Patient
VERIFIED-WM-L2-WM_2L_VRD · Algorithm: ALGO-WM-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. |
Primary current-line option
- Indication
- IND-WM-2L-VRD
- Regimen
- Bortezomib + Rituximab + Dexamethasone (BDR) × 6-8 cycles — chemo-free alternative for r/r WM (incl CXCR4-WHIM-mutated)
- Drugs + NSZU
- Bortezomib (DRUG-BORTEZOMIB) 1.3 mg/m² · SC days 1, 8, 15, 22 of each 35-day cycle (weekly × 4, then 13-day rest) · SC ⚠ NSZU — not for this indication
- Rituximab (DRUG-RITUXIMAB) 375 mg/m² · IV day 1 OR weekly × 4 induction, then maintenance per protocol · IV ⚠ NSZU — not for this indication
- Dexamethasone (DRUG-DEXAMETHASONE) 40 mg · PO/IV days 1, 8, 15, 22 of each 35-day cycle · PO ⚠ NSZU — not for this indication
- Supportive care
- SUP-PJP-PROPHYLAXIS, SUP-HSV-PROPHYLAXIS, SUP-HBV-PROPHYLAXIS
- Hard contraindications
- CI-HBV-NO-PROPHYLAXIS, CI-BORTEZOMIB-SEVERE-NEUROPATHY
- Reason
- Primary current-line option selected by ALGO-WM-2L at step 3; branch-driving red flag: RF-WM-TRANSFORMATION-PROGRESSION.
Other current-line alternatives (2 tracks)
Same treatment line; review when biomarker, access, contraindication, or patient-context assumptions change.
- Indication
- IND-WM-2L-ZANUBRUTINIB
- Regimen
- Zanubrutinib monotherapy continuous for r/r WM (ASPEN schedule) — alternative to ibrutinib
- Drugs + NSZU
- Zanubrutinib (DRUG-ZANUBRUTINIB) 160 mg PO BID OR 320 mg PO once daily · Continuous until progression or unacceptable toxicity · PO ✓ NSZU covered
- Reason
- Current-line alternative presented for HCP consideration
- Indication
- IND-WM-2L-CARFILZOMIB-CXCR4MUT
- Regimen
- Carfilzomib + Rituximab + Dexamethasone (CaRD) × 6 cycles — for CXCR4-WHIM-mutated WM (BTKi-resistant subset)
- Drugs + NSZU
- Carfilzomib (DRUG-CARFILZOMIB) 20 mg/m² days 1+2 of cycle 1, then 36 mg/m² days 1, 2, 8, 9, 15, 16 of subsequent cycles · IV days 1+2, 8+9, 15+16 of each 28-day cycle × 6 · IV ⚠ NSZU — not for this indication
- Rituximab (DRUG-RITUXIMAB) 375 mg/m² · IV day 2 of each cycle · IV ⚠ NSZU — not for this indication
- Dexamethasone (DRUG-DEXAMETHASONE) 20 mg · IV/PO before carfilzomib doses (premed + therapeutic) · PO ⚠ NSZU — not for this indication
- Supportive care
- SUP-PJP-PROPHYLAXIS, SUP-HSV-PROPHYLAXIS, SUP-HBV-PROPHYLAXIS
- Hard contraindications
- CI-HBV-NO-PROPHYLAXIS, CI-LVEF-LOW-FOR-ANTHRACYCLINE
- Reason
- Current-line alternative presented for HCP consideration
Why this branch was chosen
Triggers from the patient profile that fired and drove the chosen branch.
Step 3 → branch IND-WM-2L-VRD
- RF-WM-TRANSFORMATION-PROGRESSION ★ winner: Waldenström with clinical / biochemical features concerning for transformation to DLBCL: rapid LDH rise, asymmetric / rapidly enlarging nodal or extranodal mass, PET-CT SUVmax >10 (WM rarely PET-avid; high SUV concerning), B-symptoms in previously asymptomatic patient, or hypercalcemia. Mandates urgent excisional biopsy of PET-avid lesion.
