Profil de fragilité excluant la dose complète de CHC-Bv dans l'ALCL: ECOG ≥3, OU (âge ≥75 avec G8 ≤14), O...

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ID	`RF-ALCL-FRAILTY-AGE`
Type	Signal d’alerte
État	reviewed 2026-04-27 \| pending_clinical_signoff
Maladies	`DIS-ALCL`
Sources	`SRC-ESMO-PTCL-2024` `SRC-NCCN-BCELL-2025`

Origine du drapeau rouge

Définition	Frailty profile precluding full-dose CHP-Bv in ALCL: ECOG ≥3, OR (age ≥75 with G8 ≤14), OR composite frailty (age ≥70 + Charlson ≥3 + albumin <3.5). Triggers de-escalation to brentuximab-vedotin monotherapy or attenuated CHP-Bv (50-75% doses).
Direction clinique	désescalade
Catégorie	âge de fragilité

Logique de déclenchement

{
  "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"
}

Notes

G8 (Geriatric-8) screening tool validated in oncology; ≤14 indicates need for full CGA. ALCL is unusual among PTCLs in that brentuximab monotherapy alone (1.8 mg/kg q3w) is meaningfully active in frail unfit patients (~40-60% ORR data extrapolated from r/r ALCL). Avoid vincristine + brentuximab combo when neuropathy already present. AlloHCT typically off-table; autoSCT consolidation post-CR remains reasonable in selected fit-elderly.

Utilisé par

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