Patient
SYNTHETIC-REVIEW-ECOG-4 · Algorithm: ALGO-DLBCL-1L
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. |
| 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 | Excluded (negative) |
| BIO-HCV-STATUS | Excluded (negative) |
| BIO-HIV-STATUS | Excluded (negative) |
Why this branch was chosen
Triggers from the patient profile that fired and drove the chosen branch.
Step 1 → branch IND-DLBCL-1L-RCHOP
- RF-DLBCL-FRAILTY-AGE ★ winner: Frailty profile precluding full-dose R-CHOP: ECOG ≥3, OR (age ≥80 with ≥1 grade-2 comorbidity), OR composite frailty (age ≥75 + hypoalbuminemia <3.0 + ≥2 concomitant comorbidities).
SRC-NCCN-BCELL-2025SRC-ESMO-DLBCL-2024
MDT brief
Discussion questions (1, 0 blocking)
MDT talk tree (4 steps)
| # | Owner | Topic | Action |
|---|
| 1 | radiologist | Staging / disease burden | Has complete staging been done (Lugano + PET/CT or CT)? |
| 2 | hematologist | Specialist review | Lymphoma diagnosis — leading specialty for treatment management. |
| 3 | palliative_care | Specialist review | Reduced performance status / decompensated comorbidity — goals-of-care assessment needed. |
| 4 | pathologist | Specialist review | Confirm lymphoma histology + assess transformation risk (DLBCL/Richter). |
Skills (required) — mandatory virtual specialists (1)
Skills (recommended) — for consideration (2)
Data quality
Incomplete for MDT sign-off. MDT sign-off is incomplete until critical clinical data gaps are resolved.
- Biomarker coverage: 0/0 known (100%), 0 missing, 0 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. | - |
Technical MDT skill metadata (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 | 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 |
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).