Treatment plan — DIS-CHL

OpenOnco · Treatment Plan

PLAN-AUTO-CHL-001-V1 · v1 · 2026-04-27

Patient

AUTO-CHL-001 · Algorithm: ALGO-CHL-1L

Clinical significance of mutations (ESCAT / OncoKB)

Tumor-board context — the engine does not use these tiers to rank tracks

Biomarker	Variant	ESCAT	OncoKB	Clinical significance	Drugs	Sources
No clinically actionable variants matched in this profile.

Treatment options (2 tracks)

Standard plan

★ DEFAULT

Indication

IND-CHL-1L-ABVD

Regimen

ABVD (Adriamycin + Bleomycin + Vinblastine + Dacarbazine), 2-6 cycles

Drugs + NSZU

Doxorubicin (DRUG-DOXORUBICIN) 25 mg/m² · IV days 1+15 of 28-day cycle · IV ✓ NSZU covered
Bleomycin (DRUG-BLEOMYCIN) 10 units/m² · IV days 1+15 of 28-day cycle · IV ✓ NSZU covered
Vinblastine (DRUG-VINBLASTINE) 6 mg/m² · IV days 1+15 of 28-day cycle · IV ✓ NSZU covered
Dacarbazine (DRUG-DACARBAZINE) 375 mg/m² · IV days 1+15 of 28-day cycle · IV ✓ NSZU covered

Supportive care

SUP-ANTIEMETIC-PREMED

Hard contraindications

CI-LVEF-LOW-FOR-ANTHRACYCLINE

Reason

Engine default per algorithm ALGO-CHL-1L: {'step': 1, 'outcome': False, 'branch': {'result': 'IND-CHL-1L-ABVD'}, 'fired_red_flags': [], 'winner_red_flag': None}

Aggressive plan

Indication

IND-CHL-1L-A-AVD

Regimen

A+AVD (Brentuximab vedotin + Adriamycin + Vinblastine + Dacarbazine), 6 cycles

Drugs + NSZU

Brentuximab vedotin (DRUG-BRENTUXIMAB-VEDOTIN) 1.2 mg/kg · IV days 1+15 of 28-day cycle × 6 · IV ✓ NSZU covered
Doxorubicin (DRUG-DOXORUBICIN) 25 mg/m² · IV days 1+15 of 28-day cycle · IV ✓ NSZU covered
Vinblastine (DRUG-VINBLASTINE) 6 mg/m² · IV days 1+15 of 28-day cycle · IV ✓ NSZU covered
Dacarbazine (DRUG-DACARBAZINE) 375 mg/m² · IV days 1+15 of 28-day cycle · IV ✓ NSZU covered

Supportive care

SUP-ANTIEMETIC-PREMED, SUP-GCSF-NEUTROPENIA

Hard contraindications

CI-LVEF-LOW-FOR-ANTHRACYCLINE, CI-BORTEZOMIB-SEVERE-NEUROPATHY, CI-HBV-NO-PROPHYLAXIS

Reason

Alternative track presented for HCP consideration

Pre-treatment investigations

Investigations before treatment start · critical / standard / desired · merged across tracks

ID	Name	Priority	Category	Needed for
TEST-CBC	Загальний аналіз крові з лейкоцитарною формулою	Critical	lab	all tracks
TEST-CMP	Розширений біохімічний аналіз крові	Critical	lab	all tracks
TEST-HBV-SEROLOGY	Серологія HBV: HBsAg, anti-HBc, anti-HBs	Critical	lab	all tracks
TEST-HIV-SEROLOGY	Серологія ВІЛ (антитіла HIV-1/2 + p24)	Critical	lab	all tracks
TEST-LDH	Лактатдегідрогеназа (ЛДГ)	Critical	lab	all tracks
TEST-LFT	Печінкові проби (АЛТ, АСТ, білірубін, ЛФ, ГГТП, альбумін)	Critical	lab	all tracks
TEST-LN-EXCISIONAL-BIOPSY	Ексцизійна біопсія лімфатичного вузла	Critical	histology	all tracks
TEST-PREGNANCY	β-ХГЛ (тест на вагітність)	Critical	lab	all tracks
TEST-ECHO	Ехокардіографія (ТТЕ) з оцінкою ФВ ЛШ	Standard	imaging	all tracks
TEST-PET-CT	ПЕТ/КТ із 18F-ФДГ	Standard	imaging	all tracks

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

Classical Hodgkin lymphoma stage III-IV (advanced) — selects A+AVD (ECHELON-1) over ABVD if brentuximab accessibleRF-CHL-ADVANCED-STAGE

CONTRA-AGGRESSIVE

Hard contraindications to escalation

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
Severe pre-existing peripheral neuropathy is an absolute contraindication to bortezomib — therapy will likely worsen the neuropathy to a disabling and often permanent extent.CI-BORTEZOMIB-SEVERE-NEUROPATHY
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

