Perfil de fragilidad que influye en la selección de la terapia con MF/Sézary: ECOG ≥3, OR (nivel ≥75 con G8 ≤14...

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

ID	`RF-MF-SEZARY-FRAILTY-AGE`
Tipo	Señal de alerta
Situación	reviewed 2026-04-27 \| pending_clinical_signoff
Enfermedades	`DIS-MF-SEZARY`
Fuentes	`SRC-ESMO-CTCL-2024` `SRC-NCCN-BCELL-2025`

Origen de la bandera roja

Definición	Frailty profile influencing MF/Sézary therapy selection: ECOG ≥3, OR (age ≥75 with G8 ≤14), OR composite frailty (age ≥70 + Charlson ≥3 + albumin <3.5). Triggers preference for skin-directed therapy (PUVA, topical mechlorethamine), low-dose oral methotrexate, IFN, or mogamulizumab (well-tolerated systemically) over multi-agent chemotherapy regimens.
Dirección clínica	decreciente
Categoría	edad de fragilidad

Lógica de activación

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "ecog",
      "threshold": 3
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age",
          "threshold": 75
        },
        {
          "comparator": "<=",
          "finding": "g8_score",
          "threshold": 14
        }
      ]
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age",
          "threshold": 70
        },
        {
          "comparator": ">=",
          "finding": "charlson_score",
          "threshold": 3
        },
        {
          "comparator": "<",
          "finding": "albumin_g_dl",
          "threshold": 3.5
        }
      ]
    }
  ],
  "type": "composite_score"
}

Notas

MF/Sézary is typically chronic / indolent in early stages, allowing skin-directed approach (topical corticosteroids, mechlorethamine gel, bexarotene topical, narrowband UVB, PUVA) for stage IA-IIA regardless of age. Frail elderly with stage IIB+ or Sézary: low-dose oral MTX (10-25 mg weekly), IFN-α, or mogamulizumab — all well-tolerated. Avoid multi-agent gem-doxo / CHOP-like regimens in frail (no curative endpoint, considerable toxicity, marginal PFS gains). AlloHCT is the only curative modality but typically off-table for frail elderly.

Utilizado por

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