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"extraction_version": "1.0",
"extraction_date": "2026-02-23",
"patient": {
"id": "UMC-556219",
"age": 60,
"gender": "Male"
},
"cancer": {
"type": "Diffuse Large B-Cell Lymphoma",
"subtype": "non-GCB (ABC type)",
"stage": "IV",
"primary_site": "Lymphoma",
"metastases": [
"Bone marrow (15% involvement)",
"Retroperitoneal nodes (3.2cm)",
"Mesenteric mass (4.8cm)"
],
"biomarkers": {
"pdl1_expression": "N/A",
"tmb": "N/A",
"msi_status": "MSS"
},
"diagnosis_date": "2024-03-18"
},
"immunotherapy": {
"therapy_type": "ACT",
"drug_name": "Axicabtagene ciloleucel",
"drug_class": "CAR-T",
"treatment_setting": "metastatic",
"line_of_therapy": "Second-line",
"planned_start_date": "2026-03-10",
"ici_details": null,
"act_details": {
"act_type": "CAR-T",
"target_antigen": "CD19",
"cell_source": "autologous",
"preconditioning_regimen": "Fludarabine + Cyclophosphamide",
"t_cell_harvest_date": "2026-02-14",
"expected_crs_risk": "moderate-high",
"expected_neurotoxicity_risk": "moderate"
}
},
"prior_treatments": {
"chemotherapy": {
"received": true,
"regimens": [
"R-CHOP",
"R-ICE",
"Gemcitabine (bridging)"
],
"response": "CR (R-CHOP), PR (R-ICE), Stable disease (Gemcitabine)"
},
"prior_immunotherapy": {
"received": true,
"drugs": [],
"response": ""
}
},
"medications": {
"ppi_use": {
"currently_on_ppi": false,
"ppi_name": "",
"duration_months": 0
},
"antibiotic_history": {
"recent_antibiotics": true,
"exposures": [
{
"antibiotic_name": "Levofloxacin 500mg",
"antibiotic_class": "fluoroquinolone",
"start_date": "2026-01-25",
"end_date": "2026-02-05",
"days_before_ici": 14
},
{
"antibiotic_name": "Piperacillin-tazobactam 4.5g",
"antibiotic_class": "beta-lactam",
"start_date": "2025-12-18",
"end_date": "2025-12-27",
"days_before_ici": 73
}
]
}
},
"comorbidities": [
"Hypertension",
"hyperlipidemia",
"Type 2 diabetes",
"chronic back pain"
],
"microbiome": {
"sample_date": "2026-02-05",
"sequencing_method": "Shotgun metagenomic sequencing (Illumina NovaSeq, 12M reads)",
"diversity": {
"shannon_index": 2.7,
"simpson_index": 0.82,
"observed_species": 164
},
"key_bacteria": {
"Akkermansia muciniphila": 1.8,
"Faecalibacterium prausnitzii": 3.6,
"Ruminococcaceae": 9.2,
"Ruminococcus lactaris": 1.8,
"Lachnospiraceae": 8.8,
"Lachnospira pectinoschiza": 1.2,
"Roseburia": 1.8,
"Bifidobacterium spp.": 2.2,
"Bacteroides eggerthii": 2.4,
"Proteobacteria": 8.4,
"E. coli": 4.2,
"Klebsiella pneumoniae": 1.8,
"Enterococcus faecalis": 2.1,
"Bacteroides uniformis": 3.6,
"Blautia spp.": 4.2
},
"metabolites": {
"scfa": {
"butyrate_uM": 15.8,
"propionate_uM": 11.2,
"acetate_uM": 38.4
},
"bile_acids_available": true,
"tryptophan_metabolites_available": false
},
"data_quality": {
"completeness": "moderate",
"source": "Precision Microbiome Diagnostics",
"limitations": [
"Single time-point during active antibiotics",
"Reduced diversity from antibiotics + chemotherapy"
]
}
},
"clinical_context": {
"urgency": "",
"patient_goals": [
"CAR-T therapy consultation",
"Relapsed/Refractory DLBCL treatment"
],
"specific_concerns": [
"CAR-T efficacy",
"CAR-T toxicity (CRS, neurotoxicity)",
"Microbiome dysbiosis",
"Low butyrate",
"Antibiotic disruption"
]
}
} |