Profil de fragilité excluant l'induction de CHOEP/CHP-Bv à dose complète dans le PTCL NOS: ECOG ≥3, OU (a...

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

Origine du drapeau rouge

Définition	Frailty profile precluding full-dose CHOEP / CHP-Bv induction in PTCL NOS: ECOG ≥3, OR (age ≥75 with G8 ≤14), OR composite frailty (age ≥70 + Charlson ≥3 + albumin <3.5). Triggers de-escalation to CHOP (omit etoposide), GEM-P, romidepsin / pralatrexate monotherapy, or brentuximab monotherapy (if CD30+).
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
        }
      ]
    }
  ],
  "type": "composite_score"
}

Notes

Etoposide adds toxicity (cytopenia, mucositis, secondary leukemia long-term) without clear OS benefit in elderly per German High-Grade NHL Study Group reanalysis — CHOP without etoposide reasonable for ≥60y or frail. CD30+ frail elderly: CHP-Bv preferred over CHOEP if fit-enough; brentuximab monotherapy palliative-curative for very frail. AutoSCT consolidation generally off-table for frail elderly. AlloHCT contraindicated. CGA-guided dose attenuation essential — PTCL outcomes poor and treatment-related mortality must be balanced against modest cure rates.

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