Treatment plan — Diffuse Large B-Cell Lymphoma, Not Otherwise Specified

OpenOnco · Treatment Plan

Treatment plan — Diffuse Large B-Cell Lymphoma, Not Otherwise Specified

PLAN-SYNTHETIC-REVIEW-ANTI_HBC_TOTAL-POSITIVE-V1 · v1 · 2026-10-18

Patient

SYNTHETIC-REVIEW-ANTI_HBC_TOTAL-POSITIVE · Algorithm: ALGO-DLBCL-1L

DiagnosisDiffuse Large B-Cell Lymphoma, Not Otherwise Specified

MOH / ICD-10C83.3

ICD-O-39680/3

Clinical significance of mutations (ESCAT)

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

✅ Covered biomarkers (matched in KB)

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

⚠️ Not included in plan

Biomarker	Status
BIO-CD20-IHC	BIO definition in KB; no ESCAT BMA entry — verify with clinician
BIO-CD79B-IHC	BIO definition in KB; no ESCAT BMA entry — verify with clinician
BIO-HBV-STATUS	BIO definition in KB; no ESCAT BMA entry — verify with clinician
BIO-HCV-STATUS	Excluded (negative)
BIO-HIV-STATUS	Excluded (negative)

Primary current-line option

Standard plan

★ DEFAULT

Indication

IND-DLBCL-1L-RCHOP

Regimen

Rituximab + CHOP (R-CHOP), 6 cycles

Drugs + NSZU

Rituximab (DRUG-RITUXIMAB) 375 mg/m² · IV day 1 of each 21-day cycle · IV ✓ NSZU covered
Cyclophosphamide (DRUG-CYCLOPHOSPHAMIDE) 750 mg/m² · IV day 1 of each 21-day cycle · IV ⚠ NSZU — not for this indication
Doxorubicin (DRUG-DOXORUBICIN) 50 mg/m² · IV day 1 of each 21-day cycle · IV ✓ NSZU covered
Vincristine (DRUG-VINCRISTINE) 1.4 mg/m² (capped at 2 mg total) · IV day 1 of each 21-day cycle · IV ⚠ NSZU — not for this indication
Prednisone (DRUG-PREDNISONE) 100 mg · PO days 1-5 of each 21-day cycle · PO ⚠ NSZU — not for this indication

Supportive care

SUP-PJP-PROPHYLAXIS, SUP-TLS-PROPHYLAXIS, SUP-ANTIEMETIC-PREMED

Hard contraindications

CI-HBV-NO-PROPHYLAXIS, CI-LVEF-LOW-FOR-ANTHRACYCLINE

Reason

Primary current-line option selected by ALGO-DLBCL-1L at step 3; branch-driving red flag: RF-FITNESS-ECOG-FIT.

Other current-line alternatives (1 tracks)

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

Aggressive plan

Indication

IND-DLBCL-1L-POLA-R-CHP

Regimen

Polatuzumab vedotin + Rituximab + CHP (Pola-R-CHP), 6 cycles + 2× rituximab

Drugs + NSZU

Polatuzumab vedotin (DRUG-POLATUZUMAB-VEDOTIN) 1.8 mg/kg · IV day 1 of each 21-day cycle, cycles 1-6 · IV ✗ Not registered in UA
Rituximab (DRUG-RITUXIMAB) 375 mg/m² · IV day 1 of each 21-day cycle, cycles 1-8 (last 2 cycles rituximab-only) · IV ✓ NSZU covered
Cyclophosphamide (DRUG-CYCLOPHOSPHAMIDE) 750 mg/m² · IV day 1 of each 21-day cycle, cycles 1-6 · IV ⚠ NSZU — not for this indication
Doxorubicin (DRUG-DOXORUBICIN) 50 mg/m² · IV day 1 of each 21-day cycle, cycles 1-6 · IV ✓ NSZU covered
Prednisone (DRUG-PREDNISONE) 100 mg · PO days 1-5 of each 21-day cycle, cycles 1-6 · PO ⚠ NSZU — not for this indication