SRC-NCCN-BCELL-2025SRC-ESMO-WM-2024
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-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-LFT | Liver Function Tests (ALT, AST, bilirubin, ALP, GGT, albumin) | Critical | lab | — | all tracks |
| TEST-PREGNANCY | Beta-HCG | Critical | lab | — | standard |
| TEST-SPEP-UPEP | SPEP / UPEP with IFE | Critical | lab | — | all tracks |
| TEST-ECHO | Echocardiography | Standard | imaging | — | all tracks |
| TEST-IMMUNOGLOBULINS | Quantitative Immunoglobulins | Standard | lab | — | all tracks |
| TEST-NGS-LYMPHOID-PANEL | Lymphoid NGS Panel | Desired | genomic | CSD Lab ✓ (code TBC) | all tracks |
Red flags — PRO / CONTRA aggressive
PRO-AGGRESSIVE
Triggers that push toward the aggressive track
- AITL with autoimmune hemolytic anemia (AIHA, DAT+) and/or immune thrombocytopenia (ITP) — paraneoplastic phenomenon needing concurrent immunosuppression alongside T-cell-directed therapy
AITL is the T-cell lymphoma most associated with autoimmune cytopenias — AIHA (warm IgG-mediated, DAT+) and ITP can present before, during, or after lymphoma therapy. Standard approach: prednisone-containing chemo (CHOEP/CHP-Bv backbone…
RF-AITL-AUTOIMMUNE-CYTOPENIASRC-NCCN-BCELL-2025SRC-ESMO-PTCL-2024 - CXCR4 WHIM-like nonsense or frameshift mutation in the C-terminal regulatory domain (e.g., S338X, R334X) in Waldenström macroglobulinemia (WM). CXCR4 WHIM-like mutations co-occur with MYD88 L265P in ~30-40% of MYD88-mutant WM and cause constitutive CXCR4 signaling via loss of the C-terminal regulatory domain. These mutations confer relative resistance to BTK inhibitor (BTKi) monotherapy — lower overall response rate and major-response rate, slower IgM decline kinetics compared to CXCR4-WT MYD88-mutant WM (Treon NEJM 2015; Castillo Blood 2020).
Fires to route ALGO-WM-2L step 1 to carfilzomib-based therapy (IND-WM-2L-CARFILZOMIB-CXCR4MUT) rather than zanubrutinib BTKi monotherapy (IND-WM-2L-ZANUBRUTINIB), as BTKi efficacy is substantially attenuated in CXCR4-mutated WM.
Detection: CXCR4 C-terminal sequencing by targeted PCR + Sanger or NGS panel with CXCR4 C-terminus coverage. Note: standard NGS panels frequently omit CXCR4 C-terminus; dedicated assay required. Bone marrow aspirate with CD138+ enrichment preferred for adequate WM clone representation.
CXCR4 mutation testing is recommended at WM diagnosis per NCCN B-Cell Lymphomas 2025 (alongside MYD88 L265P) to guide initial therapy selection. In CXCR4-mutated patients, BTKi monotherapy response is attenuated; proteasome-inhibitor-based regimens or BR are preferred 1L per NCCN/ESMO. In 2L, carfilzomib-based regimens offer benefit in BTKi-refractory or BTKi-intolerant CXCR4-mutated WM.
