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CML patient with comorbidity excluding specific 2nd-gen TKIs: significant cardiovascular...

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IDRF-CML-ORGAN-DYSFUNCTION
TipoSeñal de alerta
Situaciónreviewed 2026-04-25 | pending_clinical_signoff
EnfermedadesDIS-CML
FuentesSRC-ELN-CML-2020 SRC-NCCN-MPN-2025

Origen de la bandera roja

DefiniciónCML patient with comorbidity excluding specific 2nd-gen TKIs: significant cardiovascular disease (PAOD, prior MI/stroke, uncontrolled HTN — avoid nilotinib/ponatinib), pulmonary disease (COPD, prior pleural disease — avoid dasatinib), severe GI disease (avoid bosutinib), pancreatitis history (avoid nilotinib)
Dirección clínicainvestigación
Categoríadisfunción de los órganos

Lógica de activación

{
  "any_of": [
    {
      "finding": "cv_high_risk",
      "value": true
    },
    {
      "finding": "prior_mi_or_stroke",
      "value": true
    },
    {
      "finding": "peripheral_arterial_disease",
      "value": true
    },
    {
      "finding": "pulmonary_disease_significant",
      "value": true
    },
    {
      "finding": "prior_pleural_effusion",
      "value": true
    },
    {
      "finding": "pancreatitis_history",
      "value": true
    },
    {
      "finding": "ibd_or_severe_diarrhea",
      "value": true
    }
  ],
  "type": "composite"
}

Notas

Direction "investigate" — surfaces comorbidity-matched TKI choice as a supplementary annotation rather than a binary indication switch. ELN 2020 comorbidity matrix: - CV disease / hyperlipidemia / DM → AVOID nilotinib + ponatinib - Pulmonary / pleural disease → AVOID dasatinib - GI disease (IBD, baseline diarrhea) → AVOID bosutinib - Pancreatitis / hepatic dysfunction → AVOID nilotinib - Default low-comorbidity → imatinib (cost) or dasatinib/nilotinib (response) STUB — requires clinical co-lead signoff.

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