Treatment plan — DIS-CHL

OpenOnco · Treatment Plan

PLAN-CHL-2L-001-V1 · v1 · 2026-04-27

Patient

CHL-2L-001 · Algorithm: ALGO-CHL-2L

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)

Aggressive plan

★ DEFAULT

Indication

IND-CHL-2L-PEMBROLIZUMAB

Regimen

Pembrolizumab 200 mg IV q3w — r/r cHL post-BV (KEYNOTE-204 schedule)

Drugs + NSZU

Pembrolizumab (DRUG-PEMBROLIZUMAB) 200 mg flat dose · IV every 21 days, until progression or unacceptable toxicity (typical max 35 cycles ~2 years per KEYNOTE-204) · IV ✓ NSZU covered

Hard contraindications

CI-PEMBROLIZUMAB-AUTOIMMUNE

Reason

Engine default per algorithm ALGO-CHL-2L: {'step': 3, 'outcome': False, 'branch': {'result': 'IND-CHL-2L-PEMBROLIZUMAB'}, 'fired_red_flags': [], 'winner_red_flag': None}

Aggressive plan

Indication

IND-CHL-2L-BRENTUXIMAB-MAINTENANCE

Regimen

Brentuximab vedotin maintenance post-ASCT for high-risk cHL (AETHERA, 16 cycles)

Drugs + NSZU

Brentuximab vedotin (DRUG-BRENTUXIMAB-VEDOTIN) 1.8 mg/kg (max 180 mg) · IV every 21 days × 16 cycles, starting 30-45 days post-ASCT · IV ✓ NSZU covered

Supportive care

SUP-PJP-PROPHYLAXIS

Hard contraindications

CI-BORTEZOMIB-SEVERE-NEUROPATHY

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-PREGNANCY	β-ХГЛ (тест на вагітність)	Critical	lab	all tracks
TEST-ECHO	Ехокардіографія (ТТЕ) з оцінкою ФВ ЛШ	Standard	imaging	all tracks
TEST-LN-CORE-BIOPSY	Core-біопсія лімфатичного вузла (image-guided)	Standard	histology	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

Frailty profile precluding full-dose ABVD or A+AVD in classical Hodgkin lymphoma: ECOG ≥3, OR (age ≥60 with ≥2 comorbidities — elderly cHL has worse outcomes regardless of regimen), OR composite frailty (age ≥75 + Charlson ≥3 + albumin <3.5). Triggers de-escalation to AVD (omit bleomycin), VEPEMB (gem-vinorelbine-based), or BV-AVD. RF-CHL-FRAILTY-AGE
Classical Hodgkin lymphoma primary-refractory disease (positive interim PET2 with Deauville 4-5 or end-of-treatment PET-positive) OR early relapse <12 months post-ABVD/A+AVD — high-risk subset routes to salvage chemo (ICE / DHAP / BV-bendamustine) followed by autoSCT consolidation; consider BV-nivolumab combination for chemo-refractory. RF-CHL-TRANSFORMATION-PROGRESSION
Patient has NOT previously received brentuximab vedotin (BV) — eligible for BV-containing first-line and salvage regimens in CD30-expressing diseases: A+AVD in advanced cHL (ECHELON-1, Connors NEJM 2018), BV-CHP in CD30+ PTCL/ALCL (ECHELON-2, Horwitz Lancet 2019), BV monotherapy or BV-containing salvage in R/R cHL (AETHERA post-ASCT consolidation). This eligibility flag is used as an inclusion gate for BV-using algorithm branches; firing means standard BV-route is open. Co-fires with disease-specific CD30-positivity flags. RF-PRIOR-BV-NAIVE

CONTRA-AGGRESSIVE

Hard contraindications to escalation

Pembrolizumab (and other PD-1/PD-L1 inhibitors) augment T-cell responses; in patients with active autoimmunity or post-transplant immunosuppression, this can precipitate severe organ-specific flares (colitis, hepatitis, pneumonitis, transplant rejection) that may be fatal or require transplant loss. CI-PEMBROLIZUMAB-AUTOIMMUNE
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

What NOT to do

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

Aggressive plan (IND-CHL-2L-PEMBROLIZUMAB)

НЕ призначати при active autoimmune disease (CI-PEMBROLIZUMAB-AUTOIMMUNE) — risk of severe irAE flare.
НЕ призначати при solid-organ transplant — risk of acute graft rejection from PD-1 blockade.
НЕ ігнорувати baseline thyroid function + cortisol + glucose — endocrine irAE common.
НЕ ігнорувати new pneumonitis-suspect symptoms (cough, dyspnea) — HRCT immediately; pneumonitis is most-feared irAE.
НЕ припиняти при Grade 1 endocrinopathy — replacement therapy + continue treatment.
НЕ ігнорувати myocarditis-suspect symptoms (chest pain, dyspnea, troponin rise) — discontinue + emergent cardiology.
НЕ забути плану до alloSCT consolidation в fit transplant-eligible responders — PD-1 monotherapy не куративна, durable PR + bridge to SCT.
НЕ передбачати alloSCT immediately after PD-1 termination — pembrolizumab impacts on post-allo GVHD risk; ≥4 weeks washout + careful conditioning regimen selection.
НЕ призначати без funding pathway clarification — pembrolizumab off-label для cHL в UA.

Aggressive plan (IND-CHL-2L-BRENTUXIMAB-MAINTENANCE)

НЕ комбінувати з bleomycin — additive lethal pulmonary toxicity (absolute).
НЕ призначати при pre-existing Grade ≥2 peripheral neuropathy — risk-benefit unfavorable; surveillance only.
НЕ розпочинати maintenance до 30 днів post-ASCT — risk of poor engraftment + cytopenia.
НЕ розпочинати maintenance після 45 днів post-ASCT — best benefit when started early (AETHERA inclusion criterion).
НЕ ігнорувати new neuropathy — reduce dose до 1.2 mg/kg на resume; permanent discontinuation для Grade ≥3.
НЕ продовжувати maintenance понад 16 циклів — protocol-defined; longer benefit not established.
НЕ використовувати для low-risk cHL (CR pre-ASCT + relapse >12 мс + nodal-only at relapse) — risk-benefit unfavorable.
НЕ призначати без funding pathway clarification — brentuximab НЕ НСЗУ-reimbursed для cHL maintenance.
НЕ забути PJP prophylaxis протягом maintenance + ≥6 міс після останньої дози.

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Aggressive plan

Induction · Pembrolizumab 200 mg IV q3w —

21-day cycles × Until progression or unacceptable toxicity (typically ≤2 years / 35 cycles)

Aggressive plan

Induction · Brentuximab vedotin maintenanc

21-day cycles × 16 cycles (~12 months) starting 30-45 days post-ASCT

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-FRAILTY-AGE, RF-CHL-INFECTION-SCREENING, 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-ESMO-HODGKIN-2024: ESMO Clinical Practice Guideline on Hodgkin Lymphoma (2024)
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
Aggressive plan Pembrolizumab 200 mg IV q3w — r/r cHL post-BV (KEYNOTE-204 schedule) (REG-PEMBROLIZUMAB-CHL)	✓ зареєстровано	✓ покривається	₴-? — verify pathway	НСЗУ formulary
Aggressive plan Brentuximab vedotin maintenance post-ASCT for high-risk cHL (AETHERA, 16 cycles) (REG-BRENTUXIMAB-MAINTENANCE-CHL)	✓ 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-CHL-2L-001-V1 | version: 1 | generated: 2026-04-27T12:36:01.364461+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.