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MDS con IPSS-M alto o muy alto riesgo (2022 actualización molecular incorporando 31 genes mutat...

Vista determinista de la entidad fuente YAML. La autoridad clínica sigue con los ID de fuente citados y estado de firma del revisor.

IDRF-IPSS-M-HIGH
TipoSeñal de alerta
Situaciónreviewed 2026-04-27 | pending_clinical_signoff
EnfermedadesDIS-MDS-HR DIS-MDS-LR
FuentesSRC-ESMO-MDS-2021 SRC-IPSS-M-BERNARD-2022 SRC-NCCN-AML-2025

Origen de la bandera roja

DefiniciónMDS 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
Dirección clínicaintensificar
Categoríapuntuación de riesgo
Algoritmo de cambiosALGO-MDS-HR-1L, ALGO-MDS-LR-1L

Lógica de activación

{
  "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"
}

Notas

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.

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Algoritmos