What NOT to do

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

Standard plan (IND-CHL-1L-ABVD)

НЕ комбінувати з brentuximab vedotin — ABSOLUTE pulmonary toxicity contraindication.
НЕ використовувати G-CSF на ABVD — підвищує pulmonary toxicity bleomycin.
НЕ продовжувати bleomycin при DLCO drop ≥25% — switch to AVD (drop bleo).
НЕ пропускати baseline LVEF + DLCO + fertility preservation discussion.
НЕ використовувати високопоточний O2 при анестезії після bleomycin (lifetime risk).
НЕ починати без HBV скринінгу + entecavir prophylaxis при HBsAg+ — реактивація на стероїдному пульсі реальна (також actionable при anti-HBc+ — моніторити HBV-DNA q-cycle).
НЕ переривати ART у HIV+ пацієнтів — HIV-HL outcomes approach HIV-negative cHL з концурентним ART; уникати ritonavir-boosted PIs (vincristine interaction); PJP prophylaxis throughout.

Aggressive plan (IND-CHL-1L-A-AVD)

НЕ комбінувати brentuximab з bleomycin — ABSOLUTE; lethality risk.
НЕ пропускати G-CSF support — neutropenia з brentuximab + анти-mitotic вища.
НЕ ігнорувати pre-existing peripheral neuropathy — Grade ≥2 = absolute CI.
НЕ призначати без verifiedного funding pathway — brentuximab не НСЗУ-reimbursed.
НЕ починати brentuximab без HBV скринінгу + entecavir prophylaxis при HBsAg+ або anti-HBc+ — anti-CD30 ADC має документований HBV reactivation risk; продовжувати ≥12 міс після останньої дози BV.
НЕ переривати ART у HIV+ — A+AVD акцептабельний з ART; інтегразний backbone preferred (vincristine-PI interaction); PJP prophylaxis throughout.

Monitoring schedule

Monitoring schedule by treatment phase

Standard plan · MON-R-CHOP-REGIMEN

Phase	Window	Tests	Checkpoints
baseline	Within 2 weeks before cycle 1	TEST-CBC, TEST-CMP, TEST-LFT, TEST-LDH, TEST-B2-MICROGLOBULIN, TEST-HBV-SEROLOGY, TEST-HCV-ANTIBODY, TEST-HIV-SEROLOGY, TEST-PET-CT, TEST-LN-EXCISIONAL-BIOPSY, TEST-FLOW-CYTOMETRY, TEST-CD20-IHC, TEST-ECHO, TEST-PREGNANCY, TEST-BM-ASPIRATE, TEST-BM-TREPHINE	Confirm CD20+ DLBCL histology; rule out double-hit (FISH for MYC/BCL2/BCL6) Confirm HBV status + entecavir prophylaxis plan if HBsAg+ or anti-HBc+ Baseline LVEF ≥50% before doxorubicin IPI calculation documented (age, ECOG, LDH, stage, extranodal sites) CNS-IPI calculation if anatomic risk sites or composite score concerning Fertility preservation discussion (sperm banking / oocyte cryo) for childbearing-age
on_treatment	Day 1 of every 21-day cycle	TEST-CBC, TEST-CMP, TEST-LFT	ANC ≥1500 + platelets ≥100K before each cycle (delay or G-CSF if not) Neuropathy grade documented (CTCAE) — vincristine modification if ≥2 LVEF re-check after cumulative doxorubicin ~300 mg/m²
interim_response_assessment	After cycles 2-4 (interim PET-CT)	TEST-PET-CT, TEST-LDH	Lugano response criteria + Deauville score If Deauville 4-5 with mass progression → consider salvage or trial
end_of_treatment	After cycle 6 (within 6-8 weeks)	TEST-PET-CT, TEST-CBC, TEST-CMP, TEST-LDH	Confirm CR vs PR vs SD vs PD by Lugano/Deauville Begin survivorship plan: cardiac surveillance schedule, vaccination catch-up, second-cancer screening
follow_up_short	Every 3 months × 2 years post-treatment	TEST-CBC, TEST-CMP, TEST-LFT, TEST-LDH	Surveillance for relapse (~40% relapse risk by 2 years overall) HBV reactivation monitoring continues for 12 months post anti-CD20
follow_up_long	Every 6 months years 3-5, then annually	TEST-CBC, TEST-LFT, TEST-ECHO	Late cardiomyopathy screening (LVEF) annually if cumulative dox >300 Annual second-malignancy screening (skin, breast, etc. age-appropriate)

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Baseline

Within 2 weeks before cycle 1

Induction · ABVD (Adriamycin + Bleomycin +

28-day cycles × 2-4 (early-stage + ISRT) OR 6 (advanced); response-adapted per interim PET-CT Deauville