Supportive care

SUP-PJP-PROPHYLAXIS, SUP-TLS-PROPHYLAXIS, SUP-ANTIEMETIC-PREMED

Hard contraindications

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

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-DLBCL-1L-RCHOP

RF-IPI-LOW: —
RF-FITNESS-ECOG-FIT ★ winner: —

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-CD20-IHC	CD20 Immunohistochemistry	Critical	histology	CSD Lab ✓ (code TBC)	all tracks
TEST-CMP	Comprehensive Metabolic Panel	Critical	lab	—	all tracks
TEST-FISH-PANEL	FISH (Fluorescence In Situ Hybridization)	Critical	genomic	CSD Lab ✓ (code TBC)	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-LN-EXCISIONAL-BIOPSY	Excisional LN Biopsy	Critical	histology	—	all tracks
TEST-PREGNANCY	Beta-HCG	Critical	lab	—	all tracks
TEST-B2-MICROGLOBULIN	Beta-2 Microglobulin	Standard	lab	—	all tracks
TEST-ECHO	Echocardiography	Standard	imaging	—	all tracks
TEST-PET-CT	FDG PET/CT (whole body)	Standard	imaging	—	all tracks

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

Age-adjusted IPI ≥2 in patient <60 yo — high-risk young-adult DLBCL; supports DA-EPOCH-R consideration over R-CHOP per CALGB 50303 / Wilson and AYA-DLBCL series
Age-adjusted IPI (Shipp 1993) uses 3 factors (stage III-IV, LDH>ULN, ECOG ≥2) and was validated in <60 yo; aaIPI ≥2 marks the high/high-intermediate cohort with R-CHOP 5-yr OS ~50-60%. CALGB 50303 did not show DA-EPOCH-R superiority over…
RF-AAIPI-HIGHSRC-NCCN-BCELL-2025SRC-ESMO-DLBCL-2024
DLBCL with International Prognostic Index ≥2 — selects intensified Pola-R-CHP over R-CHOP per POLARIX evidence
Per POLARIX trial: in IPI ≥2 newly-diagnosed DLBCL, Pola-R-CHP showed superior PFS (~6.5% absolute at 2 years) vs R-CHOP. Toxicity profile comparable except higher peripheral neuropathy with polatuzumab. Major access constraint in Ukraine…
RF-DLBCL-HIGH-IPISRC-NCCN-BCELL-2025SRC-ESMO-DLBCL-2024
High-risk biology in DLBCL NOS: double-expressor (MYC + BCL2 by IHC, no rearrangement), TP53 mutation, or non-GCB cell-of-origin in elderly / high-IPI context. Distinct from HGBL "double-hit" which is its own entity (DIS-HGBL-DH) — but double-expressor remains DLBCL NOS and shifts toward intensified backbone.
Double-expressor (≈30% of DLBCL): inferior PFS/OS on R-CHOP; POLARIX subgroup analysis shows Pola-R-CHP benefit largest in non-GCB + double-expressor. TP53 mutation: PFS halved on R-CHOP; consider Pola-R-CHP and earlier consolidation…
RF-DLBCL-HIGH-RISK-BIOLOGYSRC-NCCN-BCELL-2025SRC-ESMO-DLBCL-2024
DLBCL with International Prognostic Index 4-5 (high risk) — supports Pola-R-CHP intensification per POLARIX and triggers CNS-prophylaxis discussion via CNS-IPI
IPI 4-5 in newly-diagnosed DLBCL gives 5-yr OS ~50% on R-CHOP-21 × 6; POLARIX showed clearest absolute benefit for Pola-R-CHP in this stratum. CNS-IPI 4-6 (which overlaps strongly with IPI 4-5) further triggers IT-MTX or HD-MTX…
RF-IPI-HIGHSRC-NCCN-BCELL-2025SRC-ESMO-DLBCL-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
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

Standard plan (IND-DLBCL-1L-RCHOP)

Do not start without HBV screening + entecavir prophylaxis if HBsAg+ or anti-HBc+ — risk of fatal reactivation is significantly elevated on anti-CD20.
Do not prescribe without baseline LVEF ≥50% — anthracyclines are cardiotoxic; cardiomyopathy is often irreversible.
Do not ignore CNS-IPI — for patients with CNS-IPI ≥4 or high-risk anatomic sites (testicles, breasts, kidneys/adrenals, paranasal sinuses) add CNS prophylaxis (HD-MTX intercalated).
Do not skip the fertility preservation discussion in patients of reproductive age — cyclophosphamide causes azoospermia + amenorrhea.
Do not give vincristine intrathecally — FATAL. WHO/FDA require IV mini-bag packaging.
Do not escalate dose with febrile neutropenia without G-CSF — G-CSF prophylaxis for high-risk patients (age >65, prior cytopenia, advanced disease).

