Onco Wiki / drapeau rouge

Le SMD passe d'une classification à risque inférieur à une classification à risques plus élevés par IPSS-R (élevée/très élevée,...

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-MDS-HIGH-RISK-IPSS
TypeSignal d’alerte
Étatreviewed 2026-04-25 | pending_clinical_signoff
MaladiesDIS-MDS-HR DIS-MDS-LR
SourcesSRC-ESMO-MDS-2021 SRC-IPSS-M-BERNARD-2022 SRC-NCCN-AML-2025

Origine du drapeau rouge

DéfinitionMDS escalates from lower-risk to higher-risk classification by IPSS-R (high / very high, >4.5 points) or IPSS-M (High / Very High) — treatment intent shifts from cytopenia management to disease modification + alloHCT bridging
Direction cliniqueintensifier
Catégoriehigh-risk-biology
Algorithme de décalageALGO-MDS-LR-1L

Logique de déclenchement

{
  "any_of": [
    {
      "finding": "ipss_r_category",
      "value": "high"
    },
    {
      "finding": "ipss_r_category",
      "value": "very_high"
    },
    {
      "finding": "ipss_m_category",
      "value": "High"
    },
    {
      "finding": "ipss_m_category",
      "value": "Very_High"
    },
    {
      "comparator": ">=",
      "finding": "bm_blasts_pct",
      "threshold": 10
    }
  ],
  "type": "risk_score"
}

Notes

Triggers shift from MDS-LR algorithm (ESA → luspatercept → lenalidomide for del 5q) to MDS-HR algorithm (HMA azacitidine 1L + alloHCT bridge in eligible patients). IPSS-M reclassifies ~46% of patients vs IPSS-R (Bernard et al. 2022) — both are accepted; IPSS-M preferred when molecular data available. The flag also triggers when bm_blasts >= 10% (MDS-IB2 / MDS-EB-2) regardless of IPSS-R math, because that morphology alone qualifies as higher-risk. STUB — requires clinical co-lead signoff.

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Algorithmes

Indication