OpenOnco · Treatment Plan

Treatment plan — T-Lymphoblastic Leukemia/Lymphoma

PLAN-VAR-T-ALL-RELAPSED-V1 · v1 · 2026-06-27

Patient

VAR-T-ALL-RELAPSED · Algorithm: ALGO-T-ALL-2L

DiagnosisT-Lymphoblastic Leukemia/Lymphoma

MOH / ICD-10C91.0

ICD-O-39837/3

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

Standard plan

★ DEFAULT

Indication

IND-T-ALL-2L-NELARABINE

Regimen

Nelarabine monotherapy for r/r T-ALL/T-LBL (adult dosing)

Drugs + NSZU

Nelarabine (DRUG-NELARABINE) 1500 mg/m² · IV 2-hour infusion days 1, 3, 5 every 21 days; up to 2 cycles induction, then evaluate · IV ✗ Not registered in UA

Supportive care

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

Reason

Primary current-line option selected by ALGO-T-ALL-2L at step 1.

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-CECT-CAP	CECT chest/abdomen/pelvis	Critical	imaging	—	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-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-RENAL-FUNCTION-EGFR	Renal function with eGFR	Critical	lab	—	all tracks
TEST-CSF-CYTOLOGY-FLOW	CSF cytology + flow cytometry	Standard	pathology	CSD Lab ✓ (code TBC)	all tracks
TEST-ECHO	Echocardiography	Standard	imaging	—	all tracks
TEST-PET-CT	FDG PET/CT (whole body)	Standard	imaging	—	all tracks
TEST-URIC-ACID	Serum Uric Acid	Standard	lab	—	all tracks
TEST-NGS-LYMPHOID-PANEL	Lymphoid NGS Panel	Desired	genomic	CSD Lab ✓ (code TBC)	desired (standard)

What NOT to do

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

Standard plan (IND-T-ALL-2L-NELARABINE)

Do NOT continue with Grade ≥2 neurologic event — neurotoxicity may be irreversible (Guillain-Barré-like).
Do NOT combine with pentostatin — additive neurotoxicity.
Do NOT give concurrent intrathecal chemotherapy in the same week — additive CNS toxicity.
Do NOT skimp on donor search in parallel — alloSCT — the only curative option.
Do NOT skip TLS prophylaxis in hyperleukocytosis.
Do NOT skip baseline neurologic exam — necessary for interpretation of neurotoxicity.
Do NOT give full dose at CrCl <50 — reduce 25-50%, close monitoring.
Do NOT forget about PJP prophylaxis.

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Nelarabine monotherapy for r/r T-ALL/T-LBL (adult dosing)

21-day cycles × Up to 2 induction cycles then bridge to alloSCT in fit responders; longer in palliative setting

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-T-ALL-CNS-LEUKEMIA, RF-T-ALL-EMERGENCY-TLS-LEUKOSTASIS, RF-T-ALL-FRAILTY-AGE, RF-T-ALL-HIGH-RISK-BIOLOGY, RF-T-ALL-MEDIASTINAL-AIRWAY, RF-T-ALL-ORGAN-DYSFUNCTION, RF-T-ALL-TRANSFORMATION-PROGRESSION

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-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: 2026-06-27.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT07502118	NexCAR19 (Talikabtagene Autoleucel) in Relapsed/Refractory B-Cell Malignancies (NexCAR19)	PHASE2 / PHASE3	RECRUITING	Health Institutes of Turkey	—	Small N (<50) Surrogate endpoint only Single country
NCT04532268	A Study of Humanized CD19 CAR-T Cells Therapy for Patients With Relapsed and/or Refractory B-cell ALL and B-cell NHL	EARLY_PHASE1	RECRUITING	Zhejiang University	—	Single country
NCT07070323	A Multicenter, Open-Label, Non-Randomized, Single-Arm Clinical Study of Nanobody CD5-CAR T Cell Therapy for Refractory/Relapsed T Lymphocyte Malignancies	PHASE1 / PHASE2	RECRUITING	Beijing GoBroad Hospital	—	Single country
NCT04195633	Donor Stem Cell Transplant With Treosulfan, Fludarabine, and Total-Body Irradiation for the Treatment of Hematological Malignancies	PHASE2	RECRUITING	Fred Hutchinson Cancer Center	—	Single country
NCT04544592	UCD19 CarT in Treatment of Pediatric B-ALL and B-NHL	PHASE1 / PHASE2	RECRUITING	University of Colorado, Denver	—	Small N (<50) Single country
NCT06866873	CD-19 CAR-T Cell for Pediatric ALL or Lymphoma	NA	RECRUITING	Hong Kong Children's Hospital	—	Small N (<50) Surrogate endpoint only Single country
NCT06874946	Nanobody-Based Anti-CD5 CAR-T for Relapsed/Refractory T-ALL/NHL	PHASE1 / PHASE2	RECRUITING	Peking University People's Hospital	—	Small N (<50) Surrogate endpoint only Single country
NCT05620680	CD7 CAR-T Cells in T-cell Lymphoma/Leukemia	NA	RECRUITING	Shenzhen University General Hospital	—	Small N (<50) Single country
NCT04972942	Targeted Immunotherapy After Myeloablative TBI-Based Conditioning & AlloHCT in CAYA With High Risk T-Cell ALL & Lymphoma	PHASE1	RECRUITING	New York Medical College	—	Phase 1 only Small N (<50) Single country
NCT06350994	Early Assessment of Cardiac Function After Treatment With CAR-T Cells	N/A	RECRUITING	Assistance Publique - Hôpitaux de Paris	—	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 Nelarabine monotherapy for r/r T-ALL/T-LBL (adult dosing) (REG-NELARABINE-TCELL) 1/1 component drug(s) not registered in Ukraine +1	✗ not registered	✗ out-of-pocket	₴-? — verify pathway	not recorded
Trial · NCT07502118 NexCAR19 (Talikabtagene Autoleucel) in Relapsed/Refractory B-Cell Malignancies (NexCAR19) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04532268 A Study of Humanized CD19 CAR-T Cells Therapy for Patients With Relapsed and/or Refractory B-cell ALL and B-cell NHL No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07070323 A Multicenter, Open-Label, Non-Randomized, Single-Arm Clinical Study of Nanobody CD5-CAR T Cell Therapy for Refractory/Relapsed T Lymphocyte Malignancies No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04195633 Donor Stem Cell Transplant With Treosulfan, Fludarabine, and Total-Body Irradiation for the Treatment of Hematological Malignancies No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04544592 UCD19 CarT in Treatment of Pediatric B-ALL and B-NHL No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06866873 CD-19 CAR-T Cell for Pediatric ALL or Lymphoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06874946 Nanobody-Based Anti-CD5 CAR-T for Relapsed/Refractory T-ALL/NHL No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05620680 CD7 CAR-T Cells in T-cell Lymphoma/Leukemia No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04972942 Targeted Immunotherapy After Myeloablative TBI-Based Conditioning & AlloHCT in CAYA With High Risk T-Cell ALL & Lymphoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06350994 Early Assessment of Cardiac Function After Treatment With CAR-T Cells 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-T-ALL-RELAPSED-V1 | version: 1 | generated: 2026-06-27T09:41:02.388049+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.