W5c RF authoring. Converts free-text `{condition: "CXCR4-WHIM mutation positive"}` in ALGO-WM-2L step 1 into a formal RF entity. Step 1 is a partial gate: the RF covers the CXCR4-mutation branch; the second branch ("bortezomib-intolerant…
RF-WM-CXCR4-WHIM-MUTANTSRC-NCCN-BCELL-2025SRC-ESMO-WM-2024 - Waldenström with symptomatic hyperviscosity syndrome (serum viscosity >4 cp typical, or symptomatic at any level): blurred vision, headache, retinal hemorrhage, mucosal bleeding, neurologic dysfunction
Hyperviscosity is medical emergency requiring plasmapheresis BEFORE any cytotoxic therapy (rituximab can cause IgM "flare" worsening hyperviscosity). Direction "hold" — does NOT shift regimen, but imposes plasmapheresis prerequisite…
RF-WM-HYPERVISCOSITYSRC-NCCN-BCELL-2025SRC-ESMO-WM-2024
CONTRA-AGGRESSIVE
Hard contraindications to escalation
- Active or latent HBV without antiviral prophylaxis is an absolute contraindication to starting B-cell-depleting / immunomodulatory monoclonal antibody therapy (anti-CD20, anti-CD30 ADC, anti-CD38). Severe HBV reactivation hepatitis risk including fulminant hepatic failure.CI-HBV-NO-PROPHYLAXIS
- Pre-treatment LVEF <50% is an absolute contraindication to anthracycline-containing regimens (R-CHOP, Pola-R-CHP, ABVD, BV-AVD, etc.). Cardiotoxicity from doxorubicin is dose-cumulative and often irreversible; starting with already-impaired function risks acute decompensation.CI-LVEF-LOW-FOR-ANTHRACYCLINE
What NOT to do
Explicit prohibitive rules, each grounded in a regimen / supportive care / contraindication entity
Standard plan (IND-WM-2L-VRD)
- Do not start BDR without HBV screening + entecavir prophylaxis if HBsAg+ or anti-HBc+.
- Do not prescribe rituximab with symptomatic hyperviscosity without plasmapheresis first — IgM flare risk.
- Do not use bortezomib with pre-existing Grade ≥2 peripheral neuropathy — absolute CI; switch to carfilzomib (CaRD).
- Do not use twice-weekly IV bortezomib — weekly SC substantially reduces peripheral neuropathy.
- Do not skip acyclovir HSV/VZV prophylaxis throughout proteasome inhibitor therapy.
- Do not skip dexamethasone dose reduction to 20 mg if age >75 or frail — steroid toxicity (infection, hyperglycemia, falls).
- Do not forget PJP prophylaxis throughout ≥6 months after last anti-CD20 dose.
- Do not ignore new peripheral neuropathy — reduce bortezomib or switch to CaRD if Grade ≥3 or painful.
Standard plan (IND-WM-2L-ZANUBRUTINIB)
- Do NOT prescribe in MYD88-WT WM (rare) — BTKi not active; chemoimmuno (DRC, BDR) preferred.
- Do NOT skip CXCR4 sequencing — WHIM-mutated subset (~30%) has weaker depth of response; consider proteasome-inhibitor alternative.
- Do NOT prescribe rituximab with symptomatic hyperviscosity without plasmapheresis first — rituximab causes IgM flare in subset.
- Do NOT combine with warfarin without strict monitoring — bleeding risk.
- Do NOT prescribe with concomitant strong CYP3A4 inhibitor without dose reduction to 80 mg PO BID.
- Do NOT skip baseline ECG — afib reduced but possible.
- Do NOT skip baseline LFTs — Child-Pugh C avoid; severe impairment dose-reduce.
Aggressive plan (IND-WM-2L-CARFILZOMIB-CXCR4MUT)
- Do not prescribe without CXCR4 status check — drug particularly justified for WHIM-mutated subset (informational stratification).
- Do not skip baseline ECHO + LVEF assessment — carfilzomib cardiotoxicity signal substantial.
- Do not ignore new dyspnea / chest pain / hypertension >180/110 — cardiology consult immediately.
- Do not skip pre-carfilzomib hydration (NS 250-500 mL IV) — TLS + cardiac protection.
- Do not start without HBV screening + entecavir prophylaxis.
- Do not prescribe rituximab with symptomatic hyperviscosity without plasmapheresis first.
- Do not skip acyclovir HSV/VZV prophylaxis throughout proteasome inhibitor therapy.
