La dysfonction d'organe au début de la grossesse influe sur la sélection systémique de la MF/Sézary : FVEF <50% (g...

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

Origine du drapeau rouge

Définition	Baseline organ dysfunction influencing MF/Sézary systemic-therapy selection: LVEF <50% (gemcitabine, doxorubicin contraindicated), CrCl <30 (methotrexate, lenalidomide dose constraints), bilirubin >3× ULN (brentuximab dose-modify Child-Pugh B; avoid C — limits ALCANZA option), or baseline peripheral neuropathy ≥grade 2 (brentuximab combination / vincristine prohibitive).
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": 30
    },
    {
      "comparator": ">=",
      "finding": "bilirubin_ratio_to_uln",
      "threshold": 3
    },
    {
      "finding": "child_pugh_class",
      "value": "C"
    },
    {
      "comparator": ">=",
      "finding": "peripheral_neuropathy_grade",
      "threshold": 2
    }
  ],
  "type": "lab_value"
}

Notes

MF/Sézary systemic options (mogamulizumab, brentuximab, romidepsin, bexarotene, IFN, low-dose MTX, gemcitabine, liposomal doxorubicin) span wide toxicity profiles — organ-dysfunction RF reroutes to better-tolerated agents. Mogamulizumab CCR4-targeted (MAVORIC) has minimal organ toxicity except infusion reactions / dermatitis — good organ-dysfunction-friendly choice. Bexarotene caution with hepatic / pancreatic dysfunction (hypertriglyceridemia / pancreatitis). Avoid vorinostat / romidepsin in significant renal/hepatic dysfunction.

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