Aggressive plan (IND-DLBCL-1L-POLA-R-CHP)

Do not prescribe without a verified funding pathway — daratumumab... sorry, polatuzumab is not NSZU-reimbursed; the patient must be informed BEFORE being offered.
Do not start without HBV screening + entecavir prophylaxis if HBsAg+ or anti-HBc+ — anti-CD20 reactivation risk is not reduced by polatuzumab.
Do not prescribe without baseline LVEF ≥50% — anthracycline cardiotoxicity is the same as with R-CHOP.
Do not ignore pre-existing peripheral neuropathy — polatuzumab MMAE causes neuropathy; Grade ≥2 baseline = absolute CI.
Do not skip CNS prophylaxis if CNS-IPI ≥4 — same risk as with R-CHOP.
Do not use with concomitant strong CYP3A4 inhibitor without monitoring — increased neuropathy + myelosuppression.

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-term)	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-term)	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 · Rituximab + CHOP (R-CHOP), 6 cycles

21-day cycles × 6 (with consideration of 2-month interim PET-CT after cycles 2-4)

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 · Polatuzumab vedotin + Rituximab + CHP (Pola-R-CHP), 6 cycles + 2× rituximab

21-day cycles × 6 (Pola-R-CHP) + 2× rituximab consolidation (cycles 7-8)

Response assessment

After cycles 2-4 (interim PET-CT)

Follow-up

Every 3 months × 2 years post-treatment

MDT brief

Discussion questions (4, 2 blocking)

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
BLOCKING OQ-BIOMARKER-BCL2-EXPRESSION-IHC
What is the status of BCL2 expression by IHC (BIO-BCL2-EXPRESSION-IHC)? It is required by track(s): IND-DLBCL-1L-RCHOP, IND-DLBCL-1L-POLA-R-CHP. Expected value: BCL2-IHC ≥50% combined with MYC-IHC ≥40% defines double-expressor (DEL) phenotype — poorer prognosis but not an excluder; HGBL-DH (FISH double-hit) must be ruled out.
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.
→ pathologist
BLOCKING OQ-BIOMARKER-DLBCL-COO-HANS
What is the status of Cell-of-origin classification (Hans IHC algorithm) (BIO-DLBCL-COO-HANS)? It is required by track(s): IND-DLBCL-1L-RCHOP, IND-DLBCL-1L-POLA-R-CHP. Expected value: GCB or non-GCB by Hans algorithm — non-GCB has worse R-CHOP outcomes; some centres consider R-CHOEP for non-GCB.
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.
→ pathologist

MDT talk tree (6 steps)

#	Owner	Topic	Action
1	pathologist	Biomarker status BLOCKING	What is the status of BCL2 expression by IHC (BIO-BCL2-EXPRESSION-IHC)? It is required by track(s): IND-DLBCL-1L-RCHOP, IND-DLBCL-1L-POLA-R-CHP. Expected value: BCL2-IHC ≥50% combined with MYC-IHC ≥40% defines double-expressor (DEL) phenotype — poorer prognosis but not an excluder; HGBL-DH (FISH double-hit) must be ruled out.
2	pathologist	Biomarker status BLOCKING	What is the status of Cell-of-origin classification (Hans IHC algorithm) (BIO-DLBCL-COO-HANS)? It is required by track(s): IND-DLBCL-1L-RCHOP, IND-DLBCL-1L-POLA-R-CHP. Expected value: GCB or non-GCB by Hans algorithm — non-GCB has worse R-CHOP outcomes; some centres consider R-CHOEP for non-GCB.
3	hematologist	Staging / disease burden	What is the current LDH? Marker of tumor burden and transformation.
4	radiologist	Staging / disease burden	Has complete staging been done (Lugano + PET/CT or CT)?
5	clinical_pharmacist	Specialist review	Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.
6	infectious_disease_hepatology	Specialist review	Active viral etiology (HCV/HBV) requires parallel antiviral management and reactivation risk assessment.

Skills (required) — mandatory virtual specialists (1)

Hematologist / oncohematologist required
Lymphoma diagnosis — leading specialty for treatment management.
Owns: OQ-LDH-CURRENT

Skills (recommended) — for consideration (3)

Clinical pharmacist recommended
Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.
Infectious disease / hepatology recommended
Active viral etiology (HCV/HBV) requires parallel antiviral management and reactivation risk assessment.
Pathologist (general) recommended
Confirm lymphoma histology + assess transformation risk (DLBCL/Richter).
Owns: OQ-BIOMARKER-BCL2-EXPRESSION-IHC, OQ-BIOMARKER-DLBCL-COO-HANS

Data quality

Incomplete for default-track review. Default-track review is incomplete until required biomarker gaps are resolved.