Response assessment

After cycles 2-4 (interim PET-CT)

Follow-up

Every 3 months × 2 years post-treatment

Aggressive plan

Baseline

Within 2 weeks before cycle 1

Induction · A+AVD (Brentuximab vedotin + A

28-day cycles × 6

Response assessment

After cycles 2-4 (interim PET-CT)

Follow-up

Every 3 months × 2 years post-treatment

MDT brief

Skills (required) — mandatory virtual specialists (1)

Гематолог / онкогематолог required
Лімфомний діагноз — провідна спеціальність для терапевтичного ведення.
Owns: OQ-LDH-CURRENT
skill: hematologistv0.1.0reviewed 2026-04-25STUBsign-offs: 0lead: TBD

Skills (recommended) — for consideration (2)

Клінічний фармацевт recommended
Хіміоімунотерапевтичний схема — drug-drug interactions, dose adjustments, premedication.
skill: clinical_pharmacistv0.1.0reviewed 2026-04-25STUBsign-offs: 0lead: TBD
Патолог (загальний) recommended
Підтвердження гістології лімфоми + оцінка ризику трансформації (DLBCL/Richter).
Owns: OQ-CD20-CONFIRMATION
skill: pathologistv0.1.0reviewed 2026-04-25STUBsign-offs: 0lead: TBD

Open questions (3, 1 blocking)

BLOCKING OQ-CD20-CONFIRMATION
Чи підтверджено CD20+ статус гістологією (IHC)? Без CD20+ rituximab/obinutuzumab не показані.
Anti-CD20 терапія — основа для більшості ліній; відсутність експресії CD20 повністю змінює regimen.
→ pathologist
OQ-STAGING-COMPLETE
Чи виконано повне стадіювання (Lugano + PET/CT або CT)?
Прогноз і вибір треку залежать від stage та tumor burden.
→ radiologist
OQ-LDH-CURRENT
Який актуальний LDH? Маркер пухлинного навантаження і трансформації.
LDH входить у прогностичні індекси індолентних лімфом.
→ hematologist

Data quality

Missing critical: cd20_ihc_status, lugano_stage
Missing recommended: ldh_ratio_to_uln, fib4_index, pet_ct_date
Unevaluated RedFlags: RF-CHL-ADVANCED-STAGE, RF-CHL-FRAILTY-AGE, RF-CHL-INFECTION-SCREENING, RF-CHL-ORGAN-DYSFUNCTION, RF-CHL-TRANSFORMATION-PROGRESSION

Skill catalog (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
Specialist з клітинної терапії (CAR-T)	`cellular_therapy_specialist`	v0.1.0	2026-04-25	cellular_therapy
Клінічний фармацевт	`clinical_pharmacist`	v0.1.0	2026-04-25	clinical_pharmacy
Гематолог / онкогематолог	`hematologist`	v0.1.0	2026-04-25	hematology_oncology
Гематопатолог (специфічно для лімфом / лейкозів / мієломи)	`hematopathologist`	v0.1.0	2026-04-25	hematopathology
Інфекціоніст / гепатолог	`infectious_disease_hepatology`	v0.1.0	2026-04-25	infectious_diseases
Медичний онколог (хіміотерапевт солідних пухлин)	`medical_oncologist`	v0.1.0	2026-04-25	solid_oncology
Молекулярний генетик / молекулярний онколог	`molecular_geneticist`	v0.1.0	2026-04-25	molecular_oncology
Паліативна допомога	`palliative_care`	v0.1.0	2026-04-25	palliative_care
Патолог (загальний)	`pathologist`	v0.1.0	2026-04-25	pathology
Сімейний лікар / терапевт	`primary_care`	v0.1.0	2026-04-25	primary_care
Психолог / онкопсихолог	`psychologist`	v0.1.0	2026-04-25	psychosocial
Радіотерапевт (променева терапія)	`radiation_oncologist`	v0.1.0	2026-04-25	radiation_oncology
Лікар-радіолог	`radiologist`	v0.1.0	2026-04-25	diagnostic_imaging
Соціальний працівник / кейс-менеджер	`social_worker_case_manager`	v0.1.0	2026-04-25	psychosocial
Хірург-онколог	`surgical_oncologist`	v0.1.0	2026-04-25	surgical_oncology
Specialist з трансплантації (BMT)	`transplant_specialist`	v0.1.0	2026-04-25	cellular_therapy

Sources cited

SRC-ECHELON-1-CONNORS-2018: Brentuximab Vedotin with Chemotherapy for Stage III or IV Hodgkin's Lymphoma (2018)
SRC-NCCN-BCELL-2025: NCCN Clinical Practice Guidelines in Oncology: B-Cell Lymphomas (v.2.2025)

Експериментальні опції (клінічні дослідження)

Третій трек плану — open-enrollment trials з ClinicalTrials.gov. Останнє оновлення: 2026-04-26. Render-time metadata; engine selection не змінюється цим блоком (CHARTER §8.3).