- Do not ignore TLS prophylaxis cycle 1 in high-burden disease.
- Do not forget off-label disclosure — carfilzomib registered for r/r MM; WM off-label.
Monitoring schedule
Monitoring schedule by treatment phase
Standard plan · MON-CLL-BTKI
| Phase | Window | Tests | Checkpoints |
|---|
| Baseline | Within 2 weeks before start | TEST-CBC, TEST-CMP, TEST-LFT, TEST-LDH, TEST-B2-MICROGLOBULIN, TEST-FISH-PANEL, TEST-NGS-LYMPHOID-PANEL, TEST-IMMUNOGLOBULINS, TEST-HBV-SEROLOGY, TEST-HCV-ANTIBODY, TEST-HIV-SEROLOGY, TEST-CECT-CAP, TEST-ECHO | - Confirm CLL diagnosis: CD19+ CD5+ CD23+ flow on PB ≥5K monoclonal B-cells
- Risk stratification: del(17p), TP53, IGHV mutational status, karyotype
- iwCLL treatment indication documented (if asymptomatic — defer to surveillance)
- Cardiac baseline (atrial fibrillation history, hypertension control)
- HBV status + entecavir prophylaxis if HBsAg+ or anti-HBc+ (anti-CD20 in VenO regimen)
|
| On treatment (BTKi) | Monthly × 3 months, then every 3 months | TEST-CBC, TEST-CMP, TEST-LFT | - ALC trend (lymphocytosis early on BTKi is expected — not progression)
- Bleeding events; major bleed → hold BTKi
- AF symptoms → ECG; if AF → cardiology + anticoagulation strategy
|
| On treatment (venetoclax) | Per CLL14 schedule during 12-month VenO course | TEST-CBC, TEST-CMP, TEST-LFT, TEST-URIC-ACID | - TLS labs (K+, phosphate, calcium, uric acid, creatinine) per ramp-up schedule
- ANC + platelets pre each obinutuzumab dose
- Infusion reactions to obinutuzumab (especially first dose)
|
| Response assessment | After cycle 6 (VenO) or every 6 months on BTKi | TEST-CBC, TEST-CECT-CAP, TEST-FLOW-CYTOMETRY | - iwCLL response criteria (CR, PR, PR-L on BTKi, SD, PD)
- MRD assessment by flow on PB at end of VenO 12-month course
|
| Follow-up | Every 3-6 months after treatment / continuously on BTKi | TEST-CBC, TEST-CMP, TEST-LFT | - Surveillance for relapse (median PFS years for both regimens)
- Watch for Richter transformation (rapid LDH rise, new B-symptoms, isolated mass) — re-biopsy
- Second primary malignancy screening
|
Timeline
Treatment timeline — derived from regimen + monitoring schedule
Standard plan
Induction · Bortezomib + Rituximab + Dexamethasone (BDR) × 6-8 cycles — chemo-free alternative for r/r WM (incl CXCR4-WHIM-mutated)
35-day cycles × 6-8 cycles induction; rituximab maintenance optional based on response/depth
Standard plan
Baseline
Within 2 weeks before start
Induction · Zanubrutinib monotherapy continuous for r/r WM (ASPEN schedule) — alternative to ibrutinib
28-day cycles × Continuous
Response assessment
After cycle 6 (VenO) or every 6 months on BTKi
Follow-up
Every 3-6 months after treatment / continuously on BTKi
Aggressive plan
Induction · Carfilzomib + Rituximab + Dexamethasone (CaRD) × 6 cycles — for CXCR4-WHIM-mutated WM (BTKi-resistant subset)
28-day cycles × 6 cycles induction; rituximab maintenance optional based on response
MDT brief
Discussion questions (5, 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
OQ-BIOMARKER-CXCR4-WHIM
What is the status of CXCR4 WHIM-like mutation (BIO-CXCR4-WHIM)? It is required by track(s): IND-WM-2L-CARFILZOMIB-CXCR4MUT. Expected value: positive (WHIM-mutated) preferred — BTKi response weaker; OR bortezomib-intolerant patient with neuropathy.
