Onco Wiki / drapeau rouge

CML patient with cardiovascular / metabolic / pulmonary comorbidity profile that constrai...

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.

IDRF-CML-COMORBIDITY-COMPLEX
TypeSignal d’alerte
Étatreviewed 2026-04-26 | pending_clinical_signoff
MaladiesDIS-CML
SourcesSRC-ELN-CML-2020 SRC-ESMO-CML-2017 SRC-NCCN-MPN-2025

Origine du drapeau rouge

DéfinitionCML patient with cardiovascular / metabolic / pulmonary comorbidity profile that constrains 2nd-generation TKI choice. Specifically: uncontrolled hypertension, prior arterial thrombotic event, QTc-prolongation risk (baseline QTc > 460 ms or QT-prolonging medications), pancreatitis history, pulmonary hypertension, or pleural-effusion-prone state. Drives selection toward asciminib (STAMP inhibitor, cleanest CV/QTc profile) over nilotinib (CV / QTc / metabolic risk), dasatinib (pleural effusion / pulmonary hypertension), or bosutinib (GI / hepatic) when 2nd-gen TKI is otherwise indicated by RF-CML-HIGH-RISK-ELTS.
Direction cliniquedésescalade
Catégoriehigh-risk-biology
Algorithme de décalageALGO-CML-1L, ALGO-CML-2L

Logique de déclenchement

{
  "any_of": [
    {
      "finding": "uncontrolled_hypertension",
      "value": true
    },
    {
      "finding": "prior_arterial_thrombotic_event",
      "value": true
    },
    {
      "comparator": ">",
      "finding": "baseline_qtc_ms",
      "threshold": 460
    },
    {
      "finding": "qt_prolonging_medications",
      "value": true
    },
    {
      "finding": "pancreatitis_history",
      "value": true
    },
    {
      "finding": "pulmonary_hypertension",
      "value": true
    },
    {
      "finding": "pleural_effusion_history",
      "value": true
    }
  ],
  "type": "composite_score"
}

Notes

Co-determines TKI selection with RF-CML-HIGH-RISK-ELTS. The combination matters: high-risk CML *plus* CV-comorbidity → asciminib preferred (per ASCEMBL trial 3L+ data extrapolating to comorbid 1L use under expanded ELN guidance); high-risk CML without CV-comorbidity → nilotinib or dasatinib remain reasonable. Imatinib remains acceptable in low-risk comorbid patients where treatment-free remission is not the primary goal. STUB — author content above reflects published evidence but has not been clinically reviewed. Two-reviewer per CHARTER §6.1 required before this RedFlag is wired into ALGO-CML-1L / ALGO-CML-2L decision_tree branches. reviewer_signoffs: 0

Utilisé par

Algorithmes

Signal d’alerte