AML refractory or relapsed: <5% blast clearance after induction, or relapse after CR (ear...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-AML-TRANSFORMATION-PROGRESSION`
Type	Red flag
Status	reviewed 2026-04-25 \| pending_clinical_signoff
Diseases	`DIS-AML`
Sources	`SRC-ELN-AML-2022` `SRC-NCCN-AML-2025`

Red Flag Origin

Definition	AML refractory or relapsed: <5% blast clearance after induction, or relapse after CR (early relapse <6 mo, late relapse ≥6 mo). Switch to salvage chemotherapy (FLAG-IDA, MEC) ± targeted (FLT3+: gilteritinib; IDH+: ivosidenib/enasidenib) + alloHCT bridge
Clinical direction	intensify
Category	transformation-progression
Shifts algorithm	ALGO-AML-1L

Trigger Logic

{
  "any_of": [
    {
      "finding": "aml_refractory",
      "value": true
    },
    {
      "finding": "aml_relapse",
      "value": true
    },
    {
      "comparator": ">=",
      "finding": "bm_blasts_post_induction_pct",
      "threshold": 5
    },
    {
      "finding": "mrd_positive",
      "value": true
    }
  ],
  "type": "composite"
}

Notes

Direction "intensify" — but operationally this is a 2L+ flag that re-routes plan generation to salvage workup rather than 1L choice. At 1L this flag implies "the patient is not fitting the 1L pathway — switch to refractory-AML algorithm". OS in r/r AML is poor (<20% at 5 years); alloHCT after CR2 is the only consistent curative path. STUB — requires clinical co-lead signoff.

Used By

Algorithms

ALGO-AML-1L - ALGO-AML-1L