APL high-risk by Sanz score: presenting WBC >10 K/μL — requires anthracycline addition (i...

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

ID	`RF-APL-HIGH-RISK-BIOLOGY`
Type	Red flag
Status	reviewed 2026-04-25 \| pending_clinical_signoff
Diseases	`DIS-APL`
Sources	`SRC-APL0406-LOCOCO-2013` `SRC-ELN-APL-2019` `SRC-NCCN-AML-2025`

Red Flag Origin

Definition	APL high-risk by Sanz score: presenting WBC >10 K/μL — requires anthracycline addition (idarubicin) to ATRA + ATO (or AIDA-style) rather than chemo-free ATRA + ATO
Clinical direction	intensify
Category	high-risk-biology
Shifts algorithm	ALGO-APL-1L

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">",
      "finding": "wbc_k_ul",
      "threshold": 10
    },
    {
      "finding": "apl_sanz_risk",
      "value": "high"
    }
  ],
  "type": "composite"
}

Notes

Sanz risk: low (WBC ≤10 + plt >40), intermediate (WBC ≤10 + plt ≤40), high (WBC >10). High-risk patients NOT eligible for chemo-free ATRA + ATO (APL0406 trial enrolled only low/intermediate). ATRA + ATO + idarubicin OR classic AIDA (ATRA + idarubicin) are accepted high-risk options; ATRA + ATO + idarubicin is preferred if ATO available. STUB — requires clinical co-lead signoff.

Used By

Algorithms

ALGO-APL-1L - ALGO-APL-1L
ALGO-APL-2L - ALGO-APL-2L

Indications

IND-APL-1L-ATRA-ATO - IND-APL-1L-ATRA-ATO
IND-APL-RELAPSED-GEMTUZUMAB - IND-APL-RELAPSED-GEMTUZUMAB
IND-APL-SALVAGE-ATRA-ATO - IND-APL-SALVAGE-ATRA-ATO