A treatment-track biomarker requirement is missing from the patient profile; the MDT should verify the test result, method, specimen, and date before relying on this option.
→ molecular_geneticist
OQ-BIOMARKER-MYD88-L265P
What is the status of MYD88 L265P mutation (BIO-MYD88-L265P)? It is required by track(s): IND-WM-2L-ZANUBRUTINIB. Expected value: positive.
A treatment-track biomarker requirement is missing from the patient profile; the MDT should verify the test result, method, specimen, and date before relying on this option.
→ molecular_geneticist
MDT talk tree (6 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 | molecular_geneticist | Biomarker status | What is the status of CXCR4 WHIM-like mutation (BIO-CXCR4-WHIM)? It is required by track(s): IND-WM-2L-CARFILZOMIB-CXCR4MUT. Expected value: positive (WHIM-mutated) preferred — BTKi response weaker; OR bortezomib-intolerant patient with neuropathy. |
| 4 | molecular_geneticist | Biomarker status | What is the status of MYD88 L265P mutation (BIO-MYD88-L265P)? It is required by track(s): IND-WM-2L-ZANUBRUTINIB. Expected value: positive. |
| 5 | radiologist | Staging / disease burden | Has complete staging been done (Lugano + PET/CT or CT)? |
| 6 | clinical_pharmacist | Specialist review | Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication. |
Skills (required) — mandatory virtual specialists (1)
Skills (recommended) — for consideration (3)
- Clinical pharmacist recommended
Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.
- Molecular geneticist / molecular oncologist recommended
Indication references an actionable genomic biomarker — mutation / target / actionability interpretation needed.
Owns: OQ-BIOMARKER-CXCR4-WHIM, OQ-BIOMARKER-MYD88-L265P
- 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: 0/2 known (0%), 2 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-WM-CXCR4-WHIM-MUTANT, RF-WM-FRAILTY-AGE, RF-WM-HIGH-RISK-BIOLOGY, RF-WM-HYPERVISCOSITY, RF-WM-INFECTION-SCREENING, RF-WM-MYD88-L265P-ACTIONABLE, RF-WM-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. | - |
| Missing biomarker | Label | MDT owner | Default track | Required by | Next action |
|---|
BIO-CXCR4-WHIM | CXCR4 WHIM-like mutation | molecular_geneticist | no | IND-WM-2L-CARFILZOMIB-CXCR4MUT | Verify result, method, specimen, and report date before sign-off. Expected/constraint: positive (WHIM-mutated) preferred — BTKi response weaker; OR bortezomib-intolerant patient with neuropathy |
BIO-MYD88-L265P | MYD88 L265P mutation | molecular_geneticist | no | IND-WM-2L-ZANUBRUTINIB | Verify result, method, specimen, and report date before sign-off. Expected/constraint: positive |
Technical MDT skill metadata (4/16 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-WM-2024: ESMO Clinical Practice Guideline on Waldenström Macroglobulinaemia (2024)
- 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: 2026-07-15.
