Dysfonctionnement des organes de base excluant l'induction standard de MCL (Nordic R-MaxiCHOP/Ara...

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-MCL-ORGAN-DYSFUNCTION`
Type	Signal d’alerte
État	reviewed 2026-04-27 \| pending_clinical_signoff
Maladies	`DIS-MCL`
Sources	`SRC-ESMO-MCL-2024` `SRC-NCCN-BCELL-2025`

Origine du drapeau rouge

Définition	Baseline organ dysfunction precluding standard MCL induction (Nordic R-MaxiCHOP/AraC, R-DHAP, R-CHOP, BR): LVEF <50% (R-CHOP / R-DHAP anthracycline contraindicated), CrCl <50 (HD-cytarabine in Nordic / R-DHAP requires renal function — neurotoxicity risk; CrCl <30 absolute contraindication), bilirubin >3× ULN, severe cardiac dysfunction (ibrutinib relative contraindication), or active bleeding diathesis.
Direction clinique	désescalade
Catégorie	dysfonction d'organe

Logique de déclenchement

{
  "any_of": [
    {
      "comparator": "<",
      "finding": "lvef_percent",
      "threshold": 50
    },
    {
      "comparator": "<",
      "finding": "creatinine_clearance_ml_min",
      "threshold": 50
    },
    {
      "comparator": ">=",
      "finding": "bilirubin_ratio_to_uln",
      "threshold": 3
    },
    {
      "finding": "nyha_class_3_or_4",
      "value": true
    },
    {
      "finding": "active_bleeding",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

HD-cytarabine (>2 g/m² per dose in Nordic, R-DHAP) is the cerebellar-toxicity-limiting drug — CrCl <50 mandates dose reduction (1 g/m² instead of 2-3 g/m²); CrCl <30 absolute contraindication. LVEF <50%: avoid R-CHOP backbone — use BR (StiL NHL1 — bendamustine + R, no anthracycline); for fit younger transplant candidates with LVEF 40-50%, R-DHAP without anthracycline acceptable as transplant bridge. Cardiac comorbidity + intended BTKi: zanubrutinib / acalabrutinib preferred over ibrutinib (lower AF / HTN per ALPINE / ELEVATE-RR data).

Utilisé par

No reverse references found in the YAML corpus.