NCT	Name	Phase	Статус	Спонсор	UA
NCT06377540	MT2022-60: Ph 2 Study of Pembro+ BEAM With ASCT for Relapsed Hodgkin Lymphoma	PHASE2	RECRUITING	Masonic Cancer Center, University of Minnesota	—
NCT05362773	A Study of MGD024 in Patients With Relapsed or Refractory Hematologic Malignancies	PHASE1	RECRUITING	MacroGenics	—
NCT04561206	Brentuximab Vedotin and Nivolumab for the Treatment of Patients With Relapsed/Refractory Classical Hodgkin Lymphoma	PHASE2	RECRUITING	City of Hope Medical Center	—
NCT02797717	Treatment for Classical Hodgkin Lymphoma in Children and Adolescents	NA	RECRUITING	GALIA AVRAHAMI	—
NCT05900765	A Study of Zimberelimab(GLS-010) Combined With AVD for Newly Diagnosed Early-stage Hodgkin's Lymphoma	PHASE2	RECRUITING	Sun Yat-sen University	—
NCT06984146	Nivo40-AVD for Advanced Classic Hodgkin Lymphoma	PHASE2	RECRUITING	National Medical Research Radiological Centre of the Ministry of Health of Russia	—
NCT04378647	BREntuximab Vedotin in SEcond LIne Therapy BEfore Transplant	PHASE2	RECRUITING	Grupo Español de Linfomas y Transplante Autólogo de Médula Ósea	—
NCT04288726	Allogeneic CD30.CAR-EBVSTs in Patients With Relapsed or Refractory CD30-Positive Lymphomas	PHASE1	RECRUITING	Baylor College of Medicine	—
NCT05404945	Fitness-adapted, Pembrolizumab-based Therapy for Untreated Classical Hodgkin Lymphoma Patients 60 Years of Age and Above	PHASE2	RECRUITING	University of Virginia	—
NCT06563245	Brentuximab Vedotin for Newly Diagnosed cHL in Chinese CAYA Based on PET/CT Assessment	PHASE2 / PHASE3	RECRUITING	Children's Cancer Group, China	—

Перевіряти статус набору безпосередньо у дослідницькому центрі. Дані ctgov можуть відставати від поточного статусу UA-сайтів.

Доступність опцій в Україні

Per-track UA registration · НСЗУ · cost · access pathway. Render-time metadata; engine selection не залежить від цих полів (CHARTER §8.3).

Опція	Реєстрація UA	НСЗУ	Cost orientation	Access pathway
Standard plan ABVD (Adriamycin + Bleomycin + Vinblastine + Dacarbazine), 2-6 cycles (REG-ABVD)	✓ зареєстровано	✓ покривається	₴-? — verify pathway	НСЗУ formulary
Aggressive plan A+AVD (Brentuximab vedotin + Adriamycin + Vinblastine + Dacarbazine), 6 cycles (REG-A-AVD)	✓ зареєстровано	✓ покривається	₴-? — verify pathway	НСЗУ formulary
Trial · NCT06377540 MT2022-60: Ph 2 Study of Pembro+ BEAM With ASCT for Relapsed Hodgkin Lymphoma No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT05362773 A Study of MGD024 in Patients With Relapsed or Refractory Hematologic Malignancies No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT04561206 Brentuximab Vedotin and Nivolumab for the Treatment of Patients With Relapsed/Refractory Classical Hodgkin Lymphoma No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT02797717 Treatment for Classical Hodgkin Lymphoma in Children and Adolescents No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT05900765 A Study of Zimberelimab(GLS-010) Combined With AVD for Newly Diagnosed Early-stage Hodgkin's Lymphoma No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT06984146 Nivo40-AVD for Advanced Classic Hodgkin Lymphoma No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT04378647 BREntuximab Vedotin in SEcond LIne Therapy BEfore Transplant No UA site listed — international referral required	— невідомо	— невідомо	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	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT05404945 Fitness-adapted, Pembrolizumab-based Therapy for Untreated Classical Hodgkin Lymphoma Patients 60 Years of Age and Above No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor
Trial · NCT06563245 Brentuximab Vedotin for Newly Diagnosed cHL in Chinese CAYA Based on PET/CT Assessment No UA site listed — international referral required	— невідомо	— невідомо	self-pay: ₴0/course	Trial sponsor

Інформація про ціни — orientation. Перевіряти у конкретній аптеці / foundation / трайл-сайті. Status updated: 2026-04-27.

plan_id: PLAN-AUTO-CHL-001-V1 | version: 1 | generated: 2026-04-27T10:14:01.567049+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.