| NCT | Title | Phase | Status | Sponsor | UA | Signals | Eligibility (excerpt) |
|---|
| NCT06561347 | Zanubrutinib, Bendamustine, Rituximab Prev. Untreated WM | PHASE2 | RECRUITING | — | Surrogate endpoint only Single country | |
| NCT07249905 | Dose Escalation and Dose Expansion Study of MDX2003 in Patients With Different Types of Lymphoma | PHASE1 / PHASE2 | RECRUITING | — | Single country | |
| NCT07169331 | A Study to Evaluate the Efficacy and Safety of Zanubrutinib in Chinese Adults With Treatment-Naive Waldenström Macroglobulinemia | PHASE4 | RECRUITING | — | Small N (<50) Single country | |
| NCT05294731 | Treatment of Chinese Participants With B-Cell Malignancies With BGB-16673, a Bruton Tyrosine Kinase-Targeted Protein-Degrader | PHASE1 / PHASE2 | RECRUITING | — | Surrogate endpoint only Single country | |
| NCT05006716 | A Dose-Escalation and Expansion Study of BGB-16673 in Participants With B-Cell Malignancies | PHASE1 / PHASE2 | RECRUITING | — | Surrogate endpoint only | |
| NCT06986174 | A Phase 2 Study to Evaluate the Safety and Efficacy of Pacritinib in Relapsed or Refractory Waldenström Macroglobulinemia | PHASE2 | RECRUITING | — | Small N (<50) Surrogate endpoint only Single country | |
| NCT04893564 | Prognostic Value of Circulating Tumoral DNA After the First 6 Months of Treatment in Patients With Waldenström Macroglobulinemia | NA | RECRUITING | — | Surrogate endpoint only Single country | |
| NCT05640102 | Observational Study Evaluating the Efficacy and Safety of Zanubrutinib in Participants With Waldenström Macroglobulinemia | N/A | RECRUITING | — | Surrogate endpoint only | |
| NCT05780034 | A Study of AC676 for the Treatment of Relapsed/Refractory B-Cell Malignancies | PHASE1 | RECRUITING | — | Phase 1 only Single country | |
| NCT04898647 | Clinical Study of the Hyperviscosity Syndrome in Waldenström Macroglobulinemia | NA | RECRUITING | — | 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 |
|---|
| Standard plan Bortezomib + Rituximab + Dexamethasone (BDR) × 6-8 cycles — chemo-free alternative for r/r WM (incl CXCR4-WHIM-mutated) (REG-VRD-WM) | ✓ registered | ✓ covered | ₴-? — verify pathway | NSZU formulary |
| Standard plan Zanubrutinib monotherapy continuous for r/r WM (ASPEN schedule) — alternative to ibrutinib (REG-ZANUBRUTINIB-WM-RELAPSED) | ✓ registered | ✓ covered | ₴-? — verify pathway | NSZU formulary |
| Aggressive plan Carfilzomib + Rituximab + Dexamethasone (CaRD) × 6 cycles — for CXCR4-WHIM-mutated WM (BTKi-resistant subset) (REG-CARFILZOMIB-WM) | ✓ registered | ✓ covered | ₴-? — verify pathway | NSZU formulary |
| Trial · NCT06561347 Zanubrutinib, Bendamustine, Rituximab Prev. Untreated WM No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT07249905 Dose Escalation and Dose Expansion Study of MDX2003 in Patients With Different Types of Lymphoma No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT07169331 A Study to Evaluate the Efficacy and Safety of Zanubrutinib in Chinese Adults With Treatment-Naive Waldenström Macroglobulinemia No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT05294731 Treatment of Chinese Participants With B-Cell Malignancies With BGB-16673, a Bruton Tyrosine Kinase-Targeted Protein-Degrader No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT05006716 A Dose-Escalation and Expansion Study of BGB-16673 in Participants With B-Cell Malignancies No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT06986174 A Phase 2 Study to Evaluate the Safety and Efficacy of Pacritinib in Relapsed or Refractory Waldenström Macroglobulinemia No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT04893564 Prognostic Value of Circulating Tumoral DNA After the First 6 Months of Treatment in Patients With Waldenström Macroglobulinemia No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT05640102 Observational Study Evaluating the Efficacy and Safety of Zanubrutinib in Participants With Waldenström Macroglobulinemia No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT05780034 A Study of AC676 for the Treatment of Relapsed/Refractory B-Cell Malignancies No UA site listed — international referral required | — unknown | — unknown | self-pay: ₴0/course | Trial sponsor |
| Trial · NCT04898647 Clinical Study of the Hyperviscosity Syndrome in Waldenström Macroglobulinemia 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: 2026-07-15.