MDS mit IPSS-M hohem oder sehr hohem Risiko (2022 molekulare Aktualisierung mit 31 Gen mutat...

Deterministische Ansicht der Quelle YAML Entität. Klinische Autorität bleibt mit den zitierten Quell-IDs und Rezensenten Sign-off Zustand.

ID	`RF-IPSS-M-HIGH`
Art	Warnhinweis
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Erkrankungen	`DIS-MDS-HR` `DIS-MDS-LR`
Quellen	`SRC-ESMO-MDS-2021` `SRC-IPSS-M-BERNARD-2022` `SRC-NCCN-AML-2025`

Ursprung der Roten Flagge

Begriffsbestimmung	MDS with IPSS-M high or very-high risk (2022 molecular update incorporating 31 gene mutations) — restratifies ~46% of patients vs IPSS-R; supports HR-MDS treatment pathway including alloHCT discussion + HMA-based 1L
Klinische Richtung	Intensivierung
Kategorie	Risiko-Score
Schaltet Algorithmus	ALGO-MDS-HR-1L, ALGO-MDS-LR-1L

Logik auslösen

{
  "any_of": [
    {
      "finding": "ipss_m_risk",
      "value": "high"
    },
    {
      "finding": "ipss_m_risk",
      "value": "very_high"
    },
    {
      "comparator": ">=",
      "finding": "ipss_m_score",
      "threshold": 0.5
    }
  ],
  "type": "composite_score"
}

Anmerkungen

IPSS-M (Bernard et al., NEJM Evidence 2022) integrates 31 gene mutations (TP53 multi-hit, SF3B1 favorable, ASXL1, EZH2, RUNX1, SRSF2, U2AF1, others) with IPSS-R clinical/cytogenetic features. Restratifies ~46% of patients — many IPSS-R intermediate cases upgrade to IPSS-M high/very-high (and vice versa). Trigger applicable to both MDS-HR and MDS-LR populations because IPSS-M upgrade is the canonical reason a clinically-LR patient gets routed to HR pathways. Threshold 0.5 corresponds to the "moderate-high" cutoff in Bernard's nomogram. Direction `intensify` — pushes toward alloHCT eligibility evaluation + HMA induction.

Verwendet von

Algorithmen

ALGO-MDS-HR-1L - ALGO-MDS-HR-1L