Phase 1 only Single country
NCT07441694	Study of INCA036978 in Participants With Myeloproliferative Neoplasms	PHASE1	RECRUITING	Incyte Corporation	—	Phase 1 only
NCT03452774	SYNERGY-AI: Artificial Intelligence Based Precision Oncology Clinical Trial Matching and Registry	N/A	RECRUITING	Massive Bio, Inc.	—	—
NCT07104799	Momelotinib During and After HCT in Myelofibrosis	PHASE1	RECRUITING	Massachusetts General Hospital	—	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
Aggressive plan Fedratinib (Inrebic) for ruxolitinib-resistant / intolerant PMF (REG-FEDRATINIB-PMF) 1/1 component drug(s) not on NSZU formulary	✓ registered	✗ out-of-pocket	₴-? — verify pathway	not recorded
Aggressive plan Momelotinib (Ojjaara) for MF with anemia (REG-MOMELOTINIB-PMF) 1/1 component drug(s) not registered in Ukraine +1	✗ not registered	✗ out-of-pocket	₴-? — verify pathway	not recorded
Trial · NCT01137825 Registry of Older Patients With Cancer No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06834282 CER-1236 in Patients With Acute Myeloid Leukemia (AML), Myelodysplastic Syndrome (MDS), and Myelofibrosis (MF) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT03964506 Hyperbaric Oxygen Therapy and Allogeneic Peripheral Blood Stem Cell (PBSC) Transplant 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 · NCT06770842 Ropeginterferon Alfa 2b Plus Ruxolitinib for Myelofibrosis No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06887803 A Study of Roginolisib in Combination With Ruxolitinib in Patients With Myelofibrosis (MF) Who Are Unresponsive to JAK Inhibitors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06378437 A Study of GLB-001 in Patients With Myeloid Malignancies No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07441694 Study of INCA036978 in Participants With Myeloproliferative Neoplasms No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT03452774 SYNERGY-AI: Artificial Intelligence Based Precision Oncology Clinical Trial Matching and Registry No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07104799 Momelotinib During and After HCT in Myelofibrosis 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: 2026-05-13.

plan_id: PLAN-VAR-PMF-RELAPSED-V1 | version: 1 | generated: 2026-05-13T10:01:52.561070+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.