Profil de fragilité influe sur la sélection du régime CLL: ECOG ≥3, OR (âge ≥75 avec G8 ≤14), OR...

Vue déterministe de l'entité source de la LJAM. L'autorité clinique demeure avec les ID de la source cités et l'état d'approbation de l ́examinateur.

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

Origine du drapeau rouge

Définition	Frailty profile influencing CLL regimen selection: ECOG ≥3, OR (age ≥75 with G8 ≤14), OR composite frailty (age ≥70 + Charlson ≥3 + albumin <3.5) — drives selection of fixed-duration V+O (CLL14) over continuous BTKi (better tolerability profile in elderly per ELEVATE-TN / SEQUOIA elderly subgroups), and absolutely contraindicates chemoimmuno (FCR/BR).
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
        }
      ]
    },
    {
      "comparator": ">",
      "finding": "cirs_score",
      "threshold": 6
    }
  ],
  "type": "composite_score"
}

Notes

CIRS (Cumulative Illness Rating Scale) >6 = "unfit" per CLL11 / CLL14 trial criteria — drives choice of obinutuzumab + venetoclax over chemoimmuno. Continuous BTKi (acalabrutinib, zanubrutinib) is also appropriate but requires daily compliance + cardiac monitoring; V+O is fixed-duration 12 months which many elderly prefer (definite end-date, lower long-term toxicity). Avoid ibrutinib first-gen in ≥75 with cardiovascular comorbidity. FCR/BR chemoimmuno absolutely contraindicated — TRM 5-10% in unfit + minimal benefit over targeted therapy.

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