MRD-positive at end-of-induction (≥0.01% by flow or PCR) — switch to MRD-eradication stra...

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

ID	`RF-B-ALL-TRANSFORMATION-PROGRESSION`
Type	Red flag
Status	reviewed 2026-04-25 \| pending_clinical_signoff
Diseases	`DIS-B-ALL`
Sources	`SRC-ESMO-DLBCL-2024` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	MRD-positive at end-of-induction (≥0.01% by flow or PCR) — switch to MRD-eradication strategy (blinatumomab, inotuzumab, or alloSCT consolidation).
Clinical direction	investigate
Category	transformation-progression

Trigger Logic

{
  "any_of": [
    {
      "finding": "mrd_positive_post_induction",
      "value": true
    },
    {
      "comparator": ">=",
      "finding": "mrd_level_percent",
      "threshold": 0.01
    }
  ],
  "type": "lab_value"
}

Notes

MRD post-induction is the single strongest prognostic factor in B-ALL. Drives 2L/consolidation strategy (blinatumomab → alloSCT for fit), not 1L induction choice. Flag surfaces as MDT priority.

Used By

Algorithms

ALGO-B-ALL-2L - ALGO-B-ALL-2L

Indications

IND-B-ALL-2L-INOTUZUMAB - IND-B-ALL-2L-INOTUZUMAB
IND-B-ALL-BLINATUMOMAB-MRD-OR-RR - IND-B-ALL-BLINATUMOMAB-MRD-OR-RR
IND-B-ALL-POST-CONSOLIDATION-POMP-MAINTENANCE - IND-B-ALL-POST-CONSOLIDATION-POMP-MAINTENANCE