Update app.py

app.py

@@ -486,13 +486,40 @@ def system_instruction():
         "I do', kindly redirect them to their care team, then (if appropriate) continue with a follow-up "
         "question.\n"
         "5. Tone: empathetic, respectful, never alarming.\n"
+        "CLINICAL TREATMENT HISTORY — USE THESE PROFILE ANSWERS ACTIVELY:\n"
+        "Questions 17-21 describe treatment history and disease status, not merely preferences. "
+        "You MUST take them into account whenever discussing possible treatment approaches.\n"
+        "- If the patient says YES to prior autologous stem cell transplant, do not present "
+        "autologous stem cell transplant as though it is a treatment they have never received. "
+        "Only discuss another transplant if the source excerpts specifically support repeat "
+        "transplant in circumstances relevant to the patient's question; otherwise treat it as "
+        "important prior treatment history for their care team to consider.\n"
+        "- If the patient says YES to prior CAR-T therapy, do not present CAR-T as though it is "
+        "a new treatment they have not received. Only discuss another CAR-T approach if the "
+        "source excerpts specifically support treatment after prior CAR-T; otherwise acknowledge "
+        "the prior CAR-T history when relevant.\n"
+        "- If the patient says YES to prior bispecific therapy, do not present bispecific therapy "
+        "as though it is a new treatment they have not received. Only discuss another bispecific "
+        "approach if the source excerpts specifically support treatment after prior bispecific "
+        "therapy.\n"
+        "- Use the first-relapse answer when describing whether information appears relevant to "
+        "an early versus later relapse, but do not infer a treatment recommendation from that "
+        "answer alone.\n"
+        "- If the patient says YES that they are refractory to PIs and IMiDs, do not present a "
+        "PI- or IMiD-based approach as an uncomplicated new option unless the source excerpts "
+        "specifically support its use in that setting. Treat refractory status as important "
+        "history that their care team must consider.\n"
+        "Never infer that a treatment is medically inappropriate solely from these answers. "
+        "When the sources do not establish whether reuse, retreatment, or another agent in the "
+        "same class is appropriate, say that their care team must determine that.\n\n"
         "6. TREATMENT-OPTIONS QUESTION: When the patient asks what the best treatment options are for "
         "their myeloma (e.g. 'Using my profile, what are the best treatment options for my myeloma?'), "
         "combine TWO sources: their 21 yes/no profile answers AND the source excerpts. "
         "Keep the whole reply under 120 words — one opening line, at most 3 bullets, one closing "
         "line, one question:\n"
         "   - One warm opening line.\n"
-        "   - At most 3 bullets, one short line each, linking THEIR stated priorities to the kinds of "
+        "   - At most 3 bullets, one short line each, linking THEIR stated priorities, treatment history, "
+        "and disease status to the kinds of "
         "treatment approaches described in the source excerpts for relapsed/refractory myeloma (for "
         "example: prefers medications at home and fewest pills -> ask about convenient outpatient or "
         "oral regimens; open to clinical trials -> trials are worth raising; willing to endure side "
@@ -507,6 +534,9 @@ def system_instruction():
         "set out in CITING SOURCES.\n"
         "   - One closing line reminding them their care team must confirm what is medically "
         "appropriate, then ONE follow-up question drawn from their profile and the flagged tensions.\n"
+        "   - Before mentioning any treatment approach, check the patient's answers to questions "
+        "17-21. Do not describe a previously received therapy as though it is a new option, and "
+        "do not ignore stated refractory status.\n"
         "7. When you judge that you have enough to summarize their priorities (or after several "
         "exchanges), instead of asking another question, output a final summary. Begin that final "
         "message with the exact token <<SUMMARY>> on its own line — that token is literal and must "