Biomarker coverage: 6/8 known (75%), 2 missing, 2 default-track gaps
Missing critical: lugano_stage
Missing recommended: ldh_ratio_to_uln, fib4_index, pet_ct_date
Unevaluated RedFlags: RF-AAIPI-HIGH, RF-CHRONIC-HIV-MALIGNANCY-PREVENTION, RF-DLBCL-CART-INELIGIBLE-POST-2L, RF-DLBCL-CD20-POS-EPCORITAMAB-CANDIDATE, RF-DLBCL-CD20-POS-GLOFITAMAB-CANDIDATE, RF-DLBCL-CD79B-MUT-MCD-CANDIDATE, RF-DLBCL-CNS-RISK, RF-DLBCL-FRAILTY-AGE, RF-DLBCL-HIGH-IPI, RF-DLBCL-HIGH-RISK-BIOLOGY, RF-DLBCL-INFECTION-SCREENING, RF-DLBCL-TRANSFORMATION-PROGRESSION, RF-IATROGENIC-ANTI-TNF-LYMPHOMA-PREVENTION, RF-IATROGENIC-AZATHIOPRINE-LONGTERM-PREVENTION, RF-IATROGENIC-METHOTREXATE-LONGTERM-LYMPHOMA-PREVENTION, RF-IATROGENIC-TRANSPLANT-IMMUNOSUPPRESSION-LONGTERM-PREVENTION, RF-IATROGENIC-TRANSPLANT-IMMUNOSUPPRESSION-PREVENTION, RF-IPI-HIGH, RF-IPI-INTERMEDIATE, RF-IPI-LOW, RF-OCC-GLYPHOSATE-PREVENTION, RF-OCC-PCB-PREVENTION

Missing data for doctor action

Priority	Clinical item	Owner	Why it matters	Next action	Blocks
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-BCL2-EXPRESSION-IHC`	BCL2 expression by IHC	pathologist	yes	IND-DLBCL-1L-RCHOP, IND-DLBCL-1L-POLA-R-CHP	Verify result, method, specimen, and report date before sign-off. Expected/constraint: BCL2-IHC ≥50% combined with MYC-IHC ≥40% defines double-expressor (DEL) phenotype — poorer prognosis but not an excluder; HGBL-DH (FISH double-hit) must be ruled out
`BIO-DLBCL-COO-HANS`	Cell-of-origin classification (Hans IHC algorithm)	pathologist	yes	IND-DLBCL-1L-RCHOP, IND-DLBCL-1L-POLA-R-CHP	Verify result, method, specimen, and report date before sign-off. Expected/constraint: GCB or non-GCB by Hans algorithm — non-GCB has worse R-CHOP outcomes; some centres consider R-CHOEP for non-GCB

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

Experimental options (clinical trials)

Third plan track — open-enrollment trials from ClinicalTrials.gov.

🔬 Data unavailable — ClinicalTrials.gov sync has not run. Pass experimental_search_fn to generate_plan() or sync offline (per ua-ingestion plan §3.3).

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 Rituximab + CHOP (R-CHOP), 6 cycles (REG-R-CHOP)	✓ registered	✓ covered	₴-? — verify pathway	NSZU formulary
Aggressive plan Polatuzumab vedotin + Rituximab + CHP (Pola-R-CHP), 6 cycles + 2× rituximab (REG-POLA-R-CHP) 1/5 component drug(s) not registered in Ukraine +1	✗ not registered	✗ out-of-pocket	₴-? — verify pathway	not recorded

Cost information is orientation. Verify with a specific pharmacy / foundation / trial site. Table assembled: 2026-10-18. Table assembly does not verify registration, NSZU coverage or prices. Check the currency of these data separately.

plan_id: PLAN-SYNTHETIC-REVIEW-ANTI_HBC_TOTAL-POSITIVE-V1 | version: 1 | generated: 2026-10-18T12:08:55.201302+00:00

Project intended-use limits (CHARTER §11 + §15): Outpatient oncology treatment planning to support tumor-board discussion. For independent clinician review; not for autonomous clinical decision-making.

Project intended-use limits (CHARTER